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THE
STUDY OF  MEDICINE,
JOHN MASON GOOD, M.D. F.E.S.
MEM. AM. PHIL. SOC. AND P.L.S. OE PHILADELPHIA
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IN FOUR YJ5LUMES.
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WELLS AND L1LLY-COURT-STREET

        1823. 
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CLASS TV.

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             CLASS IV,


        NEUROTICA.

     DISEASES OF  THE  NERVOUS FUNCTION*


ORDER I.

           PHRENICA.

              AFFECTING THE INTELLECT.

          II.

           iESTHETICA.

              AFFECTING THE SENSATION.


          Ill

           CINETICA.

              AFFECTING THE  MUSCLES.

          IV.

             SYSTATICA.

              AFFECTING SEVERAL OR ALL THE SENSORLAI
                 POWERS SIMULTANEOUSLY.
I,









V. 
CLASS  IV.
PHYSIOLOGICAL  PROEM.
 J- he numerous and complicated train of diseases we are now enter-
 ing upon appertains to  the highest function of  visible beings; the
 possession of which  emphatically distinguishes animals from plants,
 and the perfection of which as emphatically distinguishes man from
 all other animals: these are the diseases of the nervous function ;
 —which, in the sphere  of its activity, embraces  the powers of intel-
 lect, sensation, and muscular motion.  Each of these powers evinces
 diseases  of its  own,  and  will consequently lay a foundation for a
 distinct order, under the class before us.   While, as there are also
 other diseases that affect several of them simultaneously, we become
 furnished with a fourth  order, which will complete the series.
   All these diversities  of vital energy are now well  known to be
 dependent on the organ of the brain, as the instrument of the intel-
 lectual powers, and the  source of the sensific and motory.   Though,
 from the close connexion and synchronous action  of various other
 organs with  the  brain,  and especially the  thoracic and abdominal
 viscera,  such diversities  were often referred  to several  of the
 latter in  earlier ages  and before anatomy had traced them  satisfac-
 torily to  the brain as their fountain-head.  And  of so high  an  anti-
 quity is this erroneous hypothesis, that it has not only  spread itself
 through  every climate  on the globe, but still keeps a hold on the
 colloquial language of every people ;  and hence the heart, the liver,
 the  spleen, the reins,  and the  bowels generally, are, among all
 nations, regarded either literally or figuratively,  as so many seats of
 mental faculties  or  moral  feeling.   We trace  this common and
 popular creed among the Hebrews and Arabians, the Egyptians and
 Persians, the  Greeks and Romans ; among every savage, as well as
every civilized  tribe  ; nor is there a dialect of the present day that
is free  from it:  and we  have hence  an incontrovertible proof that
it existed as a doctrine of general belief at a time when mankind.
few  in number, formed  a common family, and were regulated by
common notions 
6
PHYSIOLOGICAL PROEM.
[CL. IV.
    The  study  of anatomy, however, has corrected the loose and
 confuted ideas of mankind upon this subject; and while it distinctly
 shows us that many of the organs popularly referred to as the seat
 of sensation, do and  must,  from  the peculiarity of their nervous
 connexion with the brain, necessarily participate in the feelings and
 faculties thus generally ascribed to them, it also demonstrates that
 the primary source of these attributes,  the quarter in which they
 originate, or which chiefly influences them, is the brain itself
   We are  speaking, .however, of man  and the higher classes of
 animals  alone ; for, as the scale in animal life descends, the organ of
 a brain is perpetually diminishing in its bulk, till at  length it totally
 disappears, and  its  place  is supplied by other fabrications, as we
 shall have occasion to observe in the sequel of this  introduction:
 which will lead us to take a brief notice  of the following  subjects:

     I. THE GENERAL  NATURE  OF THE BRAIN,  ITS  RAMIFICATIONS  AND
         SUBSTITUTES.
    II. THE PRINCIPLE OF SENSATION AND MOTION,
   III. THE INTELLECTUAL PRINCIPLE.

   I. In man, and those animals whose encephalon  approaches the
 nearest to his in  form, the brain is of an oval figure, surrounded by
 various membranes of different firmness and density, and consists of
 three  principal  divisions;  the  cerebrum or  brain,  properly so
 called, the  cerebel  or little brain, and  the oblongated  marrow.
 The first forms  the  largest and uppermost part; the second  lies
 below and behind ; the third lies levei with the second and in front
 of it; it appears to issue equally out of the two other parts, and in
 turn to give birth to the spinal  marrow;  which  may  hence be
 regarded as a continuation of the brain extended through the whole
 chain  of the back-bone.  They are similarly accompanied with  a
 cineritious or ash-coloured substance  which forms  the exterior of
 the three first divisions, but the interior of the  spinal  marrow,  and
 appears to derive its hue from  the great number of minute vessels
 that appertain to it.
  According to Mr. Bauer's very delicate  microscopic experiments,
 when  the substance  of the brain is made a subject of examination
 immediately after death, " abundance of fibres,1, to adopt the words
 of Sir Everard  Home  in  relating these  experiments,  u are  met
 with in every part of it; indeed it appears that the whole mass is a
 tissue  of fibres, which seem to consist entirely  of an accumulation
 of globules whose union is of so delicate a nature that the slightest
 touch, even the mere suction in water, deranges and reduces  them
 to that mass of globules of which the brain appears to be composed
 when examined  with less accuracy  or under less favourable circum-
stances."—Mr. Bauer found that the globules of the brain, as well
 as those  of pus,  are exactly  of the same  size as those of the blood
when deprived of their colouring matter.*
* See Sir Everard Home's Croonian Lecture, Phil. Trans, for 1818. 
CL. IV.]             PHYSIOLOGICAL  PROEM.                  7

   Sir Everard Home from these microscopic disclosures, endeavours
to show that muscular fibres are m.nute chains formed by an attach-
ment of one globule of blood to another: and that vascularity  in
coagula or extravasated blood, or in granulations produced by pus,
is effected by the escape of minute bubbles of carbonic acid gas from
the living fluid; which hereby opens a path to a certain extent into
the tenacious blood or pus that is extravasated or secreted.
   From this general organ arises a certain number of long, whitish,
pulpy, chords, composed  of bundles  of fibres, capable of  being
divided and subdivided into  minuter bundles of  fibrils,  or still
smaller fibres  as  far as the power of glasses  can  carry  the eye.
These  chords  are denominated  nerves;  they  are  surrounded,  to
their extremities, by one or  more of the common membranes of the
brain, and, by their various ramifications, convey different kinds  or
modifications of living power to different parts of the body, keep up
a perpetual communication  with its  remotest organs,  and give
motivity to  the muscles.
   As the brain consists of three general divisions, it might, at first
sight,  be  supposed that each of  these is allotted to some distinct
purpose ;  as, for example, that  of forming the  seat of intellect  or
thinking; the  seat of the local senses of sight, sound,  taste, and
smell, and the  seat of general feeling or motivity.  But  the nice
hand of the  anatomist has  confounded all  such  speculatiops  by
tracing up  to  each of these divisions both nerves of general, and
nerves of particular purposes.   Thus the  cerebrum, which gives
rise to the olfactory and optic nerves, (serving the purpose of pure
sensations)  gives  rise  also  to  the  oculorum motorii,  apparently
serving the purpose of muscular motion.  So  the cerebellum gives
rise to the trochleatores and  the trigemini, the first chiefly employed
in producing motive power, the second sensile  power: while from
the medulla oblongata originate the auditory, the  par vagum, and
the lingual; the first a nerve of hearing, the  second of feeling, and
the third of motivity :  at the same time that many parts of the brain
maintain  an interunion with other  parts by means of ganglions,
commissures and  decussations of nerves; whence  injuries on one
side are often  accompanied  with loss  of motion or feeling in the
organs of the other side.   So the curious and  ingenious, but, 1 fear,
scarcely justifiable  experiments  lately instituted by  Dr. Philip,*
and to which we shall  have occasion to return presently, sufficiently
prove that stimuli of a certain kind, as spirit of wine, applied to the
posterior part of the  naked brain of an animal, produce the same
effect on the heart, and equally increase its  action as if applied  tp
the  anterior part.  To aiiect the heart, however,  it seems neces-
sary that the stimulus should spread over a  pretty  large extent of
the  brain;  so  as  to take in, by the range of its excitement, some
of the ganglions of the brains, whose office, as Dr. Philip conceives,
is " to combine the influence of the various  parts of the nervous
* Phil. Trans. 1815. p. 5—90. 
8                  PHYSIOLOGICAL  PROEM.             [CL. IT.

system, from which they receive nerves, and to send off nerves en-
dowed with the combined influence of those parts."*   He hence ac-
counts for some organs  of the  frame being affected by every part
of the nervous system, and others by only certain small parts of it:
and the wide influence possessed  by the great sympathetic nerve,
which is less a single  nerve than a string of ganglions.   We are
also hereby shown why the  intestines, like  the heart, sympathize
with every portion of the nervous system.
  From all this, however, it is clear that we know nothing of the
reason of the actual arrangement of the brain or of its partition into
three divisions, nor of the respective share which the different parts
take in producing a common effect: and consequently it seems to be
altogether  a wild and idle attempt  to subdivide these perceptible
regions of the brain into still smaller and merely imaginary sections,
and to allot to each of them  a determinate function and faculty.
  That a sensorial communication, however, is  maintained between
some  part or other of the brain and every part of the body, and that
this communication is  conducted by the  nerves, is  unquestionable
from the following facts :
  If we divide, or tie, or merely compress a nerve of any kind, the
muscle with which it communicates becomes almost instantly paraly-
tic ;  but upon untying  or removing the compression the muscle re-
covers its appropriate,  feeling and irritability.  If the compression
be made on  any particular part of the brain, that part of the  body
becomes motionless which derives nerves from the part compress-
ed.   And if the cerebrum, cerebellum, or medulla oblongata be ir-
ritated, convulsions take place  all over  the  body : though chiefly
when the irritation is applied to the last of these three parts.  For,
according to the laws of the nervous action as collected from  a va-
riety of experiments by Dr.  Philip,t  and stated in a subsequent pa-
per to that just referred to, "Neither mechanical or  chemical sti-
muli (irritating the brain by a knife, or pouring spirits of wine up-
on it) applied to the nervous system, excite the muscles of  volunta-
ry motion, unless they are applied near to the origin of the nerves,
and spinal marrow."
  The nerves issue in pairs, one of each pair being allotted to either
side of the body.  The whole number  of pairs is thirty-nine ; of
which nine rise immediately from the great divisions  of the brain
under which we have  just contemplated  it, and are chiefly, though,
as already observed, not wholly appropriated to the four local sen-
ses ;  and thirty  from the spinal marrow through the foramina of the
bone that encases it, and are altogether  distributed over the  body
to produce  the  fifth  or general sense of touch and feeling, which,
however, by some physiologists  are regarded as distinct from  each
other, and to communicate, in an especial degree, irritability to the
muscles.
* Phil. Trans. 1815, p. 436.
-  Piii!. Trans. 1315. p. 444. 
" IV*J             PHYSIOLOGICAL  PROEM.                  9
    We have thus far represented the spinal marrow as issuing from
 the brain, in conformity with the  general doctrine that has hither-
 to been held upon the subject.  It has of late years, however, been
 contended by various physiologists,  and particularly by  Drs. Gall
 and Spurzheim, that  the spinal  marrow  itself is the origin or trunk
 of the nervous system, and that, instead  of issuing from the brain, it
 gives birth to it.  The argument is derived from the existence of a
 spinal marrow alone in acephalous monsters, and of a nervous chord
 without a brain, answering the purpose of a spinal marrow, in most
 invertebral animals.  Whence it is inferred that the nervous column
 is the radical part of the system, and that the brain is an increment
 from  it in the more perfect classes*
    The question is not of much  importance, though there is some-
 thing ingenious in thus  tracing  animal  life from its simpler forms.
 Yet the opinion seems to be in direct opposition to a well-ascertain-
 ed fact we shall have to advert  to presently, namely, that the mag-
 nitude of the brain and the extent of its intellectual powers hold an
 inverse proportion to the size of the spinal marrow, and consequent-
 ly, upon  this hypothesis, to their apparent means  of supply.   Nor
 is it the mode of induction  usually adopted by physiologists on like
 occasions ;  since they generally describe the arteries as issuing from
 the heart, instead of giving rise to it, notwithstanding that the heart,
 like the brain, has been found totally wanting in some monsters, and
 the circulation carried on  by an artery and a vein alone, of which
 Mr. Hewson gives a very singular instance ;t and  that most  of the
 worm genera are equally without a heart though they are in posses-
 sion of circulatory vessels.   We only see in these  arrangements that
 neither a brain nor a heart are essentially necessary to animal life :
 and that the great Author of nature is the lord, and  not the slave, of
 his own laws; and is capable of effecting the same general principle
 by a ruder as well as by a more elaborate design.
   There  is one part, however, of the system of nervous  power in
 the more perfect classes  of animals that is particularly worthy of our
 attention, as furnishing a rule peculiar to itself, and being without
 a parallel in any other part:  and  that  is the  origin, structure, and
 extensive influence of the great sympathetic or intercostal nerve,
 which forms a kind of system in, itself, an epicycle within the two
 cycies of cerebral and vertebral influence.  It is connected both with
 the  brain and  spinal marrow,  and may be  said  to arise  frcm
 either.  Admitting the brain to be its source, it is an offset from Lie
 sixth pair of nerve*, on  either side, and in  its course receives  a
 small tributary twig from the fifth, and branches from all the verte-
 bra?, from whose union and  decussation it is studded with numerous
 ganglions  or medullary enlargements, of which there are not less
 than three in the neck alone tinted by an  addition of cineritious sub-

 * Anatomie et Physiologie du systeme nerveux,  &c. par F. J. Gull et G. Spurz-
iicim, 4to. Paris 1810.
 t  On  the Lymph. Syst. Part n. p. 15.
  VOL. HI.               2 
10
PHYSIOLOGICAL PROEM.
[CL. IV.
stance, a larger number in its line through the chest, and others  as
it  descends  still deeper,  independently of various confluences  of
smaller branches that unite and form extensive net-works.   Having
reached the hollow of the os coccygis, it meets its twin from the op-
posite side which has pursued a similar course, and been augmented
by similar contributions.
  Thus equally enriched with the nervous stores  of  the brain and
the spinal marrow, it sends off radiations as it takes the course of the
aorta, to all the organs of the thoracic, abdominal, and hypogastric
regions,  to  the lungs, the heart, the stomach,  and intestines, the
bladder, uterus, and testes; and thus becomes an emporium of ner-
vous commerce, and an instrument of general sympathy: and what
is of infinite importance in so complicated a frame as that  of  man,
furnishes to the vital organs streams of nervous supply from so ma-
ny anastomosing currents, that if one, or more than one, should fail
or be cut off, the function may still be continued.   To this it is ow-
ing, in a very considerable degree, that the organs of the upper and
lower belly, exhibit that nice fellowship of feeling which often sur-
prises us, and that  most of them are  apt to sympathize in the actual
state of the brain.
  There is no animal whose brain is an exact counterpart to that of
man : and it has, hence, been conceived that by attending to the dis-
tinctions between the human brain and that of  other animals, we
might be able to unfold a still more  mysterious  part of the animal
economy than that of sensation or motion, and account for the supe-
rior intellect with  which man is endowed.
  But the varieties are so numerous, and the parts which are defi-
cient in one animal are found  connected with such new combina-
tions, modifications, and deficiencies in  others, that it is impossible
for us to avail ourselves of any such diversities.
  Aristotle endeavoured to establish a distinction by laying it down
as a maxim, that man has  the largest brain of all animals in propor-
tion to the size of his  body ; a maxim which has been  almost uni-
versally received from his own time to the present period.  But it
has of late years, and upon a more extensive  cultivation of compa-
rative anatomy, been found to fail in various instances: for, while
the brain of several species of the ape  kind bears  as large a  pro-
portion to the body as that of man, the brain of several kinds of birds
bears a proportion still larger.  Sbmmering has  carried the compa-
rison through a great diversity of genera and species :* but the fol-
lowing brief table  will  be  sufficient  lor the present purpose.   The
weight of the brain to that of the body, forms

           In man from               2V to sV Part
              Several simiae ...      J^

              Elephant                    T^.
* Diss, de basi Encephali, Gotting. 1778. 4to. 
CL. IV.]
PHYSIOLOGICAL PROEM.
11
              Sparrow
              Canary  Bird   .
              Goose
              Turtle (smallest)

 M. Sommering has hence endeavoured to correct the rule of Aristo
 tie by a modification under which it  appears to hold universally;
 and, thus corrected, it runs as  follows :  " man has the  largest brain
 of all animals in proportion to the general mass of nerves that issue
 from it."  Thus the brain of a horse gives only half the weight of
 that of a man, but the nerves it sends forth  are  ten times as bulky.
 The largest brain which M.  Sommering ever dissected in the horse
 kind, weighed only lib 4oz.  while  the  smallest he has met with  in
 an adult man v/as 21b.  5^oz.
   But the remark applies farther than  to man: for this acute phy-
 siologist has been able to trace  a  direct proportion between the de-
 gree of intelligence in every class of animals, and the  bulk of the
 brain, where the latter bears an inverse proportion to the nerves
 that arise from it.  And, we may hence observe, in passing, as  in-
 deed we have already hinted, that the nerves seem rather to be a
 product of the brain than  the brain  of the  nerves: for it is much
 more easy to conceive how a fountain may become exhausted in pro-
 portion to the magnitude of its streams,  than  how a reservoir can be
 augmented in proportion to the minuteness of its channels.
   Upon a general survey, I may  observe that the nervous structure
 of all vertebral animals, comprising the first four classes  of the Lm-
 nean classification,  mammals, birds, amphibials, and tithes, is charac-
 terized by the two following properties.  Firstly, the organ of sense
 consists of a gland with a long chord or spinal  marrow descending
 from it;  and, secondly, that both are securely inclosed in a bony case
 or covering.
   In man, as I have already observed, this gland is (with a few ex-
 ceptions)  larger than in any other animal in proportion to the size
 of the body; and, without any exception whatever, in proportion to
 the size of its dependent column.
   In other animals, even of the vertebral classes, or those imme-
 diately before us, we meet with  every  variety of proportion, from
 the ape wh-ch, in this respect, approaches nearest to that of man, to
 tortoises, and fishes, in which the brain does  not  much  exceed the
 diameter of the spinal  marrow itself.
   It is not, therefore, to be wondered at  that animals of a still lower
description and without a  vertebral colum .,  should exhibit proofs of
 a nervous chord or spinal  marrow without a gland or  brain of any
 kind at the top; and that this chord should even be destitute of  its
 common  bony defence.  And such is actually the conformation  of
 the nervous system  in insects,  and,  for the most part,  in worms;
 neither of which are possessed  either of a cranium or a spine ; and
in none of which we are able to trace more than a slight enlarge-
ment of the superior part of  the nervous chord, or spinal marrow
1
  l__
1JTS 
12
PHYSIOLOGICAL PROEM.
[CL. IV.
as it is called in animals possessing  a spine often  consisting of one,
and sometimes of two ganglions designed apparently, to correspond
with the organ  of a brain; the descending column chiefly taking
the  course  of  the oesophagus  and surrounding it.  The  nervous
chord, however, in these animals  is proportionally larger than in
those of a superior rank;  and, though sometimes simple, as in mol-
luscous worms, in other cases, as in insects, is possessed  at various
dislancps of minuter ganglions or little knots, from  which fresh ra-
mifications of nerves shoot forth like branches from the  trunk of a
tree, and which may perhaps be regarded  as so many distinct cere-
bels or little brains : having a close resemblance to the subordinate
system of the intercostal nerve in man, as we have already traced it
in its various ramifications and connexions.
   In worms of  apparently the simplest make, as zoophytes and  in-
fn«ory animals, no distinct structure can be discerned,  and particu-
lar! v nothing like a nervous system.  The  hydra or  nearly trans-
pnrent polypus  found so frequently in the  stagnant  waters of our
own country, with a body of  an inch long,  and  arms or tentacles in
proportion,  seems, when examined  by the largest magnifying glass-
es, to consist of a congeries of granular globule^ or molecules,  not
unlike boiled sago surrounded by a gelatinous  substance;  in some
tribes solitary,  in others  catenated.  And  hence, whatever degree
of sensation or  voluntary motion exists in such an;mals, can only be
conceived as issuing fiom these molecules  acting  the  part of ner-
vous ganglions  detached,  or  connecte '..   And  on this account M.
Virey has elegantly divided all animals into three classes according
to the nature of their nervous configuration; as first,  animals with
two nervous systems, a cerebral  and sympathetic, including mam-
mals and birds,  amphibial" and  fishes.   Secondly,  animals with a
sympathetic nervous system alone,  surrounding the oesophagus, as
molluscae and shell-fishes,  insects and proper worms.   And, thirdly,
animals with nervous  molecules,  as echini,  polypes, and  infusory
animalcules, corals, madrepores, and sponges;  all which in M.  Vi-
rey's classification are included under the term zoophytes.
   The only sense  which seems common to animals, and which per-
vades almost the whole surface of  their bodies, is  that  of general
touch or feeling; whence M. Cuvier, supposes that the material of
touch is the sensorial power in its simplest  and uncompounded state ;
and that the other senses  are  only modifications  of this material,
though peculiarly elaborated  by peculiar organs, which are also ca-
pable of receiving more delicate impressions.*  Touch, however,
has its peculiar local organ, as well  as the other senses, for particu-
lar purposes, and purposes in which unusual delicacy and precision
are required; in man this  peculiar power of touch  is well known
to be seated in the nervous papillae of the  tongue,  lips,  and extre-
mities of the fingers.  Its situation in  other animals I shall advert
to presently.
* Anatom. Comparat. i. 25. 
CL. IV.]
PHYSIOLOGICAL PROEM.
13
  The differences  in  the external  senses  of the different orders
and kinds of animals consist in their number and  degree of energy.
  All the classes of vertebral animals possess  the  same number of
senses as man.  Sight is wanting in zoophytes, in various kinds of
molluscous,  and articulated  worms, and in the  larves of several
species of insects.   Hearing does not exist, or at least has not been
traced to exist, in many molluscous worms and several  insects in a
perfect state.   Taste and smell,  like the general and simple sense
of touch, seem seldom  to be wanting in any animal.
  The local sense of touch, however, or that  which is of a more
elaborate character and capable of being exercised in a higher de-
gree, appears to be confined to the three classes of mammals, birds,
and insects: and even in the  last two it is by no  means  common to
all them, and less so among insects than among birds.
   In apes and macaucoes, constituting  the  quadrumana  of Blumen-
bach, it resides partly in the tongue, and tips  of the  fingers as in
man, but equally, and in some species even in  a superior degree, in
their toes.   In the raccoon (ursus/o/or) it exists chiefly in the under
surface  of the front toes.   In the  horse, and cattle orders, it is sup-
posed by most naturalists to exist conjointly in  the tongue, and snout,
and in the pig and mole to be confined to the snout alone ;  th s how-
ever is uncertain; as it is also, though there seems to be more  rea-
son  for such a belief, that in the elephant it is seated  in  the pro-
boscis.   Some  physiologists have supposed the bristly hairs of the
tiger, lion,  and cat, to  be an organ of the same kind; but there
seems little ground for such an opinion.  In the opossum (and  es-
pecially  the Cayenne  opossum)  it exists  very  visibly in the tail;
and M. Cuvier suspects that it has a similar existence in all the pre-
hensil-tailed mammals.
   Blutnenbach supposes the same  sense to have a place  in the same
organ in the platypus or ornithorhyncus  as  he calls it, that most
extraordinary duck-billed quadruped which has  lately  been disco-
vered in Australasia, and, by its intermixture  of organs, confounds
the different classes of animals and sets all natural arrangement at
defiance.
   The local organ of touch'or feeling in ducks and geese and some
other genera  of birds, appears to be situated  in the  integument
which covers the extremity  of the  mandibles,  and  especially  the
upper mandible, with  which apparatus they are well known to  feel
for their food in the midst of  mud in  which they can  neither see
nor perhaps smell it.
  We do not know that amphibials,  fishes,  or worms,  possess  any
thing like a local sense of touch;  it has been suspected in some  of
these and especially in the arms of the cuttle-fish,  and  in the  ten-
tacles of worms that possess this organ, but at  present it is suspicion
and nothing more.
   In the insect tribes,  we have much reason  for  believing such a
sense to  reside in the antennas or  in the tentacles; whence  the for-
mer of these  are denominated by  the German naturalists fuhlhorner 
14
PHYSIOLOGICAL PROEM.
[CL. IT.
 or feeling-horns.  This belief has not been fully established, but  it
 is highly plausible from the general possession  of the  one or the
 other of these organs by  the insect  tribes, the general  purpose to
 which they apply them, and the necessity  which  there  seems for
 some such organ from the crustaceous or horny texture of their ex-
 ternal coat.
   The senses of taste and smell in animals bear a very, near affinity
 to the local sense of touch ; and it is difficult to determine whether
 the upper mandible of the duck tribe, with  which they distinguish
 food in the mud, may  not be an organ of taste or  smell  as well as
 of  touch;  and  there  are some naturalists that in like manner re-
 gard the cirrous filaments or attennules  attached  to  the  mouths of
 insects as  organs of taste  and touch equally.  Taste in th^e more
 perfect animals resides jointly in the papilla? of the tongue and the
 palate; but I have already had occasion to  observe that it may ex-
 ist, and in  full perfection, in  the  palate alone, since it has been
 found so in persons who have  completely  lost the tongue from ex-
 ternal force or disease.
  In animals that possess the  organ of nostrils  this is  always the
 seat of smell; and in many quadrupeds, most birds, and perhaps most
 fishes, it is a sense far more acute than  in  man, and that which is
 chiefly confided in.  For the most part it resides in  the  nerves dis-
tributed over a pituitary membrane  that lines the interior of the
bones of the nostrils,  and  which is called  the Schneiderian  mem-
brane, in honour  of M. Schneider  a  celebrated anatomist, who first
accurately described it.  Generally speaking it will be  found that
the acuteness of smell bears a proportion in all animals to the  ex-
tent of surface which  this  membrane displays, and hence  in the dog,
and cattle tribes,  as well as in several others, it possesses a variety
 of folds or convolutions, and in birds is continued to the,utmost points
of the nostrils, which in different kinds open in very different parte
of the mandible.
  The frontal sinuses, which are lined with this delicate membrane,
are larger  in the  elephant than in  any other quadruped,  and in this
animal the sense is also continued  through  the  flexible organ of its
proboscis.  In the pig the smelling organ  is also  very  extensive ;
and, in most of the mammals possessing  proper horns, it ascends as
high  as  the processes of the  frontal bone  from which the horns
issue.
  It is  not known that the cetaceous  tribes possess any organ of
smell; their blowing-holes are generally regarded as such ;  but  the
point  has been by no  means fully established.  We are in the same
uncertainty in respect  to amphibials  and worms;  the sense  is sus-
pected to exist in all the former, and in several of the latter, espe-
cially in the cuttle-fish; but  no distinct organ has hitherto been
traced out  satisfactorily.
  In fishes there  is no doubt;  the  olfactory nerves are very obvi-
ously distributed on an olfactory membrane, and in several instances
the snouts are double, and consequently  the nostrils quadruple, a 
CL. IV.]
PHYSIOLOGICAL PROEM.
15
pair for each snout.  This powerful inlet of pleasure to fishes often
proves fatal to them from its very perfection;  for several kinds are
so strongly allured by the odour of majorum,  assafoetida  and other
aromas, that by smearing the hand over with these substances,  and
immersing it in the water, they will often flock towards the fingers,
and in their intoxication of delight may easily be laid hold of:  and
hence the  angler  frequently overspreads his baits  with the same
substances, and thus arms himself with a double decoy.
   There can be no doubt of the existence of the same sense in in-
sects, for they possess a very  obvious power of distinguishing the
odorous properties  of bodies  even at a considerable distance be-
yond the range of their  vision: but the organ in which this sense
resides has not been satisfactorily pointed out; Reimar supposes it
to exist in  their stigmata, and Knoch in their anterior pair of feel-
ers.
   The general organ of hearing is the ear, but not always so; for
in most of those who hear by  the  Eustachian tube only,  it is the
mouth; in the whale tribes it  is the nostrils or blow-hole.  It is so,
however, in all the more perfect  animals, which  usually for  this
purpose possess two distinct entrances into the organ, a larger and
external surrounded by a lobe ;  and a smaller and  internal opening
into the mouth.   It is this last which is denominated  the Eustachian
tube.  The shape of the lobe is  seldom found even  in  mammals
similar to that in  man, excepting among the monkey and The porcu-
pine tribes.  In many kinds their is neither external lobe nor external
passage.  Thus in the frog, and most amphibious  animals, the only
entrance is the internal or that from the mouth ; and in the cetace-
ous tribes the only effective entrance is  probably  the same kind ;
for though these  may be said to possess an external  aperture, it is
almost imperceptibly minute.   It is a curious fact that among the
serpents, the blind-worm, or common harmless snake, is the only
species that appears to possess an aperture of either sort; the rest
have a rudiment of the organ within, but we are not acquainted with
its being pervious to sound.
   Fishes are well known to possess a hearing organ, and the skate
and shark  have the rudiment of an  external ear;  but  like other
fishes they seem chiefly to  receive sound by the internal tubule
alone.
   That insects in general hear is unquestionable, but it is highly
questionable by what organ they obtain the sense of hearing.  The
antennas, and perhaps merely  because we do not know their exact
use, have been supposed by many naturalists to furnish the means;
it appears  fatal, however, to  this opinion  to  observe that  spiders
hear though they have no true antennas, and that other insects which
possess them naturally have seemed to hear as correctly after they
have been  cut off.
   The sense of vision exhibits perhaps more variety in the different
classes of animals than any of the external senses.   In  man, and the
greater number of quadrupeds it is guarded by an upper and lower 
16
PHYSIOLOGICAL  PROEM.
[CL. IV-
 eye-lid ; both of which in man,  but neither of which in most  quad-
 rupeds are  terminated  by the  additional defence and ornament of
 cilia or eye-lashes.   In the elephant, opossum, seal,  cat kind, and
 various other mammuls, all birds, and all fishes, we find a third eye-
 lid,  or nictitating membrane, as  it is usually called, arising  from the
 internal angle  of the eye and capable of covering the pupil with a
 thin transparent veil either wholly or in part, and hence of defend-
 ing the eyes from danger in their search after food.   In the dog this
 membrane is small, in oxen and horses it will extend over half the
 eve-ball; in birds it will easily cover  the whole; and it is by means
 of this veil, according to Cuvier, that the  eagle  is capable of look-
 ing  directly against the noon-day sun.  In  fishes it is almost always
 upon the stretch, as in their uncertain element they are exposed to
 more dangers than any  other  animal.  Serpents have 'neither this
 nor any other eye-lid ;  nor any  kind  of  external defence whatever
 but the common integument of the skin.
  The  largest eyes in proportion to  the size of the animal belong
to the bird tribes; and nearly the smallest  to the whale ; the small-
 est altogether to the shrew and mole ;  in the latter of which the
 eye is not larger than a pin's head.
  The  iris, with but (ew exceptions-,  partakes of the colour of the
 hair, and is  hence perpetually varying in  different species of the
same genus.  The  pupil  exhibits a very considerable,  though
not an  equal, variety in its shape.  In  man it is circular ; in the lion,
tiger, and indeed all  the cat kind, it  is oblong;  transverse in the
horse and  in ruminating animals; and heart-shaped in the  dolphin.
  In man,  and the monkey tribes, the eyes are placed directly  un-
der the forehead; in other mammals, birds,  and reptiles more or less
laterally ; in some fishes as the genus  pleuronectes, including the
turbot  and flounder tribes, both eyes are placed on the same side of
the head ; in the snail they are situated  on its horns, if the black points
on the  extremities of the horns of this worm be real eyes, of which,
however, there is  some doubt;  in spiders  the eyes are distributed
over different parts of the body,  and in different arrangements,  usu-
ally eight in number, and never less than six.  The eyes of the sepia
have lately been detected by M. Cuvier; their construction is very
beautiful, and nearly as complicated as that of vertebrated  animals
Polypes and several other zoophytes appear sensible of the presence
of light, and yet have no eyes;  as the nostrils are not in every  ani-
mal necessary to the sense of smell; the tongue to that of taste, or the
ears to that of sound. A distinct organ is not always requisite  for a dis-
tinct sense. In man himself we have already  seen this in regard to the
sense of touch, which exists both locally and generally ;  the distinct
organ of touch  is the tips of the tongue and of the fingers, but the
feeling  is also diffused, though in a subordinate and  less distinct de-
gree, over every part of the body.  It is possible, therefore, in ani-
mals that appear endowed with particular senses  without particular
 oryf.ns for  their residence, that  these senses are  diffused, like  that
 of touch, over the surface generally;  though there can be no doubt 
CL. IV.]
PHYSIOLOGICAL PROEM.
17
that, for  want of such  appropriate  organs, they be less  acute and
precise than in animals that possess them.
  Whether there be any other than the five senses common to man
and  the  higher classes of animals may be  reasonably doubted, but
we occasionally meet with peculiarities of sensation that can hardly
be resolved into any of them. Thus the bat appears to be sensible of
the  presence  of external  objects and obstructions that are neither
seen, smelt, heard, touched, or tasted : for it  will cautiously  avoid
them when all the senses are purposely closed  up.  And hence ma-
ny naturalists have ascribed a sixth sense to this animal.  It is equal-
ly difficult  by any of the known senses of fishes or of birds to account
for the  accuracy  with which their migratory tribes are  capable
of steering their annual course through the depths of the ocean,  or
the trackless regions of tiie atmosphere,  so as to  arrive at a given
season on  a given coast  or a given climate, with  the precision
of the expertest mariner.  Whilst with respect to mankind them-
selves we  sometimes  meet with persons  who  are  so peculiarly
affected by the presence of a particular object, that is neither seen,
smelt, tasted, heard, or touched, as not only  to be conscious of  its
presence, but to be  in great distress till it is  removed.  The pre-
sence of a cat not unfrequently produces such an effect: and the auth-
or has himself  been a witness of the most decisive proofs of this in
several  instances.   It is possible that the peculiar sense may,  in
such cases, result from a  preternatural modification in some of the
branches of the olfactory nerve, which may render them capable of
being stimulated in a new  and peculiar manner;  but the individuals
thus affected are no more conscious of an excitement in this  organ
of sense  than in any other: and, from the anomaly and rare occur-
rence of the sensation itself, find no terms by which to express it.
 ,  In Germany it has of late been attempted to be shown that every
man is possessed of a sixth sense, though of  a very different kind
from those just referred to; for it is a sense not only common to every
one, but  to the system at large ; and consists in that peculiar kind of
internal  but corporeal  feeling respecting the general state of one's
health that induces us to exult in being as light as a feather, as elas-
tic as a spring; or to sink  under  a sense of lassitude, fatigue, and
weariness, which cannot be accounted for, and is unconnected with
muscular labour or disease.  To this sensation M.  llubner has given
the name of caenesthesis, and several of his compatriots that of sel-
bstgejiihl, and gemeingefiihl, " self-feeling or general-feeling ;" and its
organ is  supposed to exist  in the extremities of all the nerves of the
body, except those that supply the five external senses.*  I scarcely
know why these last should have been excepted: for the sensation
itself is nothing more than  a result of that general sympathy which
appears  to take place between  different organs  and parts of  the
  * Comment, de Csenesthesi. Dissert. Aug. Med. Auct. Chr. Fred. Hubner,
  Nature and Origin of Mental Derangement, by A. Crichton. M. D. 2 vols
1798.
  VOL. IHv                     3 
18
PHYSIOLOGICAL PROEM.
[CL. IV.
 body,  expressive of a pleasurable or disquieting feeling according
 as the frame at large is in a state of general and uninterrupted health
 or affected by some cause of disquiet.
   II. As the nerves thus generally communicate with each other,
 and  with the brain, where  this organ exists, it has been a question
 in all  ages  by what means they  maintain this communication,  and
 what is the nature of the communicated influence ? or, in other words,
 what  is the fabric of  the nerves, and the quality of the nervous
• power ?
  Upon these points two very different opinions have been enter-
 tained from an early period of the world, which under different  mo-
 difications have descended to  our own times :  for by many physio-
 logists, both ancient and modern, the nerves have been regarded as
 solid capillaments, or tense and elastic strings, operating by tremors
 or  oscillations, like the chords  of a musical instrument; and by
 others as minute  and hollow cylinders conveying a  peculiar fluid.
 The word nerve,  which among the ancients was  applied to tense
 chords of every  kind,  and  especially to  bow-strings and musical
 strings, affords a clear proof how  generally the  former of these
 hypotheses  prevailed among the Greeks.  It was not, however, the
 hypothesis either of Hippocrates or Galen; for by them, while the
 nerves were regarded as the instruments  of sensation and motion,
 the medium by which they acted was supposed to be a fine etherial
 fluid, elaborated in the organ of the brain;  to which they gave the
 name of animal spirit, to distinguish it from the  proper fluid of the
 arteries which was denominated  vital  spirit.  " Not," says Galen,
 " that this animal spirit is of the substauce of the soul, but its prime
 agent  while inhabiting the brain."*  But with respect to  the man-
 ner  in which the animal  spirit operates upon the nerves they spoke
 with great  modesty ; for though they thought they  had been able
 to trace a  tubular  form in some of the  nerves, and particularly
 those of vision, they  had not been able to succeed in others.   And
 hence, says Galen,  " it is impossible for us to pronounce absolutely
 and  without proof, whether a certain power may not be transmitted
 from the brain through the nerves to  the  different  members; or
 whether the material of the animal spirit  may not itself reach the
 sentient  and moving parts ; or, in some way or ether, so  enter  into
 the  nerves as to induce in them a change  which is afterwards  ex-
 tended to the organs of motion.!
   In a state not much less unsettled, remains the subject at the pre-
 sent moment.   Dr. Hartley, in the beginning of the seventeenth
 century, revived the hypothesis that the nerves are bundles of solid
 capillaments conveying  motion, sensation,  and even perception, by
 a vibratory power, and  supported his opinion with great ingenuity

  * Do Hippccratis et Platonis Decretis, Lib. vu.  A. Tom. 1.1>. 967.  Ed Basil
 17542.
t \i. Sect. C. i>. 969, 
CL. IV.]
PHYSIOLOGICAL PROEM.
19
and  learning ;* but the opposite hypothesis that they are minute
tubes filled with the animal spirit of the Greek physiologists, had ac-
quired so  extensive a hold ever since the discovery of the circula-
tion of the blood, which presupposes the existence of tubular vessels
too subtle to be traced by the senses, that  it never obtained more
than a partial and temporary assent; and hence, from the  times of
Sydenham and Boerhaave almost down to our own day, the last has
been the popular doctrine ; is to be traced in the general  tenor of
medical writings;  and has been especially  maintained by  Sabatier
and Boyer.
   In  effect no fibres of the animal frame can be less adapt°d to  a
communication of motion  by a series of vibrations than those of the
nerves, since none exhibit a smaller degree of elasticity ; and though
we have little reason to confide in their tubular structure, or  to be-
lieve that any kind  of fluid is transmitted in this way, the close affini-
ty which  the nervous  power is now known to hold with several of
the gases that chemistry has of late years unfolded to us; and the
wonderful influence which  some of them  possess over the moving
fibres of the  animal frame, seem to leave no  question that the ner-
vous power itself is a  fluid, though not, perhaps,  of their precise
nature, yet resembling the  most active of them in its subtilty, levity,
and  rapidity  of movement.  Nor is there upon this supposition any
difficulty  in conceiving of its transmission by solid fibres or capilla-
ments of a particular kind, whilst we behold theetherial fluids, now
referred to,  transmitted in the same way by substances still more
solid and unporous.
   But there  is another question, closely connected with the present
subject, that has also greatly interested physiologists both in ancient
and  modern times, and is  not yet settled in a manner altogether sa-
tisfactory.
   It  has appeared  that the  nerves are instruments both of sensation
and  motion.   Are these two effects produced by the same nervous
fibres or by different ? or by the same fluids or  by different ?  That
there must be two distinct kinds of fibres, or of  fluids, is clear, be-
cause, as  we shall have more particularly to observe when we come
to treat of paralysis, the muscles of a limb are sometimes  deprived
of both sensation and motivity at the same period, sometimes of sen-
sation alone  while motiyity continues,  and sometimes of motivity
alone while sensation  continues.  And  hence Hippocrates and Ga-
len, the last  of whom has treated of the subject  with  great minute-
ness  in many of his writings, while they speak of only one kind  of
animal spirit, speak of two kinds of nerves, those of sense and  of
motion ; equally issuing from  the brain, and mostly  accompanying
each other, and forming parts of the same organs.
   This distinction is supported by the concurrent observations and
 experiments  of modern  physiologists,  with  the  exception  that a
 separate  and specific power has, for the most part,  been ascribed
 to each division of fibres; and, that many writers have  supposed

   * observations on Man, his frame, &c. his duty, and his expectations, 2 vols.
 8vo. 1749. 
20
PHYSIOLOGICAL PROEM.
[cL. IV.
the motive  power to be inherent in the moving fibres themselves
instead of being derived from the brain.  Glisson appears entitled to
whatever may be the credit of this last hypothesis ;  and Girtanner,
who trod in the same  footsteps, with a clear and comprehensive
mind, considerably enlarged upon it, and gave to the moving energy
the name of vis insita, as, by way of distinction, he applied that of
vis nerv a to the energy  or power of feeling.  And as he believed
that other organs besides muscles, and indeed plants as well as ani-
mals, are possessed of fibres endowed with the same power, and that
a brain is by no means essential for their production,  he, in like
manner,  changed the name of muscular to that of irritable  fibre ;
and contended that a principle of irritability is common  to fluids as.
well as to solids, and co-extensive with organized nature.*1
  Oxygene  was at this time the popular aura of the philosophers,
as caloric had been a short time before.  Lavoisier had just proved
its close  connexion  with several of the vital functions,  and  hence
the chemical divinity of Girtanner was oxygene.   He paid unbound-
ed homage to its influence, attempted to show that irritability, and
even life itself, are dependent  upon it; and that in the animal sys-
tem it is distributed to every  part by means  of  the circulating
blood.
  But the still more  striking properties of the galvanic fluid, began
now to be discovered and to captivate  the  general  attention; and
the time drew nigh in which oxygene  was doomed to fall as pros-
trate before the shrine of galvanic aura as caloric had fallen before
that of oxygene.  And it is curious to remark, how  nearly this dis-
covery was  not only  made but completed in all its bearings,  and by
the very same means, about fifty years before the attention of Gal-
vani was directed to  the subject; for as we  are told in the Philoso-
phical  Transactions  for 1732,t  that the Queen's  physician,  Dr.
Alexander  Stuart, being engaged in a course  of experiments  upon
the frog,observed, upon thrusting the  hlunt end of a probe into the
spinal marrow, after  decapitation,  that the muscles of the animal's
body were thrown into convulsive contractions; and that the same
happened to the muscles  of the head  when the probe was  thrust
into the  brain.  And by additional  experiments he advanced so far
as to infer,  that  what the nerves contribute  in muscular  motion,
cannot be produced by oscillations or elasticity,  but must be owing
to a fluid  contained in them; but which fluid he  was unfortunate
enough to conceive was a pure and  perfectly defecated elementary
water; using the  word water, however, in a general sense, as mere-
ly opposed to sal volatile, or fermented spirits, which he thought
the term animal  spirits was calculated to import.
  Whatever be the nature of the active and  etherial  fluid which
was thus traced by Stuart,  and  has  since been fully established by
  * Meinoires sur Plrritabilite, consideree comme principe de vie dans la nature
organisee. Journ. de Phys. 1790.
  t Vol. xxxvn. p. 324. 
CL. IV.]
PHYSIOLOGICAL PROEM.
21
Galvani, there can be no question of its having a powerful influenqe
upon many branches or divisions of the nervous system, though not
upon all.  Its effects upon the muscles of an animal for some hours
after death are too well known to be particularized:  and Dr. Philip
seems to have shown,  by various trains of experiments,* that it is
equally capable of maintaining respiration,  and the  operation of
several of the animal secretions, especially those that induce diges-
tion, for as long a period.  But in drawing from  such  facts the co-
rollary that the  " identity of galvanic electricity and nervous influ-
ence is established by these  experiments;" he  seems to  proceed
farther than he is warranted: for we have no right to say more, than
that galvanic electricity is a stimulus exciting the nervous influence
into a state of continued  secretion, or continued  action; which may
possibly be done by various other stimuli, as  well as by that of gal-
vanism.
  Upon the  whole the nervous  system  seems to present itself, in
the different  classes of animals, under various scales  of elaboration;
but in  every scale to be a secernent organ through its entire range ;
operating by means of two or more  different sets of fibres, which
may be secretories or conductors of as many different fluids or mo-
difications of the same  fluid.
  In the higher and more complicated classes of animals it consists
of a cylindrical chord  or spinal  marrow, a  central or  ganglionic
compages and a brain, all communicating and acting  in harmony.
In some of the inferior classes we find the cylindrical chord alone,
and in  others the ganglionic compages :  while in the  lowest of all
we  trace  a variety of distinct and granular molecules,  which seem
to act the part of nervous ganglions,  though we cannot discover
their connexion.
  The brain has so much of the general  structure and character of
a gland, as to be admitted to be an organ of this kind  almost without
a dissentient  voice  in  the  present  day.   This is a point conceded
even by Dr.  Cullen, notwithstanding that by supposing the  energy
of the  brain  to be  a mere quality rather than a specific essence,
and to be incapable of undergoing  any  change of recruit  and ex-
haustion,  he  finds no adequate  use for its glandular conformation.
As we  are justified, however, by all the force of analogy in regard-
ing it as a gland,  though unquestionably a gland of a peculiar kind,
and as  we are equally justified on  the same  ground of analogy in
regarding the  nervous power or energy by which it maintains a
communication with every part of the system, as a fluid of a pecu-
liar kind,  we are almost driven to the necessity of contemplating it
as the source from which this  fluid issues and by which it is supplied
as it becomes exhausted.
  It is  probable  that the  nervous  fluid on its first  secretion, and
simplest s'ate, is as homogeneous as that of the blood; but that, like
the blood, it becomes changed  by particular  actions, either of the
particular parts of  the  brain, or of particular nerves  themselves
-----------------•--------------------------.........--------
               * Phil. Trans. 1815. p. 5—90. 
22                 PHYSIOLOGICAL  PROEM.             [cL. IV.

into fluids possessing different powers,  and capable of producing
very different effects.  And as we have reason to believe with Ga-
len, that the nerves are  a continuation of the matter of the brain,*
it is not improbable that many or all of them are  endowed  with
something of its secernent  power, and are  capable  of assisting in
the secretion  of the same  fluid in its simplest state, or in some of
its simpler modifications.  And we may  hence see the  reason of
that complicated mechanism which distinguishes the  higher classes
of animals,  and how it is possible for a nervous system to  exist,
though with inferior powers, under a less composite  fabrication.
  This, however, is not mere conjecture : for in different ramifica-
tion- of the nerve«.  we can trace such different effects actually pro-
duced ; and as it has sufficiently appeared that the operative power
is a quick and subtle fluid, we are directly led to conclude that such
difference of effects  must depend on a diversity of fluids or on vari-
ous modifications of a common  fluid in different ramifications: the
last of which  explanations is by far the simplest t.nd easiest.   And
hence, in certain parts of the system, the nervous influence becomes
capable of producing the effect of sensation ; in others  of motion.
And hence, again, the sensific influence is rendered capable of excit-
ing in one set  of organs a sense  of sight, in others of hearing, smell,
or taste, while that of touch is diffused over the surface generally.
  This last by its extensive diffusion is, by Mr. Hunter, called com~
mon sensation ; and his view of the subject is in perfect consonance
with  the  present.   '• It  is  more than probable," says  he,  " that
what  may be called organs of sense (local organs) have particular
nerves whose  mode of action is different  from that  of nerves pro-
ducing common sensation ; and also different from one another; and
that the nerves on which the peculiar functions of each of the or-
gans of sense  depend are not  supplied from different parts of the
brain.  The organ of sight has its peculiar  nerve : so  has that of
hearing; and probably that of smelling likewise :  and on  the same
principle  we  may suppose  the  organ of taste to have a peculiar
nerve, although these organs of sense may likewise have nerves
from different parts of the brain ; yet it is most probable such nerves
are only for the common sensations of the part, and other purposes
answered  by nerves."!
   We see farther  that for  the  purpose  of elaborating the exqui-
sitely fine and active fluid that, differently modified, excites the lo-
cal organs of  sense, and  excites them in perfection, it is necessary
that the nervous system  should exist in its highest scale  of fabrica-
tion, and be crowned with the  apparatus of a brain,  though this is
not the only use to  which the  brain is subservient:  and hence it
was long ago  pointed out by Galen, that it is from the brain alone
the nerves appropriated to  the local senses take  their rise.j  For,

         * De  Hippocr. et Flat. Dccret. Lib. in. Tom. i. p. 921.
        t Oh  the Animal Economy, p. 261.
         X Dc  Ir.strumentis  Odoratus. Edit. Basil. Tom.V p. 331. 
CL. IV.]
PHYSIOLOGICAL  PROEM.
23
though we have instances of the existence of a few of these senses
where the nervous system is found in a less finished form, they are
never complete in number, nor apparently in acuteness.
  The sense of touch, on the contrary, which, as we have already
observed, is regarded by Cuvier as produced  by the sensific fluid in
its simplest and least compounded state, or as Galen has it* " is
the dullest and rudest of all the sensient  powers," flows for the
most part, as the latter  has  also remarked, from the spinal marrow
alone, since it is from this column that the nerves of touch almost
exclusively arise.  And  hence we have little difficulty in conceiv-
ing how a sense of this  kind may exist in moluscae, shell-fishes, and
the larves of insects, which have no other nervous system  than a
medullary column, with  a slight increment at the  upper extremity,
or no increment v/hatever ;  and have no  other  sense, or none but
in a very imperfect degree.
   The nervous power producing motion, and which has been pro-
perly denominated irritative, appears to be of a still lower descrip-
tion than that of touch.   It  is hence common to the  great mass of
muscular fibres, and is probably capable of being secreted by these
fibres generally ; so that every fibre  supplies itself, where it re-
ceives no supply from any other source.  Yet the proper source  or
reservoir of this  modification of  nervous  fluid  seems  to  be a
ganglionic system: that  which, in the higher classes of animals we
have  already noticed as formed by the curious structure  and rami-
fications of  the intercostal nerve, and that which appears to be a
copy of it in worms and zoophytes, who have no other nervous or-
ganization whatever.  From the copiousness with which this cen-
tral system furnishes a recruit to the involuntary organs with which
it is peculiarly connected  in mammals,  we may see why these or-
gans  are able to  persevere in one  uninterrupted train  of action,
without  exhaustion or weariness, from the  beginning to the end of
life ; and why several of them, as the heart, the lungs, and the sto-
mach, should be able -to exhibit proofs of irritative  power  for a
considerable period of time after the  death of the system, and espe-
cially when roused  by particular  stimulants.   Fishes  in general
have few pretensions to this structure, and  hence they die sooner
than most other animals, and exhibit little muscular irritability af-
terwards.  Vet it is remarkable that in those  genera, which make
the nearest approach to a ganglionic system, as the cod  and  carp.
we have examples of a  like power.  The fish-mongers of the me-
tropolis have taken advantage  of this endowment in the  cod-kind,
and introduced the fashion of crimping or  corrugating the flesh, by
the stimulus of transverse incision^, and in some curious experiments
on the carp, lately instituted by Mr. Clift, he found its heart leap-
ing, when out of water, four hours after a separation from the bo-
dy.!   If  the  apparently isolated molecules lound  in the  make  of
the polype  and various  worms are ganglions of nervous  irritation.
* Loco citat.
I- Phil. Truni. 1815 p. 9t. 
24
PHYSIOLOGICAL PROEM.
[CL. IVi
 extending their vital  influence through  certain ranges  or  peri-
 pheries, we are  also hence enabled to account for the peculiar te-
 nacity with which the  principle of life adheres to them,  and the
 wonderful power  of reproduction which  belongs to detached  seg-
 ments.
   The curious and  striking experiments  which have lately been
 made upon animals by Dr.  Philip an&M. Le Gallois, confirm the ge-
 neral view now offered so far as they bear upon it.   These  have
 consisted in an examination into the  different effects  produced on
 the heart and lungs by suddenly destroying or cutting off the com-
 munication of the whole brain; by slowly destroying it; by destroy-
 ing it in the posterior part alone ; and in the anterior part alone;
 and  by destroying, in like manner, the spinal  marrow  at the neck,
 or where it unites with the brain; in its middle or dorsal, and in
 its lumbar region.  The animals operated upon were chiefly rabbits.
  According  to the experiments  of M. Le Gallois,* after the de-
 struction of the  brain, the action of the heart still continues for a
 considerable period of time unimpaired ;  while on the destruction
 of the spinal  marrow at its  upper  or  cervical extremity, this ac-
 tion  becomes instantly so debilitated as to be  no  longer capable of
 supporting the circulation.  Whence  he infers that it is from the
 chord of the spinal marrow, and not.  from the gland  of the brain
 that  the heart derives the principle of its life and motions.
  The experiments of Dr. Philipt are  at variance with the above
 of M.  Le  Gallois,  and  his conclusions are,  therefore, somewhat
 different.   They seem to show that both the brain and  spinal mar-
 row  may be destroyed,  and  yet the heart continue to act  forcibly
 and steadily, provided the lungs be excited by the artificial breath
 of a pair of bellows.
  The brain and spinal  marrow were destroyed by a hot wire, the
 animal being first stupefied by a blow on the occiput.  Frogs  and
 a few other animals were  here employed  as well as rabbits.  It is
not exactly stated how long, under this process, the heart continued
to beat.  Yet, contrary to what Dr. Philip seems to have expected,
but in perfect  concurrence with the hints I have just  thrown  out,
 he found that certain  stimuli applied  to the brain, whether in  the
 anterior  or posterior part of the head, increased  very sensibly the
 action of the heart, the  animal being still  prepared as just stated.
The  same effect ensued  when the same stimuli were applied to the
cervical and even the dorsal part of the spinal marrow :  but  not
when applied to the lumbar.
  Dr. Philip hence  concludes that there are  three  kinds of  vital
power: muscular, possessed by the lowest kinds  of  animals that
are destitute of both  the others; nervous, or that which is here de-
nominated the medium of touch or simple feeling, chiefly derived
 from, or dependant upon the spinal marrow, and possessed by ani-
* Expcrienses sur la principe de la Vie, &c.
t Phil. Trans. 1815. p. 15 and 414. 
IX. IV.]
PHYSIOLOGICAL PROEM.
25
mals somewhat more advanced in the scale of life ;  and sensorial,
constituting what we have just regarded as the  medium of  the  lo-
cal senses, and appertaining to the higher classes.  He adds, that
each of these may exist  alone, and consequently independently of
the rest;  but admits that where the nervous  principle co-exists
with the  muscular, it  exerts an influence over it, so that  the lat-
ter may even be overborne  or destroyed by such influence :  and
when the sensorial co-exists with both, it exercises  over both  an
equal degree of  control.
   III. But the nervous organ in its most elaborate and perfect state,
as in man, is not only the  seat of sensation and motion, but of intel-
ligence :  it is the instrument of communication between the mind
and the body, as well as between the body and the objects by which
the body,  is surrounded.   And as a failure or irregular performance
of its function in various ways, lays a foundation for an extensive di-
vision of corporeal diseases, so a like failure  or irregularity of per-
formance  in other ways lays a foundation  for  as numerous a  train of
mental maladies.
   Of the nature of the mind or soul itself, we know little  beyond
what revelation  has  informed us; we have no chemical test that
can reach its essence;  no glasses that  can trace its  mode of union
with the brain ; no analogies that can illustrate the rapidity of its
movements.  And hence  the darkness that,  in this  respect, hung
over the speculations of the  Indian gymnosophists and the philoso-
phers of Greece continues without  abatement, and has  equally  re-
sisted the labours of modern metaphysicians and physiologists. That
the mind  is an intelligent principle we know from nature; and that
it is  a principle endowed with immortality, and capable of existing
after death in a state separate from the body, to which,  however, it
is hereafter to be re-united at a period when that which is now mor-
tal shall put on immortality, and death itself be swallowed up of vic-
tory—we learn from the God of nature.   And with such information
we may well rest  satisfied : and, with suitable modesty, direct our
investigations to those lower branches of this mysterious subject that
lie within the grasp  of our reason.
   I cannot, however, drop the subject altogether without observing
that the  discussion concerning  the  particular entity of the mind,
seems to have been conducted with an undue degree of heat and con-
fidence on all sides, considering our present ignorance of whatever
substance has been appealed  as constituting its specific frame.
   Is the essence of the mind, soul, or spirit, material or immaterial 1
The question, at first sight, appears to be  of  the utmost importance
and gravity; and to involve nothing less than a belief or disbelief,
not indeed, in its divine origin, but in  its  divine similitude and im-
mortality.   Yet I may  venture to affirm, that  there  is  no question
which has been productive of so little satisfaction, or has laid a foun-
dation for wider and wilder errors within the whole range of meta-
physics.   And for this  plain  and obvious reason, that we have  no
distinct ideas of the term«, and no settled  premises to  build upon,
   vox., nr.                  4 
26
PHYSIOLOGICAL PROEM.
[CL. IV-
Corruptibility and incorruptibility, intelligent and unintelligent, or-
ganized and inorganic, are terms that convey distinct meanings  to
the mind, and impart modes of being that are within the scope of our
comprehension.   But materiality and  immateriality are equally be-
yond our reach.  Of the essence of matter  we know nothing, and
altogether as little of many of its  more active qualities:  insomuch
that, amidst all the discoveries of the day, it still remains a contro-
vertible position, whether light, heat, magnetism and  electricity are
material substances, material properties, or things superadded  to
matter and of a higher nature.
  If they be matter, gravity and ponderability are not essential pro-
perties of matter, though commonly so  regarded.  And if they be
things superadded to matter, they  are necessarily immaterial, and
we  cannot open our eyes without beholding  innumerable  proofs  of
material and  immaterial  bodies  co-existing  and acting  in  har-
monious union through the entire frame of nature.  But if we know
nothing of the essence, and  but  little of the  qualities of matter,  of
that common substrate  which is diffused around us in every direc-
tion, and constitutes the whole of the visible world, what can we
know of what is immaterial ? of  the full meaning of a term that,  in
its strictest sense, comprehends all the rest of the immense fabric of
actual and possible being; and includes, in its vast circumference,
every essence and mode of essence  of every other being, as  well
below as  above  the order of matter, and even that  of  the Deity
himself?
  Shall we take  the quality of extension  as  the line  of separation
between what is material and what is immaterial ?  This, indeed,
is the general and favourite distinction brought forward in the  pre-
sent day;  but it is a distinction  founded on  mere conjecture, and
which will by no  means stand the test of inquiry.   Is space extend-
ed?  every one  admits it to be so.  But is space material?  is it body
of any kind ?   Des Cartes, indeed, contended that it is body, and a
material body;  for he denied a vacuum, and asserted space to be a
part of matter itself: but it is probable that there is not a  single es-
pouser of this opinion in the present day.  If then extension belong
equally  to matter and to space, it cannot be contemplated  as the pe-
culiar and exclusive property of the former; and if we allow it  to
immaterial space, there is no reason  why  we should not allow it  to
immaterial spirit.  If extension appertain  not to the mind or think-
ing principle, the latter can have no place of  existence ; it can exist
no where: for  where or place is an idea that cannot be  separated
from the idea of extension.   And hence, the  metaphysical immate-
rialists of modern time freely admit that the mind has no place  of
existence; that it does exist no where; while, at the same time,
they are compelled to allow that the immaterial Creator, or univer-
sal Spirit, exists every where, substantially as well as virtually.
  Nor let it be supposed that the difficulty is  removed by  adding  to
matter the quality of solidity in conjunction with  that of extension,
and hence distnguishir.^ it as possessed of solid extent ; for the qua-
lity of solidity is less characteristic of it than any we  have thus far 
CL. IV.]
PHYSIOLOGICAL PROEM.
27
tak^n notice of;  and is perpetually fleeing from us as we pursue it.
That matter  is  infinitely divisible we dare  not  say,  because  we
shouid hereby reduce it to mathematical points, and because, also,
there would, in such case, be no certain or permanent basis to build
upon, and to ensure a punctuality  of  material cause and effect:  and
hence, ^ir Isaac Newton was obliged to suppose that it is possessed
of ultimate  atoms which are solid and unchangeable.   But of these
the senses can trace nothing, and our admission is  nothing more
than conjectural.
   Let not the author, however, be misunderstood  upon this abstruse
and difficult subject.  That the mind  has a distinct nature  and is a
distinct  reality from the body; that  it is gifted  with  immortaiity,
endowed with reasoning faculties,  and capacified for a state  of sepa-
rate existence after the death of the  corporeal frame to which it is
attached, are, in  his opinion, propositions  most clearly  deducible
from  revelation,  and, in one  or two  points, adumbrated  by a few
shadowy glimpses of nature.   And that it may be a substance strict-
ly immaterial and essentially different  from matter is both possi-
ble and probable ; and will hereafter, perhaps, when  faith  is turn-
ed into vision, and conjecture into fact, be found to be the true and
genuine  doctrine upon the  subject.   But till  this glorious era  ar-
rives ; or till, antecedently to it, it be proved, which it does not hi-
therto seem to have been, that matter, itself of divine  origin, gifted
even at present, under certain modifications, with instinct and sensa-
tion, and destined to become immortal hereafter, is physically inca-
pable, under some still more refined,  exalted, and  spiritualized mo-
dification, of exhibiting the attributes of the soul,  of  being, under
such a constitution, endowed with immortality from the first, and ca-
pacified  for existing separately from the external and grosser frame
of the body; and that it is  beyond the power of its own Creator to
render it intelligent, or to give it even brutal perception, the argu-
ment must be  loose and inconclusive  : it  may plunge  us, as it  has
plunged  thousands before, into errors, but can never conduct us to
demonstration, r It may lead us, on the one hand, to the proud Brah-
mimcal and Platonic belief that the essence of the soul  is the very
essence of the Deity, and consequently a part of the Deity himself:
or, on the other,  to the gloomy regions of modern materialism, and
to the cheerless doctrine that it dies and dissolves in one common
grave with  the body.
  It is no fair objection, however, against the immaterialist, that by
contemplating the mind as a distinct essence from  that of  the  body,
man is hereby rendered a compound being, possessing at one and the
same  time  two  distinct  lives mysteriously  united in  an individual
frame, and running in parallel lines  till  the  hour of  death.  For
whilst the known  and  obvious laws and faculties  of the  mind and
body are so widely different, as they are acknowledged to be on all
hands, some such composite  union has been and must be  allowed
under every hypothesis whatever.  And least of all have the scep-
tical physiologists of the present day any  right  to triumph upon 
28                 PHYSIOLOGICAL  PROEM.             [cL. IV.

such an objection ; who, drawing no light  from nature, and reject-
ing that of sacred writ, contemplate the mind as formed of the same
gross modification of matter as the body, and doomed to fall with it
into one common and eternal dissolution.   For even these acute ma-
terialists,  with all the aid of physiological, anatomical and  chemical
research,  instead of simplifying the human fabric, have made it more
clumsily complex, and represented it sometimes, indeed, as a  duad,
but of late more generally as a triad, of unities, a combination of a
corruptible life within a corruptible  life two  or three deep, each
possessing its own separate faculties or manifestations, but covered
with a common outside.
  This remark  more especially applies to the philosophers  of the
French school: and particularly to the system of Dumas, as modifi-
ed by Bichat ;*  under which more finished form, man is declared  to
consist of  a pair  of lives,  each distinct and co-existent  under the
names of  an  organic  and an  animal life ; with, two distinct  assort-
ments of sensibilities, an unconscious and a conscious.  Each of these
lives is limited to a separate set of organs, runs its  race in parallel
steps with the other;  commencing coetaneously and perishing at the
same  moment.!  This work appeared at the close of the  past cen-
tury; was read and admired by most physiologists; credited by ma-
ny ; and became the popular production of the day.   Within  ten or
twelve years, however,  it ran its course, and was as generally either
rejected or forgotten  even in France :  and Mr. Richerand first, and
M. Magendie afterwards, thought themselves called  upon  to modify
Bichat, in order to render him more palatable, as Bichat had alrea-
dy modified Dumas.  Under the last series of remodelling, which is
that of M. Magendie, we  have certainly an improvement,  though
the machinery is quite as complex.- Instead of two distinct lives, M.
Magendie presents us with two distinct sets or systems of  action or
relation, each of which has its separate and  peculiar functions, a
system of nutritive action or  relation, and  a  system  of vital.  To
which is added, by way  of appendix, another system, comprising the
functions of generation, j  Here, however, the brain«is not only the
seat but the organized substance of the mental powers: so that, we
are expressly told, a man  must be as he is made in  his brain, and
that education, and even logic itself, is of no use to him.   " There
are," says  M.   Magendie, "justly celebrated  persons who have
thought differently; but they have  hereby fallen  into grave er-
rors."   A Deity however is allowed to exist, because, adds the wri-
ter, it is comfortable to  think that  he exists, and on this account the
physiologist cannot doubt of his being. " L'intelligence de 1'homme,"
says he, " se compose de phenomenels tellement differens de tout ce
que presente d'ailleurs la  nature, qu'on les rapporte a un etre par-
* Principes de Physiologic 4 Tom. 8vo. Par. 1800-3.
1 Recherches sur la Vie et la Mort, &c.
t Precis Elementaire de Physiologic 2 Tom. 8vo. Paris 1816, 181". 
CL. IV.]            PHYSIOLOGICAL PROEM.                  29

ticuliere qu'on regarde commune  emanation de la Divinite.   II est
trop consolent de croire d. cet btre, pour que le physiologiste mette en
doute son existence; mais la severite  de language ou de logique
que comporte maintenant la physiologie, exige que  l'on  traite  de
I'intelligence humaine comme si elle etait laresultatde Paction d'un
organe.   En s^ecartant de cette  marche, des hommes justement ce-
lebres sont  tombes  dans des graves erreurs;  en  la suivant, on a,
d'ailleurs, le grand avantage de conserver la meme methode d'etude,
et de rendre tres-faciles, des  choses qui sont  envisagees  generale-
ment comme presque  au-dessus de  l'esprit humain."—" 11  existe
une science dont le  but est d'apprendre a raisonner justement, c'est
la logique, mais le jugement  errone ou l'esprit faux (for judgment,
genius, and imagination, and  therefore  false  reasoning, all depend
on organization)  tiennent  a l'organization.   II  est impossible de
ce changer  a. cet  egard ;  nous restons  tels que la nature nous a
faits "*
   Dr. Spurzheim has generally been considered, from  the concur-
rent tenour of his doctrines, as belonging to the class of material-
ists :  but this is to mistake  his own positive assertion upon the sub-
ject,  or to conclude in opposition to it.  He speaks,  indeed, upon
this topic with a singular hesitation and reserve, more so, perhaps,
than  upon any other point whatever; but as far as he chuses to ex-
press himself on so  abstruse a subject,  he regards the  soul as a dis-
tinct being from the body,  and  at least intimates that it may be near-
er akin to the Deity.   Man is with him also possessed  of  two lives,
an automatic, and  an animal : the  first produced by organization
alone, and destitute of consciousness; the second possessed  of con-
sciousness dependent on the soul, and merely  manifesting itself by
 organization.  " We do not,"  says  he, " attempt to  explain  how
 the body and soul are joined together  and  exercise  a mutual influ-
 ence.  We do not examine what the soul can do without the body.
Souls, so far as we know, may be united to bodies at the moment of
conception or afterwards ;  they may be different in all individuals,
 or of the same kind in every one; they may be emanations from
God, or something essentially different."!  The mind  of  this cele-
brated craniologist  seems to be wonderfully sceptical and bewildered
upon the  subject, and studiously avoids  the important question of
 capacity of  the soul for an independent, and future  existence :  but
 with the above declarations he cannot  well be arranged in the class
 of materialists.
   The hypothesis which has lately been started by  Mr.  Lawrence
is altogether of a different kind, and though undoubtedly much sim-
 pler! tnan any of the preceding, does not seem  to be  built on  a
 more stable foundation.  According to his view of the  subject,  or-
 ganized differs from ioorganized  matter merely by  the addition of
* Precis Elementaire, &c. et supra, passim.
t Physiognomical System, &c. \i. 250. 8vo. Lond. 1815.
■  Introduction to Comparative Anatomy and Physiology, &c. 8vo. 1816. 
30
PHYSIOLOGICAL PROEM.
[CL. IV.
certain properties which are called vital, as  sensibility and irrita-
bility.   Masses of matter endowed  with  these new properties  be-
come organs and systems of organs, constitute an animal frame,  and
execute distinct sets of purposes or  functions,  for functions and pur-
poses carried into execution are here  synonymous   " Life is  the
assemblage of all the  functions (or purposes) and the general  re-
sult of their exercise."*
  Life, therefore, upon this hypothesis, instead of being a two-fold
or three-fold reality, running in a  combined stream, or in parallel
lines, has no reality whatever.   It has no esse or independent exis-
tence.   It is a mere assemblage of  purposes, and accidental or tem-
porary  properties : a series of phaenomena,t as Mr. Lawrence  has
himself correctly expressed it;—a  name without a  thing.  " We
know not," says he, " the nature of the link that unites these phae-
nomena, though we are sensible that a connexion must  exist; and
this conviction is sufficient to induce us to give it a name, which  the
vulgar  regard as the sign  of a particular principle ; though in fact
that name can only indicate the assemblage of  the phenomena which
have occasioned its formation."J
  The human frame is, hence,  a barrel-organ, possessing a system-
atic arrangement of parts, played upon by peculiar powers, and  ex-
ecuting particular pieces or purposes;  and life is the music pro-
duced by the general assemblage or result of the  harmonious  ac-
tion.  So long as either the vital or the  mechanical  instrument is
duly wound  up by  a regular  supply of food or of the wince, so
long the music will continue :  but both are worn out by their own
action;  and when the machine  will no longer  work, the life has the
same close as the music; and in the  language of Cornelius Gallus,
as quoted and appropriated by Leo  X.,

        —redit in nihilum, quod fuit ante nihil.

  There is, however, nothing new  either in this hypothesis or  the
present explanation of it.   It was first started  in the  days of Aris-
totle by Aristoxenus, a pupil of his, who was  admirably skilled in
music, and by profession a  physician.   It- was propounded to the
world under the name  of the system of harmony,  either  from the
author's fondness for music, or from his comparing the human frame
to a musical instrument, and his  regarding life as  the result of all its
parts acting in accordance, and  producing a general and harmonious
effect.
  How  far Mr. Lawrence's revised  edition  of  this hypothesis may
prove satisfactory to other classes of materialists I cannot tell: but
if he should succeed, he will be more fortunate  than Aristoxenus,
who pleased neither the other materialists nor the immaterialists of
* Introduction to Comparative Anatomy and Physiology, &c. 8vo. p. 120. 1816:
 I Id. p. 122.
X Id. p. 122. 
CL. IV.]             PHYSIOLOGICAL PROEM.                31

his day.  From the latter, indeed, he could expect no countenance:
but even the Epicureans, though they held that  the mind was  cor-
ruptible, as formed of matter, which  they had no reason to believe
was then or ever would be  otherwise than corruptible  under any
modification whatever, held, at the same  time, that it  had a  sub-
stantive existence, distinct from that of the grosser-frame of the bo-
dy, and possessed of other and far higher properties: being formed of
the finest, lightest, smoothest, and most moveable material elements,
and hence  exquisitely etherialized and volatile:

                     est animi natura reperta
         Mobilis egregie, perquam constare necesse est
         Corporibus parvis, et lsevibus, atque rotundis.*

   The atomic philosophers, therefore, joined with the Platonists
and Stoics  in opposing the system of harmony, and that chiefly upon
the two following grounds,  which will apply  with as mueh force to
its present as to its primary form.   First,  admitting  that an assem-
blage  and exercise of all the functions of the machine are necessa-
ry to maintain the phenomena of life, we are left as much in the
dark as ever concerning the nature of principle  by which this har-
monious instrument becomes gradually developed and is kept in per-
petual play.  And next,  that the  life or well-being of the  animal
frame does not depend upon an assemblage and  exercise of all its
functions or purposes, since the mind may be diseased while the bo-
dy remains unaffected ; or the body  may lose some of its own or-
gans,  while  the mind, or even the general health of the body itself
may continue perfect.!
   In the  darkness,  therefore, which continues to  hang  oyer the
mysterious subject before us, I feel incompetent to enter into the
question concerning the actual essence of the mind, and am perfect-
ly content to take its general nature, powers, and destiny, from the
only volume which is capable of giving us any decided information
 upon  the subject;  to follow it up as far as that  volume may guide
 us, and to stop where it withdraws its assistance.
   Closely connected with the present question, is another of nearly
 as much perplexity, and the  consideration of which  has  not  been
 attended with much more success, but which must not be passed by
 on the present occasion without being glanced at.
   Whatever be the nature  or substance of the mind,  the brain is
 the organ in which it holds its  seat; and whence  it maintains an
 intercourse with the surrounding world.   Now, it must be obvious
 to every one who has attended to the operation of his senses, that
 there never is, nor can be  any  direct communication between the
 mind, thus stationed in the brain, and the external objects the mind
 perceives ;  which are usually, indeed, at  some  distance even from
 the sense  that gives notice of them.  Thus, in looking at a tree it
* Lucret. De Rer. Nat. in. 204.
+ Id. in. 105—266. Lactam, in vit. Epicur. Polignac. Anti. Lucer. Lib. v. 923. 
32                 PHYSIOLOGICAL PROEM.            [cL. IV.

is the eye alone that beholds  the  tree, while the mind only per-
ceives a notice of its presence by some means or  other, from  the
visual organ.  So, in touching  this table it is my  hand  alone that
comes in contact with  it,  and communicates to my mind a know-
ledge of its hardness and other qualities.  What then is the medium
by which such  communication is maintained ? which  enables  the
mind to have a perception of the form, size, colour, smell and even
distance of objects, correspondent with that of the  senses which are
seated on the surface of the body ?  and which at the same time that
it conveys this information, produces such an  additional effect, that
the mind is able, at its own option, to call up an exact notion or idea
of those qualities at a distant period, or when the objects themselves
are no longer present ?  Is there, or is there  not, any  resemblance
between the external or sensible object, and the  internal or mental
idea or notion ? If there be a resemblance, in  what does that resem-
blance consist ? and how is it  produced and  supported ? Does  the
external object throw off' representative likenesses of itself in films
or under any other modification, so  fine as to  be able, like the elec-
tric or magnetic aura, to pass without injury from  the object to the
sentient organ, and  from the sentient organ to the  sensory, or men-
tal presence-chamber ? or has the mind itself a faculty of producing,
like a mirror,  accurate countersigns, intellectual pictures or images
correspondent  with the sensible images communicated from the ex-
ternal object to the sentient organ ? If, on the contrary, there be no
resemblance, are  the mental perceptions mere notions, or intellec-
tual symbols excited in the mind by the action of the external sense ;
which, while they bear  no similitude to the qualities of the  object
discerned, answer the purpose of those qualities,  as letters answer
the purpose of sounds ?  or are we  sure  that  there is any external
world whatever; any thing beyond  the  intellectual  principle that
perceives and  the sensations and notions that are perceived ; or even
any thing beyond those sensations and notions, those impressions and
ideas themselves ?
   Several of these  questions may perhaps  appear in no small  de-
gree whimsical and brain-sick, and more worthy of St. Luke's than
of a work of physiological study.   But all of them, and at  least as
many more, of a  temperament as wild as  the wildest, have been
asked and insisted upon, and supported again  and again in different
ages and countries, from the zenith of Grecian science down to our
own day, by philosophers of  the clearest intellects in other respects.
and who had no idea of labouring under any such  mental infirmity,
nor ever dreamed  of the necessity  of being blistered and  taking-
physic.
   The nature  of the questions themselves, therefore, when  put by
the characters referred  to, sufficiently manifest the obscurity of the
subject to which they relate:  and to enter into  the  discussions  to
which they have given  rise, would lead us to an  irrecoverable dis-
tance from  the path before us.  Those who are desirous of follow-
ing them up and  of witnessing an exposure of their absurdity, can-
not do better than apply themselves to the metaphysical writings of 
CL. IV.]            PHYSIOLOGICAL  PROEM.            •    33

Dr.  Reid, Dr. Beattie, Dr. Campbell and Professor  Stewart;  who
if, on the overthrow of so many Babel-buildings, they have not been
able to raise an edifice much more substantial in their stead, have
only failed from the insuperable difficulty of the attempt^
  No man was more sensible of this difficulty than Mr. Locke, nor
has taken more pains both to avoid what  is unintelligible  and  un-
profitable, and to elucidate what may be turned to a good  account
and brought home to an ordinary comprehension.  It was his  im-
perishable Essay  on Human  Understanding that gave the first check
to the wild and visionary conceits in which the most celebrated lu-
minaries of the age were at that time  engaged ; recalled  mankind
from the chasing of shadows to the study  of realities, from a  pur-
suit of useless and inexplicable subtleties to that  of  important  and
cognoscible subjects; or rather to the only mode in which the great
inquiry before him could be followed up with any reasonable hope
of success or advantage.
  To this  elaborate and wonderful work, which has conferred an
ever-during fame, not only on its matchless  author,  but on the na-
tion to which he  belonged, and even the age'in which he lived, the
physiologist cannot pay too close an attention.  It is,  indeed, of the
highest  importance to every science, as teaching us the elements of
all science, and  the only mode by which science can be  rendered
really useful, and  carried forward to ultimate perfection ;  but it is
of immediate importance to  every branch of physical knowledge,
and particularly to that which is employed in  unfolding the struc-
ture of  the  mind, and its connexion with  the visible  fabric that in-
closes it.'  It may, perhaps,  be somewhat too long; it may occasion-
ally embrace subjects which are not necessarily connected with it;
its terms  may not  always be precise, nor its opinions in every in-
stance correct: but it discovers intrinsic  and most convincing evi-
dence that the man who wrote it must have had a head peculiarly
clear, and a heart"peculiarly sound: it is strictly original in its matter,
highly important in its subject, luminous and forcible in its argument,
perspicuous in its style, and comprehensive  in its scope.   It steers
equally clear of all former systems: we have nothing of the mystical
archetypes  of Plato, the  incorporeal phantasms of Aristotle, or the
material species of Epicurus ; we are equally  without the intelligible
world of the Greek schools, and the innate ideas of Des Cartes. Pass-
ing by all which, from actual experience  and observation it deline-
ates the features, and describes the operations of the human mind with
a degree of precision and minuteness which has never been exhibited
either before or since; and stands, and probably ever will stand, like
a iock  before the puny waves  of opposition by which it  has since
been  assailed from various  quarters.   The author may speak of it
with  warmth, but he speaks  from a digested knowledge of its merits:
for he has studied it  thoroughly and repeatedly, and there is, per-
haps, no book to  which he is so much indebted for whatever small
degree  of discrimination, or habit of reasoning  he may possibly be
allowed to lay claim to. 
34     •
PHYSIOLOGICAL PROEM.
[CL. IV.
  Upon one point  he is perfectly clear,  and that is, that the chief
objections at any time urged against this celebrated production have
proceeded from an utter mistake of its meaning, of which he could
give numerous instances, if such a digression  were allowable, from
the writings of many who have the credit of having studied it pro-
foundly.  The remark applies  to several of the most popular psy-
chologists of both North and South Britain, but especially to those
of the continent, and more  particularly still  to M. Condorcet, from
whom the French in  general have  received an  erroneous  idea of
several of its leading doctrines.   It is to this book the medical stu-
dent ought to turn himself for a knowledge of the laws that regulate
the developement and growth of  the mind,  as he should do to the
labours of Haller or Hunter for a  knowledge of those that regulate
the developement and growth of  the body, and I shall hence draw
largely upon it through the remainder of this introduction.
  The whole then of the metaphysical rfibbish of the ancient schools
being cleared  away by the purging and purifying energy of the
Essay on Human Understanding, mankind have  since  been  enabled
to contemplate the body and mind  as equally, at birth, a tibula rasat
or unwritten sheet of paper; as consisting equally of a blank  or
vacuity of impressions ; but as equally capable of acquiring  impres-
sions by the operation of external objects,  and  equally  and most
skilfully endowed with distinct powers or  faculties for this purpose;
those of the body being the external senses of sight, hearing, smell,
taste, and touch; and those of the mind the  internal senses  of per-
ception, reason, judgment, imagination,- and memory.
  It is possible that a few  slight impressions may be produced a
short time  antecedently to birth; and it is certain that one or two
instinctive tendencies which,  however,  have no connection  with
the mind, are more  perfect, because more needful, at the period  of
birth than ever afterwards;  and we have also frequent proofs of  an
hereditary or accidental predisposition towards  particular subjects.
But the fundamental doctrine before us is by no means affected by
such collateral circumstances.
  External objects first impress or operate upon the outward senses;
and these senses  by means hitherto  unexplained, and, perhaps, al-
together  inexplicable, immediately impress or operate upon the
mind, or  excite in it perceptions or ideas  of the presence and quali-
ties of such objects ; the word idea being here employed, not in any
of the significations of the schools, but in its broad,  popular mean-
ing, as importing " whatever a man observes, and is  conscious  to
himself he has in his mind ;"* whatever was  formerly intended by
the terms archetype, phantasm, species, thought, notion, or concep-
tion, or whatever else it may be which we can be employed about
in thinking.!  And to these effects  Mr.  Locke  gave  the name  of
ideas of sensation, in allusion to the source from which they are
derived.
* Locke, on Human Understanding, B. i. ch. i. i 3.
t Locke, B. i.ch. i. J 8. 
CL. IV.]
PHYSIOLOGICAL PROEM.
35
  But the mind, as we have already observed, has various senses or
faculties as well as the body; and they are quite as active and lively
in their respective functions: in consequence of which the ideas of
external objects are not only perceived, but retained, thought of,
compared, compounded, abstracted, doubted, believed, desired ; and
hence another  fountain, and of a very capacious flow, from  which
we also derive ideas:  viz. a reflex act or perception of the  mind's
own operations; whence  the ideas derived from this fountain are
denominated ideas of reflexion.
  The ideas, then, derived from these two sources, and which have
sometimes  been called objective  and  subjective, constitute all our
experience, and, consequently, all our  knowledge.  Whatever stock
of information a man may be possessed of,  however richly he may
be stored  with taste, learning,  or science,  if he turn  his attention
inwards, and diligently examine  his own thoughts, he  will find that
he has  not a single  idea  in his  mind, but  what has been derived
from the one or the other of these two channels.  But let not this
important observation be forgotten by any  one ; that  the ideas the
mind possesses will be fewer or more numerous, simpler or more
diversified, clear or confused  according  to the number of the ob-
jects presented to it, and the extent of its reflexion and examination.
Thus a clock  or a landscape may be for  ever before  our eyes, but
unless  we  direct our attention to them,  and study their different
parts, although we  cannot be deceived in their being a clock or a
landscape, we can have but a very inadequate idea of  their charac-
ter and composition.
  The ideas presented to the  mind,  from which soever of these
two sources derived, are of two kinds—simple and complex.
  Simple ideas consist of such as are  limited to a single notion or
perception; as those of unity, darkness, light, sound, simple pain or
uneasiness.  And in  the reception of these  the mind is passive;  for
it can neither make  them to itself, nor can  it, in any instance, have
any idea which does not wholly consist of them ; or, in other  words,
it cannot contemplate any one of them otherwise than in its totality.
  Complex ideas are  formed out of various simple ideas associated
together or contemplated derivatively.  And to  this class  belong
the ideas  of an army, a battle, a triangle, gratitude, veneration,
gold, silver, an  orange, an apple : in  the formation of all which it
must be obvious that the mind is active : for it is the activity of the
mind alone  that produces the complexity out of such ideas as are
simple.  And that the ideas I have now referred to are complex,
must be plain  to every one ; for every one  must be  sensible that
the mind cannot form to itself the idea of an orange, without uniting
into one aggregate the simple ideas of roundness, yellowness, juici-
ness, and sweetness; and so of the rest.
  Complex ideas are formed out of simple ideas by many operations
of the  mind; the principal of which,  however, are some combina-
tion of them, some abstraction or some comparison.  Let us take a
view of each of these. 
36                  PHYSIOLOGICAL  PROEM.           [CL. IV.

  And first of complex ideas of combination.  Unity, as I have al-
ready observed, is a simple idea ; and it is one of the most common
simple ideas that can  be presented to  the mind; for every object
without,  and every notion  within,  tend equally to  excite it: and
being a simple idea, the  mind, as I  have also remarked, is passive
on its presentation: it can neither form such an idea to itself, nor
contemplate it otherwise  than in its totality: but it can combine the
ideas of as many units as  it pleases, and hence produce the  complex
idea of a hundred, a thousand, or a hundred thousand.   So,  beauty is
a complex idea;  for the mind, in forming it, combines a variety of
separate  ideas into one common aggregate.   Thus Dryden, in de-
lineating the beautiful Victoria in his Love Triumphant,

          Her eyes, ber lips, her cheeks,  her  shape, her features,
          Seem to be drawn by Love's own hand ; by Love
          Himself in love.

  In like manner the mind can produce complex ideas  by  an oppo-^
*ite process; and that is,  by abstraction or separation.   Thuschalk,
snow, and milk, though agreeing, perhaps, in no other respect, coin-
cide in the  same colour;  and the mind,  contemplating  this agree-
ment, may abstract or separate the colour from the other properties
of these  three objects, and form the idea which is indicated by the
term whiteness ; and having thus acquired a new idea by the process
of abstraction, it  may afterwards apply it as a character to a variety
of other objects; and hence particular ideas become general or uni-
versal.
  Other complex ideas are produced by comparison.   Thus if the,
mind  take one idea, as that of' a foot, as a determinate measure, and
place it by  the side of  another idea, as the idea of a table, the re-
sult will be a formation of the complex  idea of length, breadth, and
thickness.  Or, if we vary the  primary idea, we may  obtain,  as a
result, the secondary ideas of coarseness and fineness.
  And hence, complex ideas must be almost infinitely more numer-
ous than  simple  ideas  which are their elements or materials; as
words must  be always far more numerous than letters.  I  have in-
stanced only a few of their principal kinds, and have applied them
only to a few of the great variety of subjects to  which they are re-
ferable, and by which  they are  elucidated,  in the great  work on
Human Understanding.
  It must, however, from this imperfect sketch, appear obvious that
many of  our ideas have  a natural correspondence, congruity, and
connexion with each other; and as many, perhaps, on the contrary,
a natural repugnancy, incongruity,  and disconnexion.   Thus, if I
were to  speak of a cold fire, I should put together  ideas  that are
naturally disconnected and incongruous;  and should consequently
make an absurd  proposition, or  to adopt common  language,  talk
nonsense.  I should be guilty of the same blunder if I were to talk of
a square  billiard-ball,  or  a soft, reposing rock;  but a warm fire, on 
CL. IV.]             PHYSIOLOGICAL PROEM.                 37

the contrary, a white or even a black billiard-ball, and a hard, rug-
ged rock, are  congruous ideas, and  consequently  consistent with
good sense.   Now it is the direct office of that discursive faculty of
the mind  which we call reason, to trace  out these natural coinci-
dences or disjunctions, and to connect or separate them by proper
relations: for it is a just perception of the natural connection and con-
gruity,  or of  the natural repugnancy and incongruity of our ideas
that shows a sound mind and constitutes  real knowledge.   The wise
man is he who has industriously laid in  and carefully assorted an
extensive stock of ideas; as the stupid or ignorant man  is he who,
from natural hebetude, or having  had  but few opportunities, has
collected  and  arranged but a small number.  The  man  who dis-
covers the natural relations of his ideas quickly, is a man of sagaci-
ty ; and, in  popular language, is said, and correctly so,  to possess a
quick, sharp intellect; the man,  on the  contrary, who discovers
these relations slowly, we call dull or heavy.  If he rapidly discover
and put together relations that lie  remote, and, perhaps touch only
in a few points, but those points striking and pleasant, he  is a man
of wit, genius, or  brilliant fancy, of agreeable allusion and meta-
phor ;  if he intermix ideas of fancy with ideas of reality, those of
reflexion with those of sensation, and mistake the one for the other,
however numerous his ideas may be, and whatever  their order of
succession, he  is a  madman;  he reasons from false  principles, and,
as we say in popular language, and with perfect correctness, is out
of his judgment.
   Finally, our ideas are very apt to associate or run together in
trains ; and upon this peculiar and happy disposition of the mind we
lay our chief dependance in sowing the  seeds of education.  It often
happens,  however,  that some of our ideas have  been associated
erroneously, and even in a state of early  life, before  education has
commenced ;  and hence, from the difficulty of separating them,
most of the sympathies and antipathies, the whims and prejudices
that occasionally haunt us to  the latest period of old age.
   Such, then,  is the manner, in which  the mind, at first a sheet of
white  paper,  without  characters of any kind, becomes furnished
with that vast store of ideas, the materials of wisdom and knowledge,
which the busy and boundless fancy of man paints upon  it with an
almost endless variety.  The whole is derived from experience,
the experience of sensation or of reflexion ; from the observations
of the  mind employed either about external sensible objects, or the
internal operations  of itself, perceived and reflected upon by its own
faculties.
   These faculties  are  to the mind what organs are to the body i
they are its ministers in the production, combination, and resolution
of different trains of ideas, and in supplying it with the results of its
own activity.  We  sometimes, however, are apt to speak of them
as distinct and separate existences from the mind, or as possessing
a sort of independent entity, and as controlling one another by their
individual authorities,  and occasionally, indeed, as  controlling the 
38
PHYSIOLOGICAL PROEM.
[CL. IV.
mind itself: for we accustom ourselves to describe the will as being
overpowered by the judgment; or the judgment as being over-
powered by the imagination ; or the mind  itself as being carried
headlong by the violence of its own passions.  By all which, how-
ever,  we  only mean or should  only mean,  that the mind does not,
on such occasions, exert its own faculties in a fitting or sober man-
ner, or that from some diseased affection, it  is incapable of doing so.
For the faculties of the mind are so many powers; and, as powers,
are mere attributes  of a being  or  substance,  and not the being or
substance itself.  These, therefore, being all different  powers in the
mind or in the man, to do several actions, he exerts them as he thinks
fit: but the  power  to  do  one action  is not operated upon by the
power to do another action:  for the power of thinking operates not
on the power of choosing,  nor the power of choosing on the power
of thinking:  any more than  the power of dancing operates on the
power of singing, or the power of singing on the power of dancing,*
as any one who reflects on these things will easily perceive.
   The  body  has its feelings, and  the  mind has  its  feelings also;
and it is the feelings of the  latter  which we call passions, a mere
Latin  term for the  feelings or sufferings  of  colloquial  language.
The feelings of the body are numerous and diversified, as those of
simple ache or ease, hunger, thirst, heat, cold, and a multitude of
others.  Those of  the  mind are still more  numerous and more
diversified, for  they comprise the  multifarious train  of grief, joy,
love,  hatred,  avarice,  ambition,  conceit,  and  perhaps  hundreds
more: all which whether of body or mind, Mr. Locke has endea-
voured to resolve into different  modifications  of pleasure or pain,
according as they are productive of good or evil.
   But the analogy we are thus conducting between the mind and the
body holds much farther:  for as the latter  is subject to diseases of
various kinds, so also is the former.   The  body may be  enfeebled
in all  its powers, in only a few of them, or  in only a single one.
So also may the mind:   " The  powers  of perception and imagina-
tion,"  observes M.  Pinel, " are frequently disturbed without  any
excitement of the passions.   The functions of the understanding, on
the other hand, are often perfectly sound, while the  man is driven
by his  passions to  acts of  turbulence and outrage."  And these
infirmities, whether of body or mind,  may be constitutional  and
permanent, periodical  or  recurrent, or merely incidental and tem-
porary.  The body may be of a  sanguineous  temperament, of a
platonic  temperament,  of a nervous  or  irritable temperament;
and the mind nvly,  in like manner, possess an over-weening confi-
dence  and courage  ; be characteristically dull and inactive ;  or be
even goaded on by restlessness and eager desire; it  may be quick
in apprehension and taste, but weak in memory ; strong in judgment,
but slow in imagination ; or feeble in judgment, but rapid in imagi-
nation : its feelings or  passions may be sluggish, or all alive ; or
* Locke, p. 129. 
CL. IV.]
PHYSIOLOGICAL PROEM.
39
some passion may be peculiarly energetic, while the rest remain at
the temperate point.
  When the corporeal deviations from the standard of high health
are but slight, they are scarcely entitled to the name of diseases,—
but  when severe or  extreme, they  become  subjects of  serious
attention.  It is the same with the different states of the mind with
which I have just contrasted them.  While several, or even all the
mental faculties are slightly weak or sluggish or ioaccordant with
the action of the rest, they are scarcely subjects of medical treat-
ment—for otherwise half the world would be  daily consigned to a
strait  waistcoat: but when the same changes become striking and
strongly marked, they are real diseases of the intellect ; and, in the
ensuing order,  the genera will be  found taken from the  peculiar
faculties of the mind that chance  to be thus affected.
   The mind and the  body bear also, in many cases, a  reciprocal
influence on each other;  which  is  sometimes general,  and some-
times  limited to particular faculties or functions.   It is hence  that
fever  or cephalitis produces delirium;  and vapours or low spirits
dyspepsy.
   The mind, therefore, like the  body, becomes an interesting field
of study to the pathologist, and opens to his  view an additional and
melancholy train of diseases.  It  is  these which will constitute the
subject of the first order of the  class we have now entered upon,
and which are entitled to a deep and collected attention. 
 
CLASS  IV.
NEUROTICA.
                          ORDER I.

                       PHRENICA.


              Mutants affecttng the  intellect.

 error, perversion,  or debility  of one"  or  more of  the mental
                           faculties.

 -L he word phrenica is Greek from the Greek noun <p%w " the mind"
 or " intellect."   The diseases  comprised in  the order, are so
 closely associated with each other, that, however the ordinal names
 may differ in different systems of nosology, they are, for the most
 part, grouped in some form or other under a correspondent division.
 And hence the present order will be found to  run nearly parallel
 with  the Deliria of Sauvages, the Mentales  of Linneus, the Para-
 noias  of Vogel, the  Vesaniae of Cullen, and still  more to  those of
 Crichton, and the Alienation mentale of Pinel: although the generic
 divisions are widely  different from all of them, and are attempted
 to be  rendered something clearer and more exact.   The order
 comprehends the six following :

       I. ECPHRONIA.                INSANITY.
     II. EMPATHEMA.                UNGOVERNABLE PASSION.
    III. ALUSIA.                   ILLUSION.
     IV. APHELXIA.                REVERY.
     V. PARONIRIA.                SLEEP-DISTURBANCE.
    VI. MORIA.                   FATUITY.

   Each of these will be found to include various distinct species of
 disorder proceeding from a morbid condition of one or more of the
 mental faculties or feelings, or an irrespondence of them to others;
 sometimes originating in a diseased state of the body, and sometimes
 producing such a state, as has already been explained in the pre-
ceding proem
  vol.  in.                  6 
NEUROTICA.
[CL. IV.-OR. I.
                      GENUS  I.


                      ECPHRONIA.

                    KusanCtfi.  i&vaiintt®.

DISEASED  PERCEPTION, WITH LITTLE DERANGEMENT  OF  THE JUDGMENT,
  OCCASIONALLY SHIFTING INTO  DISEASED  JUDGMENT  WITH  LITTLE  DE-
  RANGEMENT OF THE PERCEPTION ;  DISTURBING  THE MIND GENERALLY ;
  DIMINISHED SENSIBILITY; IRREGULAR REMISSIONS.

The generic term ecphronia, in the Greek writers mf^mn or txQprvni,
is  derived  from  ucfym " extra mentem"—literally " out of one's
mind," as tfttpecn is " mentis compos"  or " in one's mind."  It is
here used as among the Greeks, generically alone, in  the  ordinary
sense of  insanity;  and is  designed to include  the two following
species:

     1. ECPHRONIA MELANCHOLIA.     MELANCHOLY.
     2. -------- MANIA.           MADNESS.

  Each of these species  has been regarded by many nosologists as
forming a genus of itself, for which there seems to  be  no just rea-
son.   Dr. Cullen has thus arranged them in  his  synopsis, but  has
given them  a different arrangement, and a very subordinate  place
in his Practice of Physic, so that in the  two  works, he is, in this
respect, altogether at variance with himself.   In both,  his  order is
entitled vesaniae, which, in the first, includes fatuity, mania, melan-
choly and sleep-disturbance, (oneirodynia) as  distinct genera : but,
in the last, takes for its genera delirium, fatuity, and oneirodynia.
He contemplates delirium,  moreover, as of two  kinds, one combin-
ed with fever, and one without; the latter, he tells us, is what  wt
name insanity; and under this latter  kind alone, this apyrectic  de-
lirium or insanity, running  synonymously with  the present genus
ecphronia, he proceeds to treat of melancholy and mania as species
or subdivisions of it: throwing back  the other kind of delirium to
the class of fevers, as unconnected with the subject before him.  So
that, properly speaking, Dr. Cullen's  order of vesaniae should  run
parallel  with  the present order phrenica;  the genera of which
should be delirium and fatuitas ;  while mania and melancholy should
be the species of delirium or the first genus.
  Crichton, Parr, Young, Pinel, and  most of the German writers,
contemplate these diseases  under the  same sort of  specific subdivi-
sion.  Parr, indeed, in bis article mania, asserts that both constitute
nothing more than varieties of one common species :  yet, with an
inconsistency which, amongst much that is excellent, is too frequent
to he met with in his Dictionary, he changes his  opinion in the  ar- 
GE. I.]
NERVOUS FUNCTION.
43
 tide nosology, makes vesania the genus, and arranges melancholia,
 mania, and even oneirodynia, as separate species under it.
   The distinguishing characters, as the two species are contemplat-
 ed by the generality of nosologists are  clear.   In  melancholy the
 alienation is restrained to a few objects or trains of ideas alone ;  in
 madness it is general.  And it hence follows that gloom, gaiety, and
 mischievousness may equally exist under both species  ; according  as
 these propensities are limited to a single purpose, or  are unconfin-
 ed and extend to every thing.  Occasionally, however, among an-
 cient writers, we find melancholy insanity limited to insanity accom^
 panied with gloom or despondency, without any attention to the uni-
 versality or partiality of the disease:  for an undue socretion of me-
 lancholia, which is only a Greek term for black bile or choler, was
 supposed to be a common cause of mental dejection, and, where  it
 became habitual, to produce a  low  or  gloomy temperament;  to
 which the term melancholic has continued to be applied to the pre-
 sent day.  And hence the vulgar sense of the term, which is in uni-
 son with this view, is at variance  with the technical and pathologi-
 cal.  Yet the pathologists themselves have not been uniformly true
 to  their own import: for even  Dr. Cullen, who has followed the
 technical signification in his Synopsis,  by defining melancholy  as
 " insania partialis sine dyspepsia," sometimes  adopts the colloquial
 meaning in his Practice of Physic, and hereby betrays a confusion
 which  rarely belongs  to  him:  while Dr.  (now Sir  Alexander)
 Crichton has given himself over  completely to  the popular, or,   as
 he would perhaps call it, the antient  interpretation  of the terms;
 distinguishing mania, not by the generalization  of the delirium, but
 by its raving fury or elevated gaiety; and melancholy, not by a li-
 mitation of the delirium to single objects or train of ideas, but by its
 concomitant dejection and despondency.
   There seems to be an equal incorrectness, though of a different
 kind, in M.  Pinel, whose book is, nevertheless, of great merit.  De-
 lirium or wandering is made a pathognomic symptom in his defini-
 tion of the  genus; in other words, a  want  of correspondence be-
 tween the  judgment and the perception;  and  consequently this
 symptom should be found in every species which he  has arranged
 under it.  M. Pinel, however, has given us one species which has
 no such symptoms, and which is purposely intended to include  cases
 of what  he  calls mania  without any such discrepancy; on which
 account he denominated it mania sans delire.  All such  cases,  how-
 ever, are reducible to modifications of rage  or ungovernable pas-
 sion;  and ought by no means to  be  confounded with  mania; the
judgment being, in these instances, not at variance  with the  per-
 ception, but overpowered by the predominant  fury or passion  that
 has been excited.  They all  belong  properly to our  next genus;
 under which they will be considered.
  Much difficulty has also been felt in defining ecphronia or insani-
ty, so as to draw the line  between real disease  and habitual  way-
wardness or  oddity ; and henro while some definitions are so narrow 
44
NEUROTICA.
[CL. IV.-OR. I.
as to set at liberty half the patients  at  Bethlem  or the Bicetre;
others are so loose and capacious as to give a straight  waistcoat to
half the world.
  M.  Dufour undertook with great learning and ingenuity to prove
that as all our knowledge of an external world  is derived from the
action of the  external senses, while mental sanity depends upon the
soundness of these senses, mental insanity is alone to be referred to
a diseased condition of one or more of them.  And in proof  of this,
he gives the  case of a person who  lost his senses because he could
not be persuaded that the objects he saw in consequence of an inci-
pient cataract, arose entirely from  that complaint.   When he found
that he could not remove the. dark web which appeared to him to
be constantly floating before his eyes  he fell into such frequent fits
of violent passion that he became  quite insane.   But as soon as the
disease was completed he  became  more tractable, and  submitted to
the operation like a reasonable man."
  But this only shows us that

                   La furor bievis est,

or else that the insanity was caused, not by the cataract, but by the
frequent fits  of violent passion.   Thousands of persons have  had
cataracts in every form, and other  external senses than the eye dis-
eased in every  form, and have been  born defective in several of
these senses without the least  mark of insanity ; while other per-
sons,  apparently  inthe most perfect possession of all  the five sen-
ses, have been stark mad.  And  hence  the doctrine of M. Dufour
boasts of few advocates in the  present day.
  In insanity or delirium without fever, it is far more obvious that
there is a morbid condition of the judgment or of the perception or
of both.   Mr. Locke,  and after him  M.  Condillac, refers it to the
former alone, and characterises madness, in the general sense of the
term, by false judgment; by a disposition to associate ideas incor-
rectly and to mistake  them  for truths; and hence, says Mr. Locke,
" madmen err as men do that  argue right from wrong  principles."*
Dr. Battie on  the  contrary,  refers madness  to  the latter faculty
alone, and characterises it by  false perception ;  but  the perceptions
in madness seem, for any thing we know to the contrary, to be fre-
quently as correct as in health,  the judgment or reasoning being alone
diseased or defective.
   It is difficult to say  which of these two explanations  of madness is
most imperfect.  It is sufficient to observe  that neither of them,
taken alone,  describes a condition  of  the faculties  strictly  morbid,
and consequently neither of them defines madness.   For we  are dai-
ly meeting with thousands of mankind who are under the influence
of false judgments, who unite  incongruous or discrepant ideas, and
draw from false associations right  conclusions, yet whom we never
* B. II. Ch. xi. { 13. 
GE. 1.]
NERVOUS FUNCTION.
45
think of regarding as out of their senses.   While on the contrary, if
false perceptions be  sufficient to constitute madness, every man is
insane who mistakes  at  a  distance a square for a round tower, the
bending azure sky that terminates an extensive  landscape for the
sea, or the distant rumbling of a heavy waggon over the streets for
a peal of thunder:  and we should none of us be safe from such  a
charge for a single day of our lives.
   Dr. Cullen seems to have embraced Mr. Locke's view of the sub-
ject : for his definition of insanity (vesaniae) in the  later editions of
his synopsis is " injured functions of the  mind in judging (mentis ju-
dicantis) without pyrexy or coma."  Dr. Crichton, on the contrary
seems rather to adhere to Dr. Battie's  view, though he enlarges
and improves upon it; and hence his definition  is " General de-
rangement  of the mental  faculties, in  which diseased perceptions
are mistaken  for realities;  with  incoherent language and  unruly
conduct."
   Diseased  is  certainly a better  term than false,  which is that of
Dr. Battie ;  but " unruly  conduct" does not essentially  belong to
madness even under this excellent writer's own explanation : for of
the three species which he comprehends under this disease as a ge-
nus, viz.'mania furibunda, mania  mitts, aDd melancholia,  while the
last, as he afterwards  illustrates it,* evinces  these  symptoms only
occasionally, he  expressly tells us of the second, that the diseased
are " all happy, gav, and cheerful; that "good  humour  characte-
rises this insanity,  and hence the patients are in general  very trac-
table."!
   But the chief objection to Sir A. Crichtons definition of insanity,
is his limiting it in respect to the mental faculties, to the  power of
perception  while the judgment remains  totally unaffected.  " In re-
gard to lunatics, says he, in another  place, and men who are of a
sound mind, the faculty of judging is the same in both, but  they have
different perceptions,  and their judgments  therefore must be diffe-
rent."!
   Now if the faculties of perception, attention and memory be lia-
ble to derangement,  as  the  same writer admits, and there be " a
general derangement of mental faculties  in insanity, there  seems no
sufficient ground for exempting the faculty of judgment.   And a lit-
tle attention to the history of an  insane  patient  will, I think, suffi-
ciently support the opinion of Mr. Locke and Dr.  Cullen  upon this
point, and show that this, if not the faculty chiefly diseased, labour;;
under at least as much disease as that of perception.
   We have already observed in the proem to the present class, that
all the powers of the mind are as liable  to be affected with diseases,
iind diseases of various kinds, as those of the  body ; and that  either
the body or the mind  may be enfeebled at  the  same  time in the
* Of Mental Derangement, Book ill. Ch. m. Vol. n.
t Id. Book i. Ch. v. p. 18L, 182.  Vol. i.
| Id. Vol. I. p. 401. 
 46                      NEUROTICA.            [CL. IV.-OR. I.

 whole of its powers, in a few of its powers, or in a  single power.
 A sound mind supposes an existence of all the mind's feelings and
 intellectual powers in a state of vigour, and under the subordination
 of the i judgment, which is designed by nature to be the  governing
 or controlling principle.  And thus constituted, the mind is said to
 be in a state of" order or arrangement.  It often  happens that this
 order or arrangement is slightly  broken in upon by natural constitu-
 tion, or some corporeal affection ; but so long as the irregularity
 does not essentially interfere with the mental health,  it is no  more
 attended to than  slight irregularities  or  disquietudes of the  body.
 Yet whenever  it becomes serious and complicated it  amounts to a
 disease, and the mind is said, and most correctly so, to be deranged
 or disordered.
   This derangement may proceed from a morbid state  of any of
 the intellectual or any of  the empassioned faculties of the mind, for
 the perception may not correctly convey the  ideas we receive  by
 the external senses, or the judgment may lose its power of discrimi-
 nating them ; or the memory may not retain them, or the imagina-
 tion or the  passions may  be  in  a state of unruly excitement: all
 which will lay  a foundation for different kinds or genera of diseases,
 and in fact form the  foundation of those appertaining to the present
 order.
  Now an attentive  examination into  the habits of an insane person
 will show first, that the judgment and the perception are both injured
 during the  existence  of insanity;  and next that, though from a
 violent or complicated state of the disease, the morbid condition often
 extends to some other, or  even to all the  other mental faculties, yet
 it does not necessarily or essentially extend to them; for  a madman
 may be furious or passionate, yet  every madman is not so; his
 memory may fail or his attention be incapable of fixing itself, or his
 imagination be wild  and extravagant, but these do not  always occur.
 The faculties,  however,  of the judgment and the  perception are
 affected in every case, though they are not always equally affected  •
 at one  and  the same time : for  the morbid power  seems, for the
 most part, unaccountably to shift in succession  from the one to the
 other, so as alternately to  leave  the judgment and  alternately the
 perception free or nearly free from all estrangement whatever, the
 disease being, however, always accompanied with irregular remis-
 sions ; and often with such  a diminution of sensibility that the patient
 is uninfluenced  by the  effects  of cold, and hunger, and very gene-
 rally unsusceptible of febrile miasm.
  Thus a madman will often mistake one person who  is introduced
 to him for another,  and under the  influence of this  mistake  will
 reason correctly concerning him,  and  although he may have been
 for  years  his next  neighbour, will ask him  when  he came from
 China or  the East Indies, by what ship he returned home, and
whether  his voyage has been successful.   In  all which  the error
may be that of the perception alone.   But if,  as  is frequently the
case, the patient address his visitor by his proper name, he gives a 
GE. I.]
NERVOUS  FUNCTION.
47
ground for believing that he perceives him aright, and that the error
is  that  of the  judgment,  which thus unites incongruous ideas,
applying  a  visionary history to a real and identified person.  At
another time, he may, from the first perfectly recognize the indi-
vidual so  presented to him; and to prove  his recollection and the
correctness  of his perception,  may rapidly run  over a long list of
his relations, and a long string of anecdotes  respecting his former
life: after which he may suddenly start, and looking at the  visitor's
walking-stick, tell him that that drawn sword will never save him
from destruction, nor  all the men that slept with him in the same
bed the night before—that his rival is now pushing forward with all
speed on  a black horse with a large  army behind him, and that to-
morrow he  will fight and  lose, his crown.
   In such a case, and  it is by no means an extreme one, the percep-
tion and the judgment travel soundly and in  harmony at the outset
of the interview; but  they soon separate and abandon each other
as far as east and west.  It  is  not always easy to say whether the
fresh paroxysm  of insanity that  thus  suddenly displays  itself  is
limited to the one faculty or to the  other, or is common  to both.
For if the perception suddenly wander, the judgment has a new train
of ideas presented to it, and must necessarily take a new direction.
Yet it is  difficult to conceive how the judgment can be thus  abruptly
led astray if it  continue sound ; and hence it is more probable that
the judgment itself is  at fault and admits a train  of ideas which,
however  congruous to themselves, are incongruous to those furnish-
ed by the faculty of perception ; or both may equally wander, and
accompany  each other in the visionary scene, as they at first  asso-
ciated in  the real.   It is  obvious, however,  if I mistake not,  that
both  faculties are affected in the derangement of insanity jointly or
in irregular succession.
   How far  a morbid state  of  the mental faculties may in  any case
depend upon the mind itself,  as distinct from the sensorium or
instrument by which  it is connected  with the body, it is^ impossible
for us to know till we become acquainted with the nature of this
connexion, and  perhaps also with the essence of the mind, which,
in our present state of information, seems to be a hopeless subject  of
inquiry.   But we may possibly obtain some insight into the manner
in which  correct ideas of perception are  changed  in their nature
and rendered incorrect or  incongruous by a diseased judgment, by
attending to a process of variation that is frequently occurring  in
perfect sanity and acuteness of mind.  " The ideas we receive by
sensation," says Mr. Locke, " in adverting to this process, are  often
in grown people altered  by the judgment without  our taking notice
of it."  And he explains this position by observing that when a ball
of any uniform colour, as of gold, alabaster, or jet, is placed before
the eye,  the idea thereby  imprinted in the  mind is that only of a
flat circle variously shadowed, with different degress of light and
brightness coming to  the  organ of sight.   " But  having by use been
accustomed to perceive what kind of appearance convex bodies are 
48
NEUROTICA.
[CL. IV.-OR. L
 wont to make in us;  what alterations are made in the reflexions of
 light by the difference of the sensible figures  of bodies,  the  judg-
 ment presently, by an habitual custom,  alters the  appearances into
 their causes:  so that from that which truly is variety of shadow or
 colour, collecting the figure, it makes it pass for a mark  of figure.
 and frames to  itself the perception of *» convex figure and an uniform
 colour,"*  And the same change occurs still  more conspicuously in
 looking at an  engraving or a picture, in  which the only  idea pre-
 sented by the  eye to the perception is that  of a plane  variously
 shaded or coloured ; but which the judgment immediately changes
 and  multiplies into other ideas of life and  motion,  and running
 streams, and fathomless woods, and cloud-capt mountains.  And if in
 a sane state we find the judgment capable  of thus varying the  ideas
 of perception presented to it, we can have no great difficulty, I
 think, in conceiving by what means  such  a variation may  be
 produced and  may ramify into incongruities of great extravagance
 in a  judgment deranged by disease.
  Nor is  there much difficulty in conceiving how the  paroxysm
 should be subject to remissions or even intermissions  more or less
 regular;  or the derangement be  limited,  as  we frequently find it,
 and  especially in  melancholy, to particular  subjects  or  trains of
 ideas.  For first, all diseases have a tendency t6 remissions or inter-
 missions ;  but  those connected with the brain  or nerves more than
 any  others,  as is evident  in  hemicrania, epilepsy, hysteria^  and
 palpitation of the heart.  And next, there is no man in a state of the
 most perfect sanity whose judgment is equally strong and exact  upon
 all subjects : and few whose judgments are  not  manifestly influenced
 and led astray by partialities, or  peculiar incidents  of a  thousand
kinds; insomuch that we  dare not, on various  occasions, entrust to a
 man  of the strictest  honesty and the clearest head  a particular
subject for  his decision,  whom we should fly to as our counsellor
upon every other occurrence.  And it is not therefore very extra-
 ordinary that, in a morbid state of the mind, and particularly of that
faculty which constitutes  the judgment, there should  be an aberra-
 tion in some directions or upon some subjects which does  not exist
 upon others.
  Concerning  the  remote or even the proximate cause of the dis-
 ease, we have yet much to learn.   From the  view we have taken
in the proem  of the close  connexion between the  mind  and the
brain, it seems reasonable to conceive that the remote  cause is
 ordinarily dependent upon some misconstruction or misaffection of
 the cerebral organs: and  hence every part of them has been scruti-
 nized for proofs of so plausible an hypothesis, but hitherto to no
 purpose whatever.   The form of the cranium, its thickness, and
 other qualities; the meninges, the substance of the  brain, the
 ventricles, the pineal gland, the commissures, the cerebellum, have
 all been analyzed in turn, by the most dextrous and prying anatomists
* Hum. Underst. Book u. Ch. ix.  { 8. 
GE. I.]
NERVOUS FUNCTION.
49
of England,  France,  Germany, and Italy, but with no satisfactory
result.  The shape or thickness of the scull has been started, indeed
as a cause, by many anatomists  of high and established reputation;
but the conjecture has been  completely  disproved  by others, who
have found  the  very structures  supposed to be  most certain of
producing madness, exist in numerous instances with perfect sound-
ness of intellect.  A  particular  shape of  the scull seems, indeed, to
be often connected with  idiotism from birth or soon after birth, but
with no other species of mental derangement  whatever.
  Morgagni engaged  in an extensive course of dissections upon this
subject, and  pursued  it with  peculiar ardour:  and  his  results are
given  in  his eighth  epistle,  from  the second to the  eighteenth
article.  In some cases the brain was harder, in some softer, than in
a healthy state ; occasionally  the dura mater  was thicker,  and was
studded with soft, whitish bodies on the sides of the longitudinal
sinus.   This sinus itself sometimes evinced polypous concretions ;
and the pineal gland, or several of the glands in the plexus choroides
were in a diseased state.  Dr. Greding,*  with a like spirit of inves-
tigation, has arrived at a like diversity of facts.   Meckel tells us
that he found the brain denser  and  harder than usual ;t Dr. SmithJ
descried a bony concretion, and Plenciz and various others represent
the brain  as  bony or  calculous in various  parts; while Jones, in the
Medical Commentaries, found it softer than usual  with a thickening
of the membranes and a turgescence of the ventricles.   From all
which, nothing precise or pathognomic  can  be collected,  since all
such morbid  appearances have  been traced under other diseases as
well as under insanity.
  M. Pinel is  firmly decided upon this  point; and after a  very
extensive  course of investigations  he  asserts, with respect to the
cranium, that there are no facts yet clearly established which prove
the faculties  of the mind (except in the  case of idiotism) to be, in
any degree,  influenced by its size,  figure, or density: while with
respect to the  contents of the cranium.   " I  can  affirm," says he
" that  I have never  met with  any other appearances  within the
cavity of  the scull, than  are  observable  on opening the bodies of
persons who  have died of apoplexy, epilepsy, nervous fevers, and
convulsions."
  The observations  of Haslam are  nearly  to  the  same effect:
for they concur in showing that, except  in so considerable a mis-
formation  of  the scull or its contents, as to induce idiotism  from an
early period  of life, as in the  case of cretinism, nothing decisive can
be obtained in  reference to insanity from any variations of appear-
ance that  have hitherto been  detected.
  The dissections  of Greding extended to  not  fewer  than two
hundred and  sixteen  maniacal patients, the whole of whom, how-
* Vermischte medicinische und chiiurgsche Schnflen. Altenb. 1781.
t Hist, de l'Acad. Royale des Sciences, &c. Ann. 1760. Berol. 4to. 1761.
| Med. Observ. and Inquir. Vol. vi.
 VOL. HI.                     7 
50
NEUROTICA.
[CL. IV.—OR. I.
ever, died of disorders unconnected  with their  mental ailments:
three of the heads were exceedingly large, two exceedingly small;
some of the  scull-bones  extremely thick,  others  peculiarly thin :
in some, the frontal bones were small and contracted, in others, the
temporal bones compressed and narrow.*
  In a table containing an aggregate  of the patients received into
the  lunatic  asylum at Bicetre  during a considerable  part of the
French revolution, from  1784 to 1792, by far the  greatest nuniber
admitted were  between the  ages of thirty and forty ;  next, those
between forty and fiftv ; next to these, patients between twenty and
thirty; then those from sixty  to seventy; and lastly, those  from
fifteen to twenty; below which we have no account of any admis-
sion whatever.  Hence different stadia of life seem to exercise some
control, and the period most exposed to the disease is that in which
the  influence of the  passions  may  be  conceived to  be  naturally
strongest and most operative.   " Among  the lunatics confined  at
Bicetre," says M. Pinel, " during the third  year of the  republic, and
whose cases I particularly examined, I observed  that  the exciting
causes  of their maladies,  in a great majority of instances,  were
extremely vivid  affections of the mind; as ungovernable  or disap-
pointed ambition, religious fanaticism, profound chagrin, and unfor-
tunate love.   Out of one hundred and thirteen madmen, with whose
histories 1 took pains to make  myself acquainted, thirty-four  were
reduced  to  this  state by  domestic misfortunes: twenty-four  by
obstacles to matrimonial unions which they had ardently desired to
form;  thirty by  political events connected with the revolution;
and twenty-five  by  religious fanaticism."   Those   were chiefly
affected who belonged to professions in which  the imagination is
unceasingly  or ardently engaged, and  not controlled  in its excite-
ment by the exercise  of the tamer functions  of  the understanding,
which are more susceptible  of satiety  and fatigue.   Hence the
Bicetre registers were chiefly filled from the  professions of priests,
artists, painters, sculptors, poets, and musicians: while  they con-
 tained no instances of persons whose line of  life  demands a predo-
minant exercise of the judging faculty :  not one naturalist, physician,
 chemist, or geometrician.
   But there are  other organs that also betra}' very prominent  signs
 of diseased action in  insanity as well as the  brain, as those of the
 epigastrium and  the adjoining regions : and hence other  physiolo-
gists  have sought for a remote or even a proximate   cause of the
 malady in these, rather than in the encephalon.   This was the case
 among several, though not the majority, of the Greek  physicians, as
 we have seen already:  and  it is to this quarter that M. Pinel refers
 the proximate cause in almost every  instance  in our  own  day.
 It is here he supposes the disease to commence,  and  contends that
 the affection  of  the brain and of the mental faculties  is subsequent
 to the abdominal symptoms, and altogether dependent upon them :
* Vennische Schiiften, ut supra. 
CE. I.]
NERVOUS  FUNCTION.
51
and in proof of this he  adverts to  various dissections which have
shown a considerable derangement, not only in the function but even
in the structure of one or more of the abdominal organs, and parti-
cularly a displacement of the transverse colon.
   Lut this is to give a weight to the morbid  appearances  occasion-
ally manifested in these organs, above what is allowed to like mis-
formations in the cranium.   Yet there can be no doubt that, in  most
cases of insanity, the  brain and epigastrium suffer jointly ; and that
the disease  may, and often  does, commence  in  some  struci/iral or
functionary  affection of the abdominal organs, is perfectly clear from
the frequency of this complaint during pregnancy and in child-bed :
its being connected with a peculiar state of the genital organ*, as
we shall presently have occasion to show, and its following  upon a
sudden suppression  of the menstrual or hemorrhoidal discharge.
   Nor is it  difficult to account for this association of influence  from
the extensive  distribution of the par vagum, and more particularly
of the intercostal nerve  over the  abdominal  viscera:  on which
account a like sympathy is by no means uncommon in various other
disorders.   Thus while  a concussion or compression  of the brain
produces nausea, sickness, and constipation,  worms are frequently
found to excite convulsions or epilepsy.
   The fair  result of the  whole inquiry appears to be, that insanity,
in every instance, to adopt the language of Sir A. Crichton, "arises
from a diseased state  of the brain or nerves,  or both :"* but that in
many instances this diseased state is a primary affection, and in others
a secondary, dependent upon a morbid condition of the epigastric
or some other   abdominal  organ:  for, in whatever this  morbid
condition may consist, and whatever symptoms  it may evince, it is
not till the sensorium has  by degrees associated in the chain of
unhealthy action that the signs  of insanity are  unequivocal.  And,
in like  manner,  dyspeptic and  other abdominal symptoms are not
unfrequently brought on by a previous diseased  state  of the mind:
and it is hence peculiarly difficult, and perhaps in some cases alto-
gether impossible, to determine, where we are not acquainted with
the incipient symptoms,  whether melancholy or hypochondrias, has
originated in the state of the abdominal viscera or of the  cranium;
or in other  words, whether the one or the other be a primary or a
secondary affection.
   When, however, we are made acquainted  with the history of the
incipient symptoms, we  have a tolerable clue to guide us; and, for
the most part may  safely decide that the region primarily affected,
is that which first evinces morbid symptoms :  And hence, while we
shall  have  little scruple  in  assigning the  origin  of most cases of
hypochondrism to a morbid condition of one  or  more  of the diges-
tive organs, we  need have as little  in assigning the greater number
of cases of mania  to  a  primary misaffection of the brain or the
nerves.
* Of Mental Derangement. Vol. I. p. 138. 
52
NEUROTICA.
[CL. IV.-OR. I.
  In what that misaffection consists, is a question that has never been
settled to  the present hour, and from our total inacquaintance with
the nature of the connexion between the brain and the mind, it never
will be in any  very satisfactory  manner.   The  morbid changes,
indeed, which we have already seen are frequently to be traced in
the structure of the brain, show very sufficiently that a considerable
degree of diseased action has been taking place there ; but as these
changes are also found in  other disorders  of the head as well as in
mania, and  more especially as we cannot tell  whether they have
preceded  or been  produced by  such   action,  they  give  us  little
information  as to the nature of the diseased action itself.
  Dr.  Cullen has  offered a series of ingenious arguments  to prove
that mania  consists  in  some inequality in  the excitement  of  the
brain,* or of the nervous  power,? and in most cases in an increased
excitement.  Dr. Cullen's idea of the  nervous  power, as  we have
already had occasion to observe, is very far from being explicit:
for  he  defines it  " a subtile very moveable  fluid, included or inherent
in a manner we do not clearly understand  in every part of  the
medullary substance of the brain and  nerves."  While in other parts
of his writings he represents it as never either recruited or exhaust-
ed,  and thus conceives it  to possess qualities  beyond  the  ordinary
endowments of living matter.  Yet his  general principle appears to
be well founded, and Sir Alexander Crichton has availed himself of
it in giving a fuller explanation of this  highly probable hypothesis :
and, after  appealing to the doctrine which has already been advanced
and supported in the preceding pages of the present work, that  the
nervous power  is a peculiar fluid secreted in  the medullary sub-
stance  of  the brain or the nerves, he  endeavours to show that  the
cause of insanities is a specific  morbid  action of the  vessels which
secrete the nervous fluid in the brain ;J and which may hereby be
altered not only  in quantity but in quality.§
  From the quickness of the external  senses, the irascibility, heat
of  the skin, flushed countenance, and uncommon energy  which
maniacs evince,  we have reason to believe this morbid action to  be,
for  the most part, a preternaturally  increased action; and we  are
hence  able to account for  the various exacerbations and  remissions
which  it evinces, sometimes periodically, and sometimes irregularly.
Yet as the health of the faculties of  the mind must depend upon a
healthy energy  of  the  vessels,  too  scanty a secretion of nervous
fluid must be  as effectual a  cause of  mental derangement as  too
copious a  flow :  and  hence torpor of the vessels  of the  brain may
prove as certain a cause of a wandering mind as  entony, and, conse-
quently, typhus fever may become a source of delirium as well as
inflammatory.  And  as  the  various  secretions  can only be elabo-
* Pract. Phys. Vol. iv. Aph. mdlxii.
t Id. MDXLIV.
$ Of Mental Derangement, Vol. I. p. 174.
* Id. Vol. i. p. 169. 
GE. I.]
NERVOUS FUNCTION.
53
rated from the blood, and are often affected by its condition, we may
see also how madness may be a result  of acrid narcotics and other
poisons introduced into the blood by absorption, or a transfusion of'
blood from animals of a different nature, of which Dionis has given
some very striking examples.
  That there is a tendency not  only  to an increased secretion of
sensorial  power  in  the head in  most cases  of insanity, but to an
accumulation of  it from all parts  of the body, and especially from
the  surface, is clear from  the  patient's  diminished sensibility to
external  impressions,  and his being able to endure  the  severest
winters cold, and a fasting  of many days  without inconvenience or
indeed consciousness.  But that there is, in some cases, a diminish-
ed secretion of this fluid  producing a general debility of the living
fibre, is  also clear  from  the great tendency  manifested  by  some
maniacs to a gangrene in their  extremities, and, where  they are
uncleanly, about  the buttocks. The insensibility from this cau*e is
sometimes so considerable as to affect, not only the diffuse organ of
feeling, but some of the local senses  as  well.   And hence  some
patients lose their hearing, and others are capable of staring at the
meridian sun without pain, or any change in the diameter of the iris.*
Sometimes, however, the increased secretion of  sensorial  power is
so considerable  as  not only to affect the head, but to augment the
corporeal  sensibility generally.   And  hence  Hoffman makes  accu-
mulated sensation an ordinary symptom of this disease,!  mistaking
the exception for the general rule : and Riedlin gives us an instance
of a maniac, who, instead  of calling for  and being able to endure
large quantities of snuff, sneezed and was convulsed on smelling the
mildest aromatics.J
   It  is a  melancholy  reflection that insanity is often the  result of
an hereditary predisposition.  This, indeed, has been denied by a
few writers; but their opinion  has unhappily  been lost in the con-
current voice of those who have thought differently, and the irresis-
tible evidence of daily facts.  Mysterious as  the subject is we have
perpetual proofs that a peculiarity of mfental characters  is just as
propagable as  a  peculiarity of corporeal; and hence wit, madness,
and  idiotism are as distinctly an heir-loom  of  some families  as
scrophula, consumption and cancer of others.  In most of the  latter
we  have  already observed that something of a constitutional  make
or physiognomy  is often discernible; and the same is contended for
by many authorities in the disease before us.  Yet, if we examine
the  marks accurately, we shall find that  they  merge, for  the most
part, into the common'symptoms of a sanguineous, or a melancholic
temperament:  either  of  which constitutions exercise  such a con-
trol over  the disease as to give it a peculiar  modification  whatever
be  the nature of the exciting  cause ; which is in  truth of little
* Blumenb. Bibl. I. p. 736.
t Opp. Suppl. II. 2.
t Lin. Med. 1696. p. 29. 
54
NEUROTICA.
[CL. IV.-OR. I.
  importance to the constitutional turn the malady may take, though
  well worth attending to in the moral treatment.  " The violence of
  the maniacal paroxysm," observes M. Pinel, " appears to be indepen-
  dent of the nature of the exciting cause ; or at least, to be far more
  influenced by  the constitution of the individual, and the peculiar de-
  gree of his physical and moral sensibility.   Men of a robust constitu-
  tion, of mature years, with black hair, and susceptible of strong and
  violent passions, appear to retain the same character when visited by
  this most distressing of human misfortunes.  Their ordinary energy
  is augmented to outrageous  fury.  Violence,  on the other hand, is
  seldom characteristic of the paroxysms of individuals of more mode-
  rate passions, with brown or auburn hair.  Nothing is more common
  than to see men  with light-coloured hair, sink  into soothing and
  pleasurable reveries;  while  it seldom or never happens that  they
  become furious or unmanageable.   Their pleasing dreams, howev-
  er, are at length  overtaken  by,  and lost  amidst  the gloom  of an
  incurable fatuity.  Those of the greatest mental  excitement, of the
  warmest passions, the most active imagination, the  most  acute sen-
  sibility, are chiefly predisposed  to insanity.   A melancholy reflec-
  tion !—but such as is calculated to call forth our best and tenderest
  sympathies."
    It has  long been a current opinion that insanity is a disease more
  common  to our own country than to any other: and this opinion has
  of late been rendered more seriously alarming by  the following as-
  sertion of Dr. Powell, secretary to the  commissioners for licensing
  lunatic establishments, and which is given as the result of his official
  tables  of returns from 1775 to 1809 inclusive, divided  into  lustra
  or periods  of five years each.   " Insanity appears to  have  been
  considerably upon the increase : for if we compare the sums of two
  distant lustra, the one beginning with 1775,  and the other ending with
  1809, the proportion of patients returned  as  having been  received
 into lunatic houses during the latter period, is to that of the former
  nearly as 129 to 100."  " The facts also,"  says he, " which present
  themselves to  the observation of the traveller, whatever direction
  he may take through  this  country, and  all the local information
  which  we receive upon the subject, supply us, as I am led to think,
  with sufficient proof that the increase  must actually have been very
  considerable, though we cannot ascertain what has  been its  exact
  proportion."*
   The first part of this opinion, or that which regards insanity as  a
  disease peculiarly prevalent in England, does not  seem to rest on
  any established basis: for, calculating  with"Dr.  Powell, that the
 number of lunatic paupers and those received into public hospitals,
, which, under the act of parliament are not cognizable by the com-
  missioners, together with those neglected to be returned, compared
  with the returns entered into  the commissioners' books, bear  the
  * Med. Trans Vol. iv. p. 131. Art. Observations on the  Comparative Preva-
lence of Insanity at different periods. 
GE. I.]
NERVOUS FUNCTION.
55
proportion of three to two, which is probably far above the mark,
still the aggregate number of insane persons for the year 1800, con-
trasted with  the general census for the same year, will only  hold a
ratio of about I to 7300: while if we take, with Dr. Burrows,  the
proportion of suicides committed in foreign capitals as a test of the
extent to which insanity is prevalent in the same  towns,  which  is,
nevertheless  a loose mode of reckoning, though it is not easy to ob-
tain a better, we have reason to conclude that insanity is, compara-
tively far less frequent among ourselves than in most parts  of the
continent: the suicides of Paris, Berlin, and Copenhagen, as drawn
from tables collected  by Dr.  Burrows  for this  purpose, being  in
proportion to the relative population of London as 5 to 2 for the
first, 5 to 3 for the second, and 3 to 1 for the third.*
  Nor does the idea that insanity is an increasing oisease in our own
Gountry appear to rest on a stabler foundation.  Taking Dr.  Pow-
ell's result as drawn from  full and incontrovertible data,  and com-
paring the supposed march of the disease  with the  acknowledged
march of the population, although the  former may possibly be said
to have overstepped the latter by a few paces, the difference will
hardly justify the assertion, that " insanity is considerably upon the
increase."  And if we take into view the intensity of interest with
which this subject has for the last twenty years been contemplated
by the public, the operation of those  feelings of humanity  which
have dragged the wretched victims of  disease  from  the  miserable
abodes of prisons and neglected workhouses, and placed them under
the professional care  of the superintendants of licensed establish-
ments, and above all, the augmented number of such establishments
in consequence hereof, and  the great respectability  of many who
have the  management of them, thus giving the commissioners re-
turns which by the power of their Act of 26 Geo. III. they  could
otherwise have been  in possession of, we may, I think, fairly con-
elude that this apparent overstep,  be  it what it may,~in the march
of insanity beyond that of the population of the country, is a real
retrogression."
  At this conclusion,  we might, I think, fairly arrive, even if the
data selected by Dr. Powell were full and  incontrovertible ; but  he
himself has candidly admitted, that instead of being full and incon-
trovertible they " are subject to numerous inaccuracies, and that
any deductions which may be made from them must be imperfect."
It is still more consolatory to learn that the direct deductions from
the parochial and district  establishments are not only not in accord-
ance with Dr. Powell's, but such as seem to show that a retrogression,
instead of an advance, has actually taken  place.  Dr. Burrows has
industriously collected many of these, and, as far as they go, they
lead to such an inference almost without exception.!   Yet it is pro-
bable that even this inference does not give  us the precise fact, and
* Inquiry into certain causes relative to Insanity, &c. p. 93. 8vo. 1820.
'  Inquiry &c. ut supr. p. 66 et alibi. 
56
NEUROTICA.
[CL. IV.-OR. I.
that it is as chargeable with an error on the favourable side, as the
opposite account is on the unfavourable ; since the increase of licens-
ed houses, whose returns seem to have swelled the list of the  com-
missioners beyond it« proper aggregate, has been considerably sup-
ported by a transfer from the establishments which have thus fallen
off.  And hence, allowing the error on the one  side to  compensate
that on the other, we are brought to the conclusion which, after all,
appears more natural, that the career of insanity is only varied in
its uniformity by temporary contingencies, but thatit is by no mean?
a prevalent disease in our own country.
                        SPECIES I.

          ECHPRONIA  MELANCHOLIA.

                        i«rlanchoIj>.

THE DISCREPANCY  BETWEEN THE PERCEPTION AND THE JUDGMENT LIMIT-
  ED TO A SINGLE OBJECT, OR  A FEW CONNECTED OBJECTS, OR TRAINS
  OF IDEAS :  THE WILL WAYWARD AND DOMINEERING.

We have already stated that whatever be the exciting cause of men-
tal alienation, the symptoms are, in every instance, greatly modified
by the prevailing idiosyncrasy, and hence, though a love of solitude,
gloom, fear, suspicion and taciturnity are the ordinary signs of the
present species,  these signs often yield to symptoms widely different,
and sometimes even of an opposite character; and  we  hence be-
come possessed of the four following varieties:

« Attonita.                    Mute, gloomy,  retiring melancholy.
  Gloomy melancholy.
£ Errabunda.                 Roving, restless  melancholy,  evin-
  Restless melancholy.           cing  a constant desire to change
                                the abode.
y Malevolens.                Morose or mischievous melancholy;
  Mischievous melancholy.       occasionally terminating in suicide
                                or the injury of others.
3 Complacens.                Self-complacent and  affable melan-
  Self-complacent               choly : occasionally rejoicing in a
     melancholy.                visionary superiority of rank, sta-
                                tion  or endowment.

  The same variety of symptoms, as chiefly modified by the  pre-
vailing temperament, are noticed  by  Fracastorio.  " The phlegma-
tic," says he,  "are heavy; the sanguine, lively, cheerful, merry,
hut not witty ;  the  choleric  are  in  rapid  and perpetual motion, 
GE. I.-SP. 1.]
NERVOUS FUNCTION.
57
impatient of dwelling upon any subject.   An  acuteness of wit be-
longs to most  of the varieties, but  not to all."*  And  hence Dio-
des in opposing Galen for holding after Hippocrates, that gloom and
terror are pathognomic signs of melancholy, observes, " Upon seri-
ous consideration 1 find some patients that have nothing of these qual-
ities : and others that exhibit every  diversity  of feeling:  for  some
are sad without being fearful;  and others fearful without being sad ;
some neither, and some both."
  Besides these modifications there is  another of a  very peculiar
kind noticed by Dr.  Spurzheim, in order to show  that the faculties
of the mind are double, and that each hemisphere of the brain con-
tains a distinct set.  As I have never met  with an instance of this
variety I must describe it in his own words.   " Tiedman," says he,
" relates the example of one Moser, who  was insane on  one side,
and who observed his insanity with the other.  Gall attended a mi-
nister who, having a similar disease for three years, heard constantly
on his left side reproaches  and  injuries, and turned his head to that
side in order to look  at  the persons.  With his right side he com-
monly judged of the  madness of his left side :  but sometimes in a fit
of fever he  could not rectify his  peculiar state.   Long after being
cured, if he happened to be angry, or if he had drank more than he
was  accustomed to do, he observed, in his  left side,  a tendency to
his former alienation."!
  It may appear strange to those who have not studied  the subject
with much attention  that persons who are possessed of a diseased or
even a defective judgment should at  any time be of quick and lively
apprehension, and thus be witty without being  wise.   But  the fa-
culty of wit is dependent not so much on  the  judgment as on  the
imagination  and particularly on the memory, on the possession of a
large stock of ideas stored up for ready use, and brought forth with
rapidity.  " And hence," says Mr. Locke, " some  reason  may per-
haps be given  of that common observation that men who have  a
great deal of wit and prompt memories have not always the clearest
judgment or deepest reason.  For wit lying most in the assemblage
of ideas, and putting those together with quickness and  variety,
wherein can  be found any resemblance or congruity,  thereby to
make up pleasant pictures and agreeable visions in the fancy, judg-
ment, on the contrary lies quite on  the  other side, in separating
carefully, one from another, ideas wherein can be found the  least
difference, thereby to avoid being misled by similitude,  and by affi-
nity to take  one thing for another."!  And  hence, we  may easily
account for that  gaiety and  those ebullitions of a vivid fancy which.
so often assume the character of wit in  persons whose minds are
deranged, and especially in the  sober faculty of the judgment.
  Mirth  and wit, however, though sometimes found in the present
       * De Intellectione. Lib. II.
       t Physiognomonical System, &c. p. 144. 8vo. 1816,
       | On Human Understanding, Book II. Ch. xi. } 2.
VOL.  III.              °- 
)3
NEUROTICA.
[CL. IY.-OR. K
species of insanity, are by no means its common  characters, but on
the contrary as we have already observed, a love of solitude, gloom,
and taciturnity, and an indulgence in the distressing emotions of the
mind.  And hence, whenever hypochondrism  merges into actual in-
sanity, it almost always takes this form ; as melancholy, from a sort
of natural connexion between the two, often  assumes  many of the
symptoms that essentially appertain to the  hypochondriac disease ;
the morbid state of the brain influencing the abdominal  organs in
the latter case, as the morbid state of the  abdominal  organs influ-
ences the brain in the  former.
  The disease shows itself sometimes suddenly, but more generally
by slow and imperceptible degrees.  Among the earliest symptoms
may be mentioned head-aches, frequent attacks of giddiness, sudden
confusion of ideas, a great  disposition  to anger, violent  agitations
when irritated, and an uncommon sensibility of nerves, whereby the
patient is apt to be carried to as great excesses from causes of joy
as from  those  of grief.  There is a  desire of doing well, but the
will is wayward and unsteady,  and produces  an  inability of firmly
pursuing any laudable exertion or even purpose, on account of some
painful internal sensation, or the perverseness of the judgment led
astray by false or erroneous ideas which command a firm conviction
in the mind.*   And if the disease occur in a person possessing that
temperament which has been conceived to predispose to it, and  was
by the Greeks denominated melancholic, the  external signs become
peculiarly marked and prominent, " the patient," says Hippocrates,
in his book on insanity, " is emaciated, withered, and hollow-eyed:
and is at  the same time troubled with flatulency and acid eructations,
with  vertigo and singing in the ears : gets little sleep, and when he
closes his eyes is distracted with fearful and interrupted dreams."
  The first variety most  commonly commences with this charac-
ter, and creeps on so gradually  that it is for some time mistaken for
a mere attack  of hypochondrism or lowness of spirits, till the men-
tal alienation is at  length decided by the  wildness of the patient's
eyes, the hurry of  his step whenever  he walks, his extraordinary
gestures,  and the frequent incongruity of  his observations and re-
marks.   The first stage of the  disease is thus admirably expressed
by Hamlet: " I have of late, but wherefore I  know not, lost all my
mirth, foregone all custom of exercise ;  and, indeed, it goes so
heavily  with  my  disposition,  that this  goodly frame, the  earth,
seems to me a sterile promontory ; this most  excellent canopy, the
air, look you, this brave o'erhanging firmament, this majestical  roof
fretted with golden fire, why it appears no other thing to  me than
a foul and pestilent congregation  of vapours."
   But while the external world is thus in general  falsely recogniz-
ed by the perception or falsely discriminated by the judgment, the
mind is so completely possessed by some particular trains of imagi-
nary  ideas that the  attention is  perpetually turned to them, and the
* Crichton, of Mental Derangement, passim. 
HE. I.—SP. I.]
NERVOUS FUNCTION.
5S
judgment mistakes them for substances;  and, so far as it is sensible
of surrounding objects or scenery, is perpetually blending the vision
with  the reality.  It is not that the patient's ideas are incongruous
with  themselves but  with the world around him; for the remarks
of the melancholy man,  when his attention is once correctly fixed,
are for the most part peculiarly shrewd and pointed.  But in the
gloom that hangs over him, under the variety we  are now contem-
plating,  he can rarely be  brought into conversation, seeks for soli-
tude,  sits moping in one continued posture from morning to night;
or if he walk at  all, seeks for orchards, back-lanes, and the gloomiest
places he can find.  " One of  the chief  reasons," says Hippocrates
in his epistle  to Philopcemenes,  " that induced  the citizens of Ab-
dera  to suspect Democritus of craziness,  was that he  forsook the
city, and lived in groves and hollow trees, upon a green bank by a
brook side, or by a confluence of waters  all day and all night.
  Sauvages under the variety of melancholia attonita, gives an ex-
treme case of the present  modification,  though not from  personal
knowledge.  " The patient,"  says he, "  never moves from place to
place nor changes his posture ;  if he be  seated he never stands up;
if standing he never sits; if lying he never rises.  He never moves
his feet unless they are pushed aside by a bye-stander:  but he does
not shun the presence of man; if asked  a question he does not an-
swer, and  yet • appears to  understand what  is said.   He  does not
yield  to  admonition nor pay  any attention  to objects  of sight or
touch: he seems immersed in  profound thought, and totally occupi-
ed by foreign matters.  Yet at times  he  is more awake : if food be
put to his mouth he  eats, and if liquor be  presented he  drinks."
M. de Sauvages then adds,  that this rare  modification of the disease
occurred once to Dr. James, physician to the elector of Saxony, in
a man about thirty years old, who was  terrified with the thought
that the  Deity had condemned  him.   It continued for four months
during the autumn and winter; but the patient was at length restor-
ed to his right understanding.*
  Grief, and particularly for the loss of  friends, discontent, severe
disappointment, the dread of some real or imaginary evil, a violent
and long continued exertion of any of the passions, and  deep unin-
terrupted study, have frequently proved  accidental causes or acces-
sories of this variety of melancholy, where  the peculiarity of the
constitution has formed a  predisposition, and have sometimes pro-
duced it even where no such predisposition can be traced.  In like
manner it has proceeded from  immoderate exercise ; insolation, or
long exposure to the direct rays of the sun ; sudden transitions from
heat to cold ; powerful stimuli  applied to the stomach.
  In the case  related  by Sauvages the disease appears to have pro-
ceeded  from a heated imagination  exercised  upon  false  views of
religion : and perhaps there  is no cause  more common or more
operative,  especially in  timid minds; and more particularly still
' \osol. Mod. Class viii. Ord. ill. 
60
NEUROTICA.
[CL. IV.—OR. I.
where the conscience is alarmed by a review of a long catalogue of
real delinquencies, and a dread of eternal reprobation.
  The same causes operate in the production of roving or restless
melancholy, forming the second variety, and exhibiting a modifica-
tion which often depends obviously upon a difference of idiosyncra-
sy,  though the  cause is not always to be explained, and under  the
operation of which the patient has a constant  desire to change  his
pursuit or his residence.  And hence, while  Albert Durer is entitled
to the approbation he has so long received for his admirable picture
of melancholy under the guise of a pensive female leaning on  her
arm with fixed  looks  and  neglected dress, Shakspeare has equally
copied from nature in his description of the beautiful  and interest-
ing Ophelia,  who, instead  of  shutting herself  up from the wond,
and seeking silence  and solitude, is represented as peculiarly busy
and talkative, and  unwittingly divulging the fond secret of her  dis-
traction to every one she meets, as well in verse as in  prose.  Sad-
ness is the  prevailing colour of  the mind ;  but it is often  as Jaques
expresses it,  " a most  humourous sadness," blended with sallies of
pleasantry and wit, that it is impossible  to listen to without smiling,
notwithstanding the gravity of the occasion.  " Humorous they are,"
says Burton,  (and unhappilj for himself no one knew how  to  de-
scribe the disease better) " beyond all measure; sometimes profuse-
ly laughing, extraordinary  merry, and then  again  weeping without
a cause ; groaning,  sighing, pensive and almost distracted.  Multa
absurda  fingunt et a ratione aliena ;* they  feign many absurdities,
void of all reason : one supposeth himself to be a dog, cock, bear,
horse, glass, butter.  He is a giant, a dwarf, as strong as an hundred
men,  a lord, duke, prince.  Many of them are immoveable and fixed
in their conceits ; others vary upon every object heard or seen.   If
they see astageplay, they  run upon that a week after; if they hear
music or see dancing, theyuhave nought but bag-pipes in their brain;
if they see a  combat, they are  all for arms; if abused, the abuse
troubles  them  long  after.   Restless  in their thoughts and actions,
continually meditating,

                     velut  cfgri sotnnia, vana:
              Finguntur species r

more like dreamers  than men awake, they feign a company of entire
fantastical conceits:  they have most frivolous thoughts  impossible to
be  effected; and sometimes think verily that they hear and see pre-
sent before their eyes such phantasms or goblins they  fear, suspect,
or  conceive : they still talk  with and follow them.  u They wake,"
says Avicenna, " as  others dream.  Though they  do talk with you,
and seem to be very intent and busy, they are only thinking of a
toy;  and still that toy runs in their mind whatever it be ;  that fear,
that suspicion, that  abuse,  that jealousy, that agony, that  vexation,
that cross, that  castle in the air, that  crotchet, that whimsie,  that
* Frambrs. Consult. Lib. I. 17. 
6E. I.-SP. I.]          NERVOUS FUNCTION.                  61

fiction, that pleasant waking dream.  If it be  offensive, especially,
they cannot forget it; they may not rest or  sleep for it;  but still
tormenting themselves, Sisyphi saxum volvunt sibi suis."
   How melancholy a reflexion that the writer of this spirited des-
cription, should have drawn many of its features from himself: and
that the  work from which it is copied, engaged in for the  purpose
of diverting his thoughts, and replete with genius, learning, and the
finest humour, should  only have exasperated the  disease and urged
the pitiable patient, as there is too much reason to  fear, to  an un-
timely end.  " He composed his book," says Mr. Granger,  " with
a view of relieving his own melancholy,  but  increased it to  such a
degree, that nothing could make him laugh but going to the bridge-
foot, and  hearing the ribaldry of the bargemen, which rarely failed
to throw him into a violent fit of  laughter.  Before he was over-
come with this horrid disorder he,  in the intervals of his  vapours,
was esteemed one of the  most facetious companions in  the universi
ty."
   The third  variety, in  which the alienation assumes a morose or
mischievous character,  is  perhaps the  most common form   under
which the disease makes its appearance.  Sometimes the patient is
extremely passionate, and will quarrel furiously with every one alike
in whatever tone  or manner he is  addressed,  and expresses himself
with great violence of language, occasionally  with gross unqualified
abuse, but  occasionally also in a style of repartee that  was  never
 evinced in a  sane state.  More generally, however, he selects his
 objects of resentment: which are, for the most part, unaccountably
 taken from his nearest relations and kindest friends.   Against these
 he harbours the blackest suspicion  and jealousy, believing that they
 are haunting him to take away his  money or  his life, or to put him
 to torture.  He loads them with every term of the deadliest  hatred,
 or scowls at them with contempt,  and denounces them as fools and
 idiots.   Under the distressing influence  of this horrid form of the
 disease, the mother abominates her infant family, and the wife her
 husband: the most chaste  become lascivious: and lips which have
 hitherto  uttered nothing  but the precepts and the language of piety
 become grossly prophane,  and are the vehicles of oaths and impu-
 dence.   The  unhappy  individuals are at the same  time  not only
 sensible of what they  say or do, but occasionally sensible of its being
 wrong, will express their sorrow for it immediately afterwards, and
 say they will not  do  so  again.  But the waywardness of  the will,
 and its  want of control  by the judgment,  urges  them  forward  in
 spite of  their desire, and they relapse into the same state almost as
  soon as they have expressed their regret.  Mr. Locke has, with
 great ability  pointed  out the proper distinction between these two
  faculties of the desire and  the  will, and has exemplified it by the
  chastisement with which an indulgent father frequently finds him-
  self called upon  to visit an offending child,  and which he  wills to
 perform though his desire  is in the utmost degree reluctant.  The
  disease  before us is pregnant with examples of the same  kind, and 
62
NEUROTICA.
[CL. IV.-OR. I.
strikingly shows the correctness with which this great master of his
subject analyzed the human mind.
   We  have already observed that  the peculiar turn or modification
of the  malady depends in general far less upon the immediate and
exciting cause, than upon  the constitutional temperament, or some
operative  principle which  we  cannot  always develope.  And in
proof of this it maybe observed, that 1 have  drawn the  principal
lineaments of the description just laid down from the case  of a lady
of about sixty years of age, respecting whom I was lately consulted,
and  whose  exciting  cause  has  been, manifestly, suppressed  grief
for the death of an only son, and  separation from a daughter who
was the remaining solace of her advancing years, in consequence of
her having married a  gentleman whose station is  in a  remote part
of the globe.  Possessed  by  nature  of a high  and  commanding
spirit,  and of a peculiar  degree of energy  and activity, she ef-
fectually  succeeded,  by a violent  internal struggle,  in  subduing
the pangs that  at first suffocated  her;  and has  for several years
talked of  her daughter and  her daughter's children, for the  latter
has since become a mother, without emotion.   But v/ith the  loss of
fine feeling for her daughter, she has lost, at the same  time, all fine
feeling upon other subjects; and her judgment has sunk amidst the
general wreck.  The love of her  nearest  relations has turned to
contempt or hatred :  the ardour and animation of  her  mind, which
restrain her from taciturnity and retirement, have rendered her for-
ward and invective; rational expostulation has yielded to sudden
and unmeaning fits of  violence and  blows, and the  voice of piety to
exclamations that would formerly have shocked her beyond endur-
ance.  She too is often sensible  of  her doing wrong, and  in letters
of great sobriety and excellence, often complains  of her  own con-
duct, and the burden she is become to her friends, but the  intervals
of sanity are only of a  few hours' duration, and with all her  calm-
ness she is sure to relapse.   For many months she was  entrusted in
her own house to the  control of a professional female attendant who,
with great dexterity, at length succeeded in obtaining a due degree
of authority over her  without personal restraint;  and under the re-
gimen  of perfect quiet and seclusion from the world, she seemed to
be in a fair way of recovery ;  but the mischievous fondness of her
nearest rotations has since removed this  faithful watchwoman, and
her senses have again been bartered for her liberty.
  The symptoms most afflictive to the relations of the patient in
this variety of insanity is the tendency to behold them  with indiffe-
rence or even violent aversion, and to  utter exclamations and em-
ploy language of the most  offensive kind to a serious and a delicate
ear; and it is  the symptom apparently most unaccountable to those
who have not studied  the disease with  much attention.  I have al-
ready  remarked that in insanity the corporeal sensibility is greatly
diminished, but it is not more so than the moral sensibility;  and as
the moral sensibility disappears, all moral restraint disappears also:
and for the  very reason  that the insane man has little feeling of
cold or hunger, he has also little feeling of decency or  religion.  In 
UE. I.-SP. I.]
NERVOUS FUNCTION.
63
the present  variety the worst passions are in a state of excitement,
and the language most freely employed is the language of the pas-
sion that predominates, and there being  no  longer any moral re-
straint, it is  employed in its utmost vehemence and coarseness. And
as the fond  affections have given way to the  irascible, it should
seem to follow of course, that the greater the  love or friendship
formerly the greater the hatred at present.
   There is  one  consolation, however, though a  small one, that we
may reap from  this distressing contemplation,  and to which the
friends of the sufferer should not be indifferent.  It is that, with this
blunted sensibility of mind, the patient has no pain from a conscious-
ness of his degraded condition.  And it is singular to observe,  what
may also contribute  to  alleviate  the distress  of the sympathising
heart, how completely his unconsciousness prevails  even after a pa-
tient's restoration to health, so that  few  look back upon what they
have undergone with the  horror that would  be expected;  while
many, even  in the apprehension of a  relapse, contemplate it, and
turn their eye to the abode of misery where  they  were  lately in-
mates without dread.
   The fourth variety or  self-complacent melancholy is perhaps
less frequent than any of the  rest; but it occurs occasionally, and  is
often accompanied with a high-coloured and ruddy complexion, and
other marks of a sanguineous habit; " Such persons," says Butler,
" are much  inclined to laughter, are witty and merry, conceited in
discourse, pleasant, if they be not far gone, and  much given to mu-
sic, dancing, and to be in women's  company."   Aristotle  gives the
case of an inhabitant  of Abydos, who,  labouring  under this variety
of the   isease, would sit for a whole day as if he had been upon a
stage, listening to visionary actors ; sometimes  acting  himself, and
occasionally clapping his hands and laughing as overjoyed with the
performance.*  Such  persons have not unfrequently thought  them-
selves called upon to undertake some desperate  adventure, and are
exquisitely elated with the new and lofty character they  are about
to embrace.
   These stimulant feelings are not unfrequently  connected with er-
roneous ideas of religion, and excite in the  mind of the  patient a
belief that he is supernaturally endowed with a power of working
mira«les, or undergoing  the  severest mortifications  without injury.
The German  Psychological  Magazine is full of examples of this
kind ; and among others relates the case of a gens d'arme of Berlin,
whose  name was Gragert, of a harmless  and  quiet  disposition, but
rather of a superstitious turn  of mind.  From poverty, family mis-
fortunes, and severe  military  discipline, he brought  on a series  of
sleepless nights, and  a  mental disquietude that, according to his own
report, nothing could dissipate but  a  perusal of pious books.  In
reading the  Bible, he was struck  with the book of Daniel, and  so
much  pleased with it that  it  became  his favourite study: and
* Lib, de Reb. niir. 
64
NEUROTICA.
[CL. IV.-OR. I.
fVom this time the idea of miracles so strongly possessed his imagi-
nation that he began to believe he could perform some himself. He
was persuaded more especially that if he  were to plant an apple-
tree with a view of its becoming a cherry-tree, such  was his power
that it would bear cherries.   He was discharged from the king's ser-
vice and sent to the workhouse where he conducted himself calmly,
orderly, and industriously for two years, never doing any thing that
betrayed insanity.  At which time Dr. Pike examined him, that he
mi j-ht be discharged and sent to  his family.   He answered every
question correctly, except when the subject concerned miracles: in
regard to which he retained his old notions; adding however,at the
same time, that, if he found upon trial after  he was at home that
the event did not  correspond with his expectation, he would readi-
ly relinquish the  thought and believe  he had  been  mistaken;  and
confessed that he had already removed one error in his mind in this
way; for there was an old woman  whom he had at one time  con-
sidered as a witch, but whom he  afterwards discovered upon  trial
to be no such th;ng.
  Upon  the medical treatment of diseases of this kind we shall not
have to say much ; but  as the plan chiefly adviseable for the  pre-
sent species is equally adviseable for  the ensuing, it  will be most
expedient to reserve the discussion  of it till  the latter has been
described in its order.
                        SPECIES  II.

                ECPHRONIA  MANIA.



the discrepancy between the perception and the  judgment gene-
  ral ; GREAT EXCITEMENT OF THE MENTAL, SOMETIMES OF THE CORPO-
  REAL POWERS.

This species appears under almost infinite varieties  of character, of
which, however, it may be sufficient to mark the following, modifi-
ed for the most part by the predisposing causes that we  have alreadv
noticed, as modifying the preceding species :

    u, Ferox.           Furious and violent madness.
    C Exultans.         Gay and elevated madness.
    y Despondens.      Gloomy, despondent madness
    5 Demens.          Chaotic madness.

  The exciting causes, like the  predisposing, are chiefly those al-
ready enumerated under melancholy  ecphronia, as sudden and vin 
GE. I.-SP. II.J
NERVOUS FUNCTION.
65
 lent mental emotion; bad passions indulged habitually ; false views
 of religion, especially the dread of  reprobation and eternal punish-
 ment ; sudden reverses of fortune, whether from  bad to good,  or
 from good  to  bad ;  preying anxiety, or lurking discontent; deep
 protracted study, unrelieved from week to week by an interchange
 of exercise or society,  and breaking in upon the hours of sleep ; un-
 kindly  child-bed; a suppression of various periodical evacuations;
 and sometimes even a virtuous restraint of sexual orgasm  in a vigo-
 rous constitution,  without taking purgative or other means to reduce
 the irritative entony.
   Of these  one of the most frequent causes  is that of child-bed, and
 recovery from child-bed, though it is not always easy to. develope
 the immediate mode by which this change  in the  constitution acts
 upon the brain; for it lias occurred not only where there  has been
 some organic affection from puerperal fever, a sudden cessation  of
 the  lochia, or a sudden  relinquishment of nursing, but where the re-
 covery has  been unattended with  a  single  unfavourable  symptom,
 and the mother has  ardently persevered  in the office of a nurse.
 It shows us,  however,  very sufficiently, how strong is the chain  of
 sympathy between the brain and many remote organs of  the body,
 and especially those subservient to the function of generation.
   M. Esquirol, not  long ago, communicated a paper to the S ociete
 de Medicine upon  this important subject, enriched with the results
 of the Hospital de Salpetriere, for the years 1811, 12, 13, and  14.
 During these four years, eleven hundred and nineteen women  were
 admitted, labouring  under  mental derangement: of whom ninety-
 two (nearly an eleventh part of the whole) had  become  deranged
 after delivery, during, or immediately subsequent to  the  period  of
 suckling.  In the higher ranks of society the proportion of puerpe-
 ral maniacs he calculates to be  not less than a seventh of the whole.
 Of the above 92 cases,  16 occurred from the first to the fourth  day
 after delivery : 21 from the fifth to the fifteenth ; 17 from the  six-
 teenth to the sixtieth day ;  19 from the sixtieth to the twelfth month
 of suckling;  and in 19 cases it appeared  after voluntary or forced
 weaning.
   Of the above 92 cases 8 were idiotic, 35 melancholic, and 49 ma-
 niacal.  The respective ages were  as  follows;  22 from  20 to  25
 years: 41 from 25 to 30 years; and  12 above  30.  Fifty-six out of
 the ninety-two were entirely cured, and thirty-eight of these within
 the first six  months.   Fright was the  most frequent  cause.*
   I have said that a  virtuously  restrained orgasm in a full habit, and
 where no steps have been taken to reduce the entonic vigour,  has
 occasionally  induced mania.   There is a curious  instance of the
powerful effect of such a state  related by  Kemnesius in his History
of the Council of Trent, which though it did not  terminate in mad-
ness proved quite as  fatal.  In the year 1419, Rossa, nephew to the
King of Portugal,  and Archbishop  elect, of Lisbon,  was taken serj-

        * Quarterly Journal of Foreign Medicine^o. 1. p. 98.
  VOL.  III.       v          9 
66
NEUROTICA.            [CL. IV.—OR.  I.
 ously ill at Florence.   His physicians told him that his disease pro-
 ceeded from an excessive irritation of the genital  organs, and that
 he would certainly die unless he committed fornication or married.
 With a courage worthy of a happier issue, he resolved on death,
 and met it without breaking his vow of celibacy.*
   The following instance,  however, will prove that mania itself is
 sometimes a consequence of the same firmness of mind.  A clergy-
 man of exemplary character,  and one  of  the  most distinguished
 preachers I have the  pleasure of being acquainted with, was many
 years  ago very unexpectedly attacked with a paroxysm of mania,
 the  cause of which it seemed  impossible to unfold.  He recovered
 in about six months, and returned to a regular  and punctilious dis-
 charge of clerical duty.  He is a man of exquisite  taste, warm ima-
 gination, exalted and highly cultivated mind. With these qualifica-
 tions, in less than a year after  his recovery, he married his maid
 servant, and the world imagined he was gone or going out of his
 senses a second time.   A confidential statement of his situation soon
 proved to myself that nothing could be more  prudent or praise-
 worthy than the step he had thus  taken, and which had excited so
 much astonishment among his friends.  He was fully convinced,  he
 said, though he had  never communicated it to any one,  that  the
 cause of his unfortunate malady was a genital irritation, exciting to
 a constant desire of matrimony, which he was not in a situation to
 comply with, and which compelled him to exercise from day to day
 a severe restraint  upon his feelings.  On  being  fully  restored to
 health,  he found the same  morbid propensity beginning to return.
 I felt,  said he, it would again  drive me mad if I did not relieve  it.
 and my principles  forbade me  to think for a moment of relieving it
 immorally.  To what respectable family could I now offer myself,
 having so lately been discharged from private confinement ?   The
 servant who lived  with me was a very excellent young woman  :
 her disposition  was amiable, her mind well capable of cultivation,
 and her form and manners by no means unpleasing: and hence, after
 mature deliberation, I determined upon marrying her if she herself
 would venture upon so perilous a risk. He married her accordingly  ;
 —has ever since, for upwards of twenty years, enjoyed an almost un-
 interrupted  share of  health, and  has  been  more than  ordinarily
 happy in his family. Other examples of a like kind are to be found
in Paullini,T  Martini,^ and  Vogel ;§  but it  is unnecessary to copy
 them.   And hence castration ha£ been often advised, and submitted
 to, and occasionally with success.
  It is from a like sympathy of action between the brain and other
 parts of the  body, that we meet with  instances of the one or the
 other speeies of disease before us, produced occasionally, and, per-

       * Keinnis. Concil. Trident. Part in.  De Coelibatu sacerdotum.
       t Cent. m. Obs.  14.
       % Observazioni, ch. ir. 10.
       \ Bcobuchtungen, p. 9. 
OE. I.-SP.  II.]
NERVOUS FUNCTION.
67
haps, in habits of great sensibility, by suppressed irritations of much
smaller moment, as those of herpes,  scabies, tinea ;* a suppressed
hemorroidal flux;t  suppressed perspiration; suppressed plica,J or
an ulcer of long standing suddenly dried up.§
  Furious mania, constituting the first variety, sometimes makes its
attack very abruptly, and commences with the patient's being sen-
sible  of some indescribable  movement in his head,  which  excites
him to loud and sudden shrieks, at the same  time that he  runs up
and down the room, and mutters something to himself that is alto-
gether unintelligible: though  the symptoms even in this abrupt and
violent attack admit of much diversity.
  More commonly,  however, the disease is the work of time, and
its growth is thus admirably described by Dr. Monro in his reply to
Dr. Battie.   " High spirits,  as they are  generally termed,  are the
first symptoms of this  kind  of disorder.  These excite a man to
take  a larger quantity of wine than usual,  and  the  person thus
afflicted, from being abstemious, reserved, and modest, shall become
quite the contrary,  drink freely, talk boldly,  obscenely, swear, sit
up till midnight; sleep little, rise suddenly from bed,  go out a hunt-
ing, return  again immediately, set all his servants  to work, and
employ five  times  the  number that  is necessary.  In short, every
thing he says  or does,  betrays the  most violent agitation  of mind,
which it is not in his own power to correct.  And yet,  in the midst
of all this hurry, he will not misplace one  word or give the least
reason for any one to think he imagines  things to exist  that really
do not, or that they appear to him different from what they do to
other people.  They who see him but seldom admire his vivacity,
are  pleased with his sallies of wit and the sagacity of his remarks ;
nay, his own family are with difficulty persuaded to take proper
care of him,  till it becomes  absolutely necessary from the apparent
ruin of his health and fortune."
  This picture  is drawn from a rank of life something  above that
of mediocrity, but its general features of ebullient spirits, and hurry
and  bustle, and " much ado  about nothing," will apply to  every
rank.  Such  a person, says  Sir  A. Crichton, in allusion to the pre-
sent description, cannot be said as yet to be delirious,  but that event
soon follows, and he has then the symptoms common  to the  disease,
symptoms which only differ from a difference in the train of thoughts
which are represented in his mind.  He begins to  rave  and talk
wildly, and incoherently : swears as if in the most violent rage, and
* Art. Nat. Cur. Vol. vm. Obs. 28.
  Descottes, Journ. de Med. T. lxvi.
  Petit, Traite Oeuvre posthume. T. m.
t Sanctacrux, De Melancholia, p. 29.
  Lentilius, Miscell. I. p. 36.
$ Hoffman, Beschreibung der Weichselzopfes, &c.
  Eph. Nat. Cur. Cent. i. n. Obs. 35.
) Forestus, Lib. x. Obs. 24. 
68
NEUROTICA.
[CL. IV.-OR. I.
then immediately afterwards bursts into fits of laughter,  talks ob-
scenely,  directs offensive and  contemptuous language  against his
relations and those around him; spits at them; destroys every thing
that comes in his way; emits loud and discordant screams, and con-
tinues  this conduct till he is quite exhausted.   The state of rest
which  follows is generally short and sleepless ; the patient is obsti-
nate ; he will not speak a word ; and clenches his teeth if any thing
be offered  him to sWallow;  or else cunningly pretends to drink a
little, but  immediately squirts it out on the  person who  offers it.
Instantly he again  breaks out into all  the wild and  extravagant lan-
guage and actions he committed  before.   If kept in strict coercion
he  has often so much  command  over himself as to behave mildly
and modestly ;  and were it not for the general expression of his
countenance, and  the  peculiar  glistening  appearance and  rapid
movement of his eyes, he might  impose on many of the bye-stand-
ers,  and make them imagine that the phrenzy was over.   The
length of the paroxysm and of the interval varies greatly  in differ-
ent individuals.  But. generally speaking, the more violent the fit
the sooner it ceases from exhaustion ; and hence sometimes it ceases
in a day  or two, and sometimes runs on to a month or even more :
returning at  the distance of a few weeks  or at  certain periods of
the year.
   In the second variety,  or elevated  madness, the  passions, and es-
pecially  the  irascible  ones, are  less busy, and  the imagination is
chiefly predominant, and at work without ceasing.   It is here we
most frequently trace something of the ruling pursuit of their former
lives, so  that the covetous man is still conversant about  purchasing
lands and tenements, and  amuses himself with perpetually  augment-
ing his possessions : while the devotional  character is forever en-
gaged in a routine of prayers, fastings and ceremonies,  visions and
revelations, and fancies himself to be inspired and lifted into heaven.
The phantoms are all of a pleasureable kind, and mostly such as afford
the deluded sufferer a vast opinion of his own rank  or talents. Donatus
gives the case of a lady at Mantua, who conceited  she was married
to a king, and would kneel  down and affect to converse with him
as if he were present with his attendants; and if she found by chance
a piece of glass in the  street  she  would hug it as a jewel  sent her
from her royal lord and husband.*  He relates  another case from
Seneca of Senecio, a madman of considerable wealth, who thought
himself and every thing about him great; that he had a great wife
and great horses, and could not endure little things of any  kind;  so
that he  would  be served with great pots to drink  out of;  great
hosen, and great shoes bigger than his feet: " Like her," says Bur-
ton, " in Trallian, that supposed she could shake all the world  with
her finger, and was afraid to clench her hand lest she should crush
the world to pieces like  an apple."t
* De Hist. Med. Mirab. Lib. n. Cap. i.
t Anat. of Melancholy. Part i. Sect. 3. 
GE. I.-SP. II.]        NERVOUS  FUNCTION.
69
  Yet even here the train of thoughts or ideas which occupies the
mind  of the maniac in many instances throw no light whatever on
the nature or origin of  the complaint; and  we can still  less avail
ourselves of them than in various cases of melancholy.
  This is particularly observable in the third variety or despondent
madness; for though this modification of  the  disease may occasion-
ally be produced by suspicion, terror, or a guilty conscience,  it  is
far more frequently the result of a melancholic idiosyncracy,  or a
debilitated state of the constitution at the time of the attack, in con-
sequence of which the sensorial fluid  is secreted perhaps  even less
freely instead of more so than in a condition of health :  so that the
patient sinks by degrees into a state of insensibility ; unless he should
be roused with false courage and find means to put an end  to his ex-
istence before this  period arrives.
   In dementia  or chaotic madness this state of sensorial exhaustion
and consequent insensibility is  still more obvious, though there  is,
perhaps, less constitutional tendency to the depressing passions.  The
judgment is here more  diseased and  weakened than in  any other
form, and, none of the kindred faculties assuming a paramount pow-
er, there is a general anarchy and  confusion  in  the ideas that flit
over the sensory without connexion or association of any  kind. And
hence Pinel has admirably characterized  it, as consisting in a  " ra-
pid succession or uninterrupted alternation of insulated  ideas and
evanescent and  unconnected emotions ; continually repeated  acts  of
extravagance ;  complete forgetfulness of every previous state ; di-
minished sensibility to external impressions ;  abolition  of the facul-
ty of judgment;  perpetual activity without  object or design,  or any
internal  sense of its taking place."*
   These maniacs are often ungovernable except by means of coer-
cion, but they are more  easily restrained than those who are  in a
state of phrenzy.   They are  intractible,  and  neither listen to in-
treaty or  to menaces.    Fear  of corporal punishment,  however,
makes them obey.   They willingly  avoid the  light, burying them-
selves under the bed-clothes,  or under the  straw of their cells.
They are  totally regardless  of decency and  cleanliness, and  from
some strange motive are often found smearing themselves over with
their excrement.   For the most part they have little appetite, and
refuse the food offered  them; yet a  sense  of hunger seems some-
times to  return with great keenness  when they will greedily devour
their feces.  Of the nature of the ideas that take place in the sen-
sory, and are expressed by  an unintelligible muttering, we know
nothing  further  than that,  from  the screams and howlings  with
which their jargon is accompanied, there can  be no doubt that they
are often excited by painful sensations of body or mind.
   It is happy for those who suffer  under this as well as  under the
preceding form, that they rarely sustain a long conflict; the exhaus-
tion of sensorial power by repeated paroxysms  soon  leading to a
* De l'Alienation Mentale, Chap, in, iii. $. 176, 
70
NEUROTICA.
[CL. IV.-OR. I.
total torpitude, and consequently a death of the sensorial  organ;
though there  are instances in which a paroxysm of more violence
than usual has produced a favourable change, and suddenly restored
the patient to his senses.
  In gloomy madness, in which there is often a chronic affection of
some of the abdominal organs cooperating with a diseased condition
of the brain, we find least to justify hope ;  the  patients generally
become weakened by fresh paroxysms, and often sink into a  state oi
idiotism.
  The first variety, on the contrary, if  the  constitution  have not
been seriously broken down by intemperance, or the patient be not
suddenly carried off by the violence of the attack on its commence-
ment, will often work its own cure  by  its  own ardour; and will
gradually soften into a soberer state  from mere mental fatigue.
While in the  milder and more pleasurable modification of the second
variety,  in which  the secretion  of sensorial power  is  upon the
whole perhaps less than in a condition  of sanity (since, though the
stimulus of the disease may tend to increase it a  little, the total pri-
vation which the patient enjoys of all the vexations,  and anxieties,
and wearing vicissitudes of real life, reduce it to a moderated and
even tenour it could not otherwise possess,) nothing is more  com-
mon than for maniacs  to continue to a very advanced age.  I am at
this moment interested in  the case of a clergyman who has reached
his ninety-sixth year, and has been in a  state  of quiet insanity for
more than half a century.
  For the most part those are  most  easily as well as most  rapidly
cured, whose insanity, of  whatever kind  it be, has been produced
by accidental causes, as intoxication, sudden transition from  cold to
heat, retention of habitual discharges, or  a  revulsion by a transfer
of morbid action from other organs.   And hence the  comparative
facility with  which a  cure  is effected in insanity  after child-birth.
Whilst, on the contrary, those  are least likely to obtain a permanent
recovery who possess an hereditary taint: the disease  may  indeed
leave them for a time, but the predisposition remaining, they  com-
monly fall victims to fresh attacks after intervals of a year or two,
or even of a  few months.
  " Mania and melancholy," says Dr. Greding, writing while he was
physician to the workhouse at Waldheim, " have continued half a
year with some, and remained  forty years and upwards  with  others,
among whom one patient only in  this workhouse attained the age
of eighty-five."*
   The chance of  recovery is  considerably  greater  upon the first
than upon any subsequent attack, and especially  if the disease  have
not exceeded three months' duration when the  patient is first put
under medical treatment.   If it have, at this time, lasted a twelve-
month, the prospect of success is diminished by  half: if two years,
not above a fourth part as many recover;  and if more  than two
* Vermichle Schriften ut supra, &c. 
GE. I.-SP. II.]
NERVOUS FUNCTION.
71
years the expectation is small, though where the second year is not
much exceeded, a cure is by no means to be despaired of.
  The treatment of ecphronia has generally been  discussed under
the two heads of medical and moral.   Both have undergone a very
great improvement within the last twenty or thirty years; the first
by being considerably simplified, the second by being more tho-
roughly studied  and raised to a higher degree of importance.
  Nothing can be more injudicious  than the ordinary routine  of
medical treatment, which, till within a few years,  was equally em-
ployed in almost all the larger lunatic  establishments in our own
country and on  the continent, especially at Bethlem, the Hospice
d'Humanite, and the Hotel Dieu; and which consisted in a  course
of venesections, emetics and purgatives  administered in every case
indiscriminately, and often, indeed, without  even the  personal in-
spection of the consulting physician or other superintending medi-
cal officer; and if to these  means of cure we add the occasional use
of bathing in various forms and various temperatures, we shall very
nearly have exhausted the  merely medical process that till  of late
was ordinarily  had recourse  to.  It is satisfactory,  however, to
know, that a more  judicious and discriminative practice  has in  all
these asylums been introduced  since  the above period, and that it
has been followed by an abundant success.
   Admitting the proximate course of insanity to be in most cases an
increased action of the vessels secreting  the nervous fluid, venesec-
tion and cathartics and  a general reducent regimen seem indicated
as an ordinary mean of relief; and is unquestionably called for when
the pulse is full and strong, and the  temperament is  sanguineous:
 and the success which has  so  frequently  accompanied this practice
 stamps it with the  highest sanction  it can  receive.   But there is
 great reason to believe that even where the demand for blood-let-
 ting is unequivocal, it has been carried to a mischievous extent, and
 ruined its own benefit.   Thus Plater made  a point of repeating it
 once a  week, and tells us that he has sometimes had recourse to it
 for seventy weeks  running.*
   Much caution, however, is  necessary  even in the first trial;  for
 as a sound intellect depends  apparently upon  a certain degree of
 excitement in the sensorial vessels,  and a  certain quantity of the
 fluid secreted, derangement may take place also, as we have alrea-
 dy observed,  from diminished instead of from increased action, and
 diminished instead of increased secretion.   And such we have rea-
 son to believe is the cause of delirium whenever it  occurs  in pro-
 fuse hemorrhage, and in typhous  fevers ; and  it is obvious that in
 all such instances a reducent plan must necessarily tend to augment
 instead of to carry off the disease.  And hence the patient's general
 habit and temperament, the nature of the exciting cause, the proba-
 bility of visceral congestion, the  violence or mildness of the mania-
 cal symptoms, the  progress they have made, and the length of time
* Observ. Lib. i. p. 86. 
 72                      NEUROTICA.            [CL. IV.-OR. L

 he has laboured under them, are all to be taken  into  consideration
 before we can determine upon the  expediency of bleeding even at
 first.  And if, when we have decided upon its propriety, no benefit
 be produced from a second or a third  repetition, we  have no  en-
 couragement  to  proceed  further, and  should  withhold the  lancet
 altogether.
   To  a series of purgative medicines there is  less objection, pro-
 vided  they are not rendered too violent.  The abdominal viscera,
 it has  already appeared, form in many instances an important link in
 the morbid chain of action,and are sometimes the primary cause of the
 disease : and it hence is of great moment that they should be effectu-
 ally cleared of viscid or acrimonious matter that may irritate or clog
 them up.  But, beyond this, by keeping up such  an  increased  ac-
 tion in the abdominal region as the organs may bear without  debi-
 lity, we may diminish  or change the morbid action in the head by
 remote sympathy, or entirely withdraw it by a revulsion.  A spon-
 taneous diarrhoea has been  known in  various cases to carry  off  the
 disease as by a charm :  and the use of this class of medicines is  the
 more necessary, as the bowels of maniacal patients are apt to be  ex-
 tremely costive.  If the black hellebore of the  ancients, which  ap-
 pears to have been a different plant from that of the modern dispen-
 satories, were ever entitled to half the antimaniacal virtues ascribed
 to it, it was most  probably  upon the obvious ground of its being a
 purgative attenuant and deobstruent.
   Dr.  Dubuisson  has lately revived the use  of the  modern black
 hellebore in various species of mental alienation, as chronic mania,
 melancholy and  hypochondrism :  in all  which he  speaks of  its
 effects, after an extensive trial, as highly successful.  He has given
 it  also  in every form, as that of powder, decoction, watry extract
 and  tincture; but  prefers  the  extract  as least irritating.*   His
 opinion, however, is not supported by  the result  of general prac-
 tice, and appears to be by  far too sweeping  and indiscriminate.
 Spleissius,  nevertheless, affirms  that in  his  hands,  when given
freely, it proved sedative and produced sleep.t
   Upon no other  description of medicines can we place any rational
dependence.  Emetics, narcotics, and other sedatives,  and antispas-
 modics have been tried for ages in every form and in every pro-
portion ;  sometimes  alone,  and sometimes  in conjunction with
blisters and the warm or cold bath.  There are instances in which
they have all appeared to produce some benefit, but the far greater
number in which they have failed prevents us from  placing any
 reliance  upon them.
   Of the narcotics the chief that have been had recourse to are
opium, aconite,  bella donna, and the  stramonium.  Far more  mis-
chief than good seems to have followed from the use of all of them.
with the exception of the  first, which would probably be found a

       • * Des Vesaniesou Maladies Mentales.  Paris. 1816.
         ' Annotat in Zapat. Miiabil. p.  136. 
GE. I.-SP.  II.]         NERVOUS  FUNCTION.                  73

remedy of high value if we could duly discriminate the proper
states or modifications of  the  disease for its  use.   Dr. Cullen's
experience of it in mania he admits to be small, but he has correctly
estimated its general effects in telling us, that in some cases he found
it  useful in moderating  the violence  of the  disease, but that in
others he  found it manifestly hurtful.  A monographist  upon  this
malady could not, perhaps, be engaged more usefully than in turn-
ing his attention to the peculiarities which produce this difference.
On the continent it has also been given sometimes alone, but more
usually in conjuncture with nitre  or camphor  or both ;  but in all
these forms also with variable success.*
   Upon what ground St.  John's wort was ever advanced to the rank
of a powerful sedative I  know not; but, in this class, it at one time
took the lead and held it for ages.   Its antispasmodic powers were
regarded of so high a character as equally to put to flight hysterics,
hypochondrism and madness  of  every  kind,  and  especially  that
which was formerly described  under the name of daemonomania,t
whence, indeed, its technical name of hypericum or fuga daemonum
under which it was also  celebrated.  It occupied a  place in a  late
edition of the pharmacopoeia of the London College, and was at  one
time noticed as an antispasmodic even  by Dr. Cullen, who rejected
it  however, most deservedly, in  his  maturer courses of lectures.
Its only sensible qualities are those of a slight resinous  bitter  not
worth the trouble of extracting.
  Camphor is a sedative  far better entitled to attention and appears
to have been tried  with more extensive success than  any other
medicine of the same tribe.  It has been  given alone and in union
with other sedatives,  chiefly with opium,  nitre and the  mineral
acids, none of which however seem to have improved its powers.
Berger, Fischer, and Herz,  speak favourably of its effects  abroad;
and  in  our own country it has  had equal commendations from
physicians  of distinguished talents.  Dr. Mead thought highly of it;
Sir Clifton Wintringham tells us that he  found it,  given to  the
amount of half a  drachm  in  the  evening,  diminish  the phrenzy,
procure sleep, and produce perspiration.   Unfortunately, however,
here, as in the  case  of opium, we  have so many proofs of its utter
ineflficacy,  as to render  us at  present incapable of  placing  any
dependence upon  it in any quantity  or  with any auxiliary.   Dr.
Cullen had a  patient who  began  with five grains for the night's
dose, and advanced it gradually to thirty without any benefit, though
without any increase of the pulse.  At this time it was carried by
accident to forty grains, which produced syncope and nearly proved
fatal.   The patient, however, recovered  from  the accidental symp-
toms, but  unhappily no impression  was made  on the  constitutional
disease.|

       * Friborg. Coll. Soc. Med. Hafn. n. p. 17C.
       t Abrah.  Mayer, Archiv. der Practischen Arsnoykunde.
       X Mat. Med. Vol. n. p. 294.
   vofc. hi.                   10 
71
NEUROTICA.
[CL. IV.-OR/ I.
   The  warm and cold bath have  also had their votaries, but no
 certain  benefit appears to have been derived from either.  The last
 may be useful as a tonic in a state of convalescence, but has rarely
 produced real benefit during the progress of the disease.   Weber,
 however, thought it useful, and published  several  cases  to  this
 effect.*
   From an idea that the disease consists in an undue determination
 to the head, or an undue excitement of the vessels secreting the
 nervous fluid,  Wendtt  surrounded  the head  with cataplasms  of
 pounded ice in the form of a night-cap ; and Daniel, with a  still
 more ingenious spirit of adventure, applied cataplasms of the same
 kind to-the same organ while the body,  with a view of encouraging
 a revulsion more effectually, was plunged into a warm-bath.  The
 process will be found described in his Beytrage zur medicinischen
 Gelehrsamkeit, published in quarto at Halle in  1749.   And I men-
 tion the fact as an act of justice to the author, since the same
 process has of late years been revived in our own country as a new
 discovery.   Daniel thought  it  highly beneficial; and by its recent
 revivers it was at one time held up as  a specific : but whatever
 success may in a few rare instances have  attended  it, the  practice
 has not been able to work  itself into public favour: and  a sober
 attention to its effects does not seem to justify its further continuance.
  After all we have  chiefly  to depend on  moral  treatment.   Firm-
ness on the part of the attendant  with conciliatory manners,  has
done wonders ;  but a sense of authority must be maintained, though
occasional severity should be necessary for this  purpose : yet it will
rarely be  needful to  exceed the coercion of the strait waistcoat.
It is needless  to add that the diet should  be of the simplest kind, that
every thing  which  can tend  to  produce excitement  should  be
prohibited, and  that in public  institutions, the  patients should  be
divided  into  proper  classes.  Amusements of every kind that may
engage the attention and encourage exercise in the open air, without
rousing  the passions  or  producing fatigue, should be promoted  by
every contrivance that can  be thought  of.   And  if the  turn  or
previous occupation  of the  patient point to any particular pursuit,
and especially4.0 handicraft trades and those that employ the mind
without exhausting it,  as that of sawing,  gardening, book-binding,
or watch-making, he  should be enabled to  pursue it according to his
own desire.  The desire itself is a favourable  symptom,  and  has
 often  led to the most beneficial results.
  Judicious  conversation  and cheering  advice  are also of great
importance;  and regular daily attendance on religious  services in
 the bosom of a private  family, or with  a few  patients of a like
standard in a public institution,  may be allowed, where  the  disease
has assumed  a convalescent form,  and the service  is performed
  * Observ. Med. Fascic. i. p. 26.  See also Act. Med. Berol. Dec. i. Vol, vn
p. 61.
  t Nachricht, Von dem Klinischen institut. zu Enlangen. 1783. 8vo. 
«E. I.-SP. II.]
NERVOUS  FUNCTION.
75
soberly and dispassionately.  This will at first, perhaps, be only of
use as  promoting a habit of moral order and  quietism ; but every
good man will  indulge the hope that  it  may  afterwards introduce
into the mind the higher blessing of spiritual peace and consolation.
Yet the attempt must not be  begun too soon, and in no case till the
patient has acquired not  only a spirit  of  subordination but of
tranquillity.  Before this period nothing can be  so absurd  as to
attempt devotional instruction of any kind : for the subject of religion
can only be addressed to the  reason or to the  passions:  the former
of which  does  not exist  in a state  to be influenced, and the  latter
of which, if they could be influenced at  all, would only add to the
excitement, and increase  the disease.   The clear duty of the priest
and the physician is in this case one and the same :  it is to bring the
mind home  to the  world  around it:  to  draw it down and fix it upon
things  of time and  sense,  instead of rousing it to things invisible and
eternal: to enable it  to behold God in the materialities of his works
instead of urging it to a  contemplation of him in  the spiritualities
of his  word.  To instigate  a madman to an abstract and  elevated
communion  with his Creator,  who is incapable of holding an  inter-
course upon ordinary topics with his fellow-creature, is to cure a
frozen limb by pouring boiling water upon it,  or to teach the optics
of Newton in a nursery.
  In many  cases the cure mainly depends upon withdrawing the
patient's mind  as  much  as possible from every former scene and
every  former companion, in  setting before him a new world, and
giving an  entire change to  the current of  his recollections  and
ideas.  There are particular cases, however, and perhaps particular
periods of the  disease, if we could accurately hit upon  them, in
which the sudden admission of a well known friend or relation, and
a sudden recall of the mind to its former images and  habits, tend to
produce a  most salutary excitement,  and disperse the  maniacal
cloud like a dream.   Dr.  Gooch has given an interesting illustration
of this remark, in the case of a lady, twenty-eight years of age, of
good  constitution  but susceptible mind, who fell into a  state of
melancholy, in the ordinary sense of the term, a few  months after a
second child-birth, and at length became furious.  " She was now,"
says he, " put  under the care  of an  experienced attendant,  sepa-
rated entirely from her husband, children, and friends;  placed in a
neat cottage surrounded by  agreeable country (it  was the  finest
season of the year)  and visited regularly by  her  physician.   For
several weeks she manifested no improvement;  sometimes she was
occupied with one notion, sometimes with another;  but they were
always of the most gloomy description : at length it became her firm
belief  that she was to be  executed for her crimes in the most public
and disgraceful  way;  every noise she heard was that of the work-
men erecting the  scaffold ;  every carriage, the officers of justice
assembling at the execution  ; but what affected her most deeply
was that her infamy had  occasioned the disgrace and death of her
children and husband and that  his  spirit haunted her.  As soon as 
 76                     NEUROTICA.             [CL. 1V.-OR.  I-

 the evening closed, she  would station  herself at  a window at the
 back of the cottage, and  fix her eyes on a white post that could be
 seen through the dusk; this was the ghost of her husband ;  day and
 night he was whistling in her ears.  Several weeks  passed in this
 way;  the  daily reports varied,  but announced  nothing  happy;
 at  length  her  husband  became  impatient  and begged  to  have
 an  interview with  her,  thinking that  the  best way to convince
 her he was not dead was to show himself.   This was objected to ;
 he was told the general fact that patients are more likely to  recover
 when completely separated from their friends ; that if she saw him
 she would say it was not himself but his ghost.  But the  husband
 was obstinate and an interview was consented to.  When he arrived
 at the  cottage he was told that she had  had  a tolerable night, was
 rather more  tranquil, but that there was  no  abatement   of her
 gloomy notions.  " As soon  as I entered the drawing-room, where
 she usually spent the day, (I copy his own statement  which I  have
 now before me and which he  wrote down at the time of the occur-
 rence) she ran into  a corner,  hid  her face in a handkerchief,  then
 turned round, looked me in the face, one moment appearing  delight-
 ed  at the thought that 1 was alive, but immediately afterwards
 assuming a hideous expression of countenance, and screaming out
 that 1  was dead and come to haunt  her.  This was exactly  what
 Dr.----had anticipated, and for some  minutes 1 thought all  was
 lost.  Finding that  persuasions and  argument  only  irritated  and
 confirmed her in  her belief,  I desisted, and tried  to  draw off her
 attention to other subjects; it was some time since she had either
 seen me or her children;  I put her arm  under mine, took  her
 into the garden, and began  to relate what had occurred to me and
 them since we parted;  this  excited her attention, she soon  became
 interested,  and  I entered with the utmost minuteness and  circum-
 stantiality into the affairs of the nursery, her home, and her friends.
 I now felt that  I was gaining ground, and  when I thought I  had
 complete possession  of her mind, I ventured  to ask her in a joking
 manner,  whether I  was not very  communicative  for  a   ghost;
 she laughed ; I immediately drew her from  the subject, and again
 engaged  her  attention with  her children and  friends.  The  plan
 succeeded beyond my hope ; I dined, spent the evening with  her,
 and left her at night perfectly herself again."  He went the  next
 morning in a state of intense anxiety  to know whether his  success
 had been permanent; but her appearance at the window  with a
 cheerful  countenance soon relieved his  apprehensions. While he
 was there Dr.---- came in; he went up stairs without knowing
 the  effect of the interview,  and came down,  saying, " it looks like
 magic !"  With a view of confirming her recovery,  she was ordered
 to the  sea-side to  bathe.  As  soon as the day of her departure  was
 fixed, she began to droop again, the evening before it she was  very
 low, and on the morning of her  setting off was  as  bad as ever.
 This state  continued for several  weeks, in spite  of sea air  and
bathing, and ceased as suddenly as it had done before,  apparently in 
GE. I.-SP. II.]          NERVOUS  FUNCTION.                 77

consequence  of interviews with friends, calculated to remove the
apprehensions by which her mind was haunted.  She has since then
continued perfectly well,  and has had another child without the
slightest threatening of her former malady."*
  This was a bold venture, and the physician must be of a temper
more than  ordinarily sanguine who would predict a  like success
upon every similar attempt.  Yet we have already had occasion to
observe, that puerperal insanity is more easily recovered from than
most other forms of the disease.
                       GENUS  II.

                      EMPATHEMA.

                  3Xusoticruai)le ^asmou.

THE JUDGMENT  PERVERTED  OR OVERPOWERED BY THE  FORCE  OF SOME
  PREDOMINANT  PASSION ; THE FEATURES OF THE COUNTENANCE  CHANGED
  FROM THEIR  COMMON  CHARACTER.

The term empathema is derived from the Greek nxtlnpu, " passio,"
" affectio," whence ip.Ka.6ni, "cui insunt affectus seu perturbationes;
affectu percitus vel commotus."
  We have already had  occasion to observe that the various facul-
ties of the mind are just as liable to be separately diseased as those
of the body : for as the faculty of digestion may be  impaired while
that of respiration or  secretion remains in perfect health, so may
the perception or the judgment be  injured  while the  memory or
the imagination  continues in its former  activity.  It  is the same
with the pathetic faculties.  These I have stated are to the mental
part of the human frame what feelings  properly so called are  to the
corporeal; and hence both may be excited pleasurably or painfully;
they  may be in morbid excess or in morbid diminution :  and their
influence  may equally vary according to the peculiarity of the pas-
sion or the sense affected.  Each will therefore furnish  a distinct
division of diseases: the first constitutes the genus before us;  the
second will be found in the ensuing order.
  The present genus, however, has never hitherto been properly
arranged  or digested.  Pinel is constantly  describing the species
that belong to it in his general remarks and illustrative cases, but
allots no place to it in  his nosological arrangement, with the excep-
tion of the third species, which, as I have already observed, he has
irregularly  ranked as a subdivision of mania, under the name of
Vl !. Trans. Vol. vi. 
 78                       NEUROTICA.            [CL. 1V.-OR. I.

 manie sans delire, although he admits that the judgment and per-
 ception, and,  indeed, all the reasoning faculties of  the mind are in
 most cases undisturbed.  In like manner Sauvages has  incorrectly
 merged the  whole family into  a single species under the genus
 mania, to the utter confusion of both.
   It is not a little singular that Dr. Crichton who has written so ex-
 cellently on the diseases of the passions, and has illustrated hi* ob-
 servations with such a variety of examples, should both in his " In-
 quiry into the Nature of Mental Derangement," and in his  " Sy-
 noptical Table," either have assigned no place to these diseases, or
 have transferred  them, like Sauvages, to insanity,—under his no-
 menclature, delirium ;  although, as I  have just remarked, the per-
 ception and the judgment  (a diseased condition of which are usual-
 ly appealed to as constituting  pathognomic symptoms of insanity)
 are, for the most part, strikingly  clear in empathema,  and  often
 peculiarly acute.  This last faculty, indeed, is frequently perverted
 by the prevailing emotion or passion  of the hour; as where a man,
 under the influence of despair, reasons himself  into the lawfulness
 and expediency of suicide;  but  the argument,  though  deflected,
 runs still in a  right line; or, in other words, consists of correct rea-
 soning built on a perception of false ideas as its premises, of which
 we have had various examples in the philosophical suicides of Ger-
 many.  In the greater number of  cases, however, the judgment,
 instead of  being perverted, is merely overpowered by the empas-
 sioned emotion;  their is neither false judgment nor false  percep-
 tion.
   Ungovernable  passion or empathema,  nevertheless, though  not
 strictly insanity, is as much a mental derangement as insanity itself.

              Ira furor brevis est

 is as clear a truth  as is to be  found  in  the whole  learning of  the
 Roman empire ; and hence the elegant and  fanciful  mind of  the
 Greeks added  the  term mania to that expressive of any passion or
 emotion whatever, when in a state  of violence or misrule, as  doxi-
 mania, erotomania, chrysomania,—and in this sense mania is  often
 used in the colloquial  language of our  own day.  For poetry or
 vernacular speech mania thus employed is intelligible enough;  but
 it is not sufficiently correct for medical or physiological  purposes,
 under which predominant passion must necessarily be distinguished
 from delirium.
  The genus  empathema has  three species ; the first characterised
by the rousing power of the prevailing passion ;  the second, by its
 depressing power;  the third, by symptoms different from both, and
which will be  explained in its order.

 1. empathema entonicum.                  empassioned excitement.
 -•---------ATONICUM.                    EMPASSIONED DEPRESSION.
 3----------INANE.                       HAIR-BRAINED PASSION. 
«;E. II.-SP. I.]        NERVOUS  FUNCTION.                   7.9


                         SPECIES I.

            EMPATHEMA  ENTONICUM.

                 Emjjassumcti 2Spcitcmrut.

THE PREDOMINANT  PASSION  ACCOMPANIED WITH INCREASED  EXCITEMENT.
  ARDOUR, AND ACTIVITY ; EVE QUICK AND DARING ; COUNTENANCE FLUSH-
  ED  AND TUMID.

The varieties are innumerable: the chief are as follow,

       * Letitiae.                  Ungovernable Joy.
       S Philautiae.                Self-love.   Self-conceit.
       y Superbiae.                Pride.
       2 Gloria- famis.             Ambition.
       g Iracundiae.                Anger.
       £ Zelotypiae.                Jealousy.
   All these, and  indeed, all other passions whatever are as much
direct and indirect stimulants  to the mind as  provocative  foods or
drinks are to  the body.  Employed occasionally and in  moderation
both may be of use to us and are given to us by nature for this pur-
pose : but when urged to excess they throw the system off its healthy
balance,  rouse it by excitement  or  depress it by exhaustion, and
weaken the sensorial vessels by the wear and tear they produce.
   As those we are now contemplating  are attended with increased
 action they have some few symptoms in common, how widely soever
 they may differ in  others;  of which the chief are an  augmented
 temperature and an accelerated pulse.   If carried to such a degree
 that the judgment loses its power, or in other  words the man has
no longer any command  over himself, they betray themselves by
their effect on particular  features and particular organs, according
 as the emotion is of a painful  or a pleasurable character, or  as the
pain or the pleasure predominates in those which partake of both.
   There are  some organ", however, that seem to be equally affec-
ted under a vehement excitement of whatever  may be  the prevail-
ing passion,  as the brain, the heart, and  the lungs; for head-ache
 and apoplexy, palpitation and anhelation are alike common  to sud-
 den fits of extreme joy, terror, and rage.  The thoracic effects are
 indeed the  most striking; and hence it is that  the prsecordia have
 been more generally supposed in all ages and  countries to be the
 seat of mental emotion than the  encephalon ;  and the state of the
 heart,  as light and jumping for joy, oppressed and breaking with
 o-rief, or black  and bilious with  hatred, has been more commonly
 appealed to than that of the animal spirits ; though the latter is the
 cause,  and the former the mere effect.
   It may be thought, perhaps, that the  vulgar character of the heart 
80
NEUROTICA.
[CL. IV.-OR. I.
as indicative of hatred or revenge, is merely figurative and has no
foundation in nature.  But this is not the case: for anger when long
indulged is well known to affect the  functions of the liver, and has
oftenlaid a foundation for jaundice,  and consequently for a deeper
colour of the blood that circulates through the heart: a fact so well
known, that the seat of  anger has, in the poetical language of most
countries, been transferred to this  organ, and  bilious  or  choleric
and irascible are convertible terms in the popular language of our
own day.
   We have endeavoured to account  for the difference of effect pro-
duced by the sensorial fluid in the different organs of local sensation,
by supposing some degree of change to take place  in the nature of
this  fluid by the action of  the  respective sentient nerves at  their
origin or extremity.   It is possible that other changes may take place
in the sensorium from the influence  of peculiar mental impressions,
and that certain classes  or ramifications of nerves may be more af-
fected by particular  impressions than others.  And we may  hence
account not only for  the sympathy of the liver with the sensorium
when urged by anger, but for that of other organs under other em-
passioned excitements,  and this not  merely whether pleasurable or
painful, but according to the peculiarity of the pleasure or the pain
which forms the source  of incitation.  Thus  while anger stimulates
the liver, fear has a tendency to produce a  diarrhoea and inconti-
nence of urine ; grief disorders the stomach, and affects the lachry-
mal glands;  sudden fright  divests the muscles of locomotion,  and
produces palsy ;  while  mirth throws them into involuntary action,
and compels a  man to leap, laugh and sing.
   This,  however, is to digress; for  our present business is to con-
template the mental rather  than the corporeal effects of the passions
when urged to excess, or intemperately protracted.
   The instances of derangement produced by a sudden fit or immod-
erate  flow of joy are numerous, and not difficult  to  account for.
As this empassioned  emotion, when  indulged with a rampant domi-
nation over the judgment, is a direct stimulus of a very  powerful
kind, acting not only on the nerves  but on every part of the body,
it cannot take  place  without producing great sensorial  exhaustion,
and consequently cannot be persevered in without remissions of lan-
guor and lassitude, like  the effects of intoxication from  strong wine
or spirits.  Tbe misfortune is, that when the elevating faculties of
the mind, and  especially the imagination, are once let loose by the
operation of this  passion, and  both  run wild together, the mental
excitement will sometimes continue  after  the strength  of  the body
is completely prostrated.  And  when this  strength is sufficiently re-
cruited  for the external senses to convey once more to the percep-
tion true and lively impressions of the objects that surround them,
the perception which  has  been also morbidly affected by the vio-
lence of impassioned paroxysms will not receive or convey them in
a true state, and a permanent derangement is the consequence. Car- 
GE. II.-SP. I.]
NERVOUS  FUNCTION.
81
dan* gives the case of an artisan  of Milan, who having had the good
luck to find an instrument that  formerly belonged  to  Archimedes
ran mad with the fit of transport into which he was hereby thrown :
and Plutarch, in his life of Artaxerxes, has a like story of a soldier
who, having had  the high honour of wounding Cyrus in battle, be-
came  so  overjoyed that he lost his wits from  the moment.   Boer-
haavej and Van SwietenJ relate  cases of epilepsy that have follow-
from the same  cause.
  Occasionally the exhaustion of sensorial power hereby produced is
so sudden and total, that the whole nervous system seems instantane-
ously to become discharged of its contents, like a  Leyden phial load-
ed with electricity when touched with a brass rod, and death takes
place at the moment. There are various instances  on record in which
a like fate has followed upon the injudicious  production Of a par-
don to a culprit just on the point of his being turned off at the gal-
lows.   Valerius Maximus relates two anecdotes of matrons who^ in
like manner, died of joy on seeing  their sons return safe from the
battle at  the lake Thrasis : the one  died while embracing her son,
the other had been misinformed  and was at that  moment lamenting
his death.  The power of surprize was added therefore in this case
to that of joy, and she fell even  before  her arms could clasp him.§
Marcellus Donatus, Pechlin, and  other collectors  of medical curiosi-
ties are full  of incidents of this kind :  and a  case not very unlike
occurred a few years since to the present author, in the person of
an  intimate  friend and  most exemplary clergyman.  This  gentle-
man who had consented to be nominated one of the executors in the
will of an elderly person of considerable property  with whom  he
was acquainted, received a few years afterwards,  and at a time when
his own income was but limited, the unexpected news that the tes-
tator  was dead, and had left him sole executor, together with the
whole of his properly, amounting to three thousand pounds a year
in landed estates.  He arrived in London in great agitation, and on
entering his own door dropt down in a fit of apoplexy, from  which
he never  entirely recovered ; for though  he  regained  his  mental,
and most of his corporeal faculties, his mind was shaken and  render-
ed timid, and an hemiplegia had so weakened his right side  that he
was incapable of walking farther than a few steps.
  Could this  passion  be employed as a  medicine, and administered
with a due regard to time and measure, from its powerful influence
on the whole system there can be no doubt that it might be made
productive of the most beneficial effects.   And  there is hence  no
reason for hesitation  in admitting  many  of  the wonderful  cures
which are  reported to have  been occasionally operated  by its sud-
den incursion.  Corineus gives the case of a tertian  ague thus re-
             * De Sapientia, lib. ii.
             t De Morb. Nerv. lib. ix. cap. 12.
             X Comment. Tom. m. p. 144.
             } Lib. ix. cap. 12.
VOL.  III.                    11 
 82                      NEUROTICA.            [CL. IV.-OR.  I.

 moved; Lory that of a stricture of the pylorus with incessant vomi-
 ting;* and Trellian, what we should less  have expected, a  radical
 cure of melancholy.t
   In the second variety we have  noticed the  predominance of self-
 conceit.   The ordinary feeling is still of a  pleasureable kind, but
 never amounting to the  paroxysms  of the preceding:  its  effects
 therefore on  the soundness of the mind are  more gradual, but in
 many instances quite as marked.   It is a vain and preposterous es-
 timation of one's personal powers  or endowments, accompanied with
 so immoderate a love of one's own self on this very account, as to
 make the  possessor blind to every instance of superiority in another
 person, and hence  to save him in a  considerable  degree  from the
 pain he would otherwise endure :  for  the self-conceited man is not
 easily mortified or humiliated, and hence not  easily  cured of the
 malady.   " A wise man," says Mr.  Mason in his  Treatise on Self-
 knowledge, "has his foible as well as a fool;  but the difference be-
 tween them is, that the foibles of the one are known to himself and
 concealed from the world ; the foibles of the other are known to the
 world and concealed from  himself.  The wise man sees those frail-
 ties  in himself which others cannot; but the fool is blind to those
 blemishes in  his  character which are conspicuous to every one
 else."J  It was under the influence of this disease that Menecrates,
 as we learn from iElian, became so mad, as seriously to believe him-
 self the son  of Jupiter, and to request of Philip of Macedon that he
 might be  treated as  a god.   But it is not always that  the man thus
 deranged falls into such good hands as those of the  Macedonian mon-
 arch ; for Philip humorously determining  to make the madman's  dis-
 ease work its own cure, gave orders immediately that his request
 should be  complied with and invited  him to a grand entertainment,
 at which was a separate table  for the  new divinity, served  with  the
 most costly  perfumes and incense, but with  nothing  else.   Mene-
 crates was at  first highly delighted and received  the  worship that
 was  paid to him with the greatest complacency, but growing hungry
 by degiees  over  the empty viands that were offered him, while
 every othjr guest was  indulged  with substantial dainties,  he  at
length keenly  felt himself to  be a man, and stole  away from  the
 court in his right senses.§
  The passsion of pride has a close affinity to that of self-conceit:
 but is less confined to self-endowments, and is a relative as the for-
 mer  is a personal vanity.  The proud man may indeed have  the
same preposterous estimation  for  some supposed gift of person,  but
the grasp of the passion does not terminate here; for he carries  the
same estimation to every thing that in the remotest degree  apper-
* De Melancholia, Tom. i. p. 37.
tLib. XLI. p. 17.
X Pait. i. Ch. vir.
i Lib. xh. cap. 51. 
GE. H.-SP. I.]        NERVOUS FUNCTION.
83
tains to him, and is hence as vain of his birth, or family connexions,
his wealth, his estates, his country, his office, his honour, or his re-
ligion : and he  is hence open to more numerous mortifications, and
is in fact more frequently mortified than  the mere egotist.  Exam-
ples of a deranged mind from ungovernable pride are to be found in
every rank of life, but as those in the loftiest have the cup of intoxi-
cation  most frequently offered to them, and drink deepest of its con-
tents, it is here, among kings and courtiers, and prime ministers and
commanders, that we are to look for  the most striking instances of
this malady.  Many a crown won by good fortune, and which might
have been  preserved by moderation, has been lost by the delirium
of pride and vain-glory; of which the history of Demetrius of Mace-
donia furnishes us with one of the most memorable  examples:  who,
in  his disgraceful fall, was obliged to abandon, among  the  other
idols of his  heart, the unfinished robe which was to have hung over
his shoulders a magnificent embroidery of the sun, the moon, and all
the stars of heaven, to have represented him as the sovereign lord
of the whole.
   There is, however, another kind of  madmen,  to adopt the words
of Butler,* opposite  to these ; " that are insensibly  mad and  know
nothing of it;  such as affect to contemn all praises and glory,  and
think themselves most free when they are most mad : a company of
cynics, such as monks, hermits, and anchorites, that contemn  the
world, contemn themselves, contemn all titles,  honours, offices,  and
yet in that contempt are more proud than any man  living.   They
are proud in humility, proud in that they are not proud.   They go
in sheep's russet, many great men that might maintain themselves in
cloth of gold, and seem to be dejected ; humble by the outward car-
riage, when as inwardly they are swollen full of pride, arrogancy,
and self-conceit.  And therefore Seneca adviseth his  friend Lucilius
in his attire and gesture, his outward actions especially, to avoid all
such things as are most notable in themselves;  as a ragged  attire,
hirsute head, horrid  beard, contempt  of money, coarse lodging, and
whatever leads to fame that opposite way."t
   When the passion of  pride  is united with  that of ardent desire
after something beyond us and above us it constitutes the next feel-
ing of ambition : and hence this also is an inflating emotion, a tym-
pany of the mind, and may be  called prospective vanity, as pride is
relative vanity, and  self-conceit personal.   It is the more dangerous
to the  understanding in consequence of the double force with which
it  overpowers the judgment: and hence the slave of inordinate am-
bition is  far more  restless and in a far higher degree of excitement
than the slave of either of the other two kinds of vanity; and, as
being dependent upon a greater number of contingencies, he is most
of all open  to reverses and downfalls.
   Examples are not  necessary, and would be a waste time.  When-
ever the stimulant ideas  or thoughts that are connected with  any
* Anat. of Melanch. Part. I. Sect. ii. Vol. j. p. 182.
t Epist. v. 
84
NEUROTICA.
[CL. IV.-OR. I-
one  of this  train, of passions pass over the  mind,  the  blood,  as is
justly observed by Sir A. Crichton, rushes with impetuosity to the
head, the sentient principle  is secreted  in preternatural quantity,
and the excitement  is at last so often renewed and increases to  such
a degree as to occasion an impetuous and permanent delirium.   But
when the expectations and high desires, which pride or vanity na-
turally suggest, are blasted ; when these passions are assailed by pov-
erty, neglect, contempt, and hatred, and are unequal  to the  contest,
they now and then terminate in despondency or settled melancholy*
  But if such be a frequent effect of the stirring passions of a plea-
sureable  kind ; it is  not difficult to conceive that those accompanied
with pain, as the passion of anger, and all its compounds, suspicion,
revenge, and especially, jealousy, must make a much wider inroad
upon the domain of a well-ordered mind, and introduce confusion
and derangement.  Nor is the effect confined to  the  head;  for a
stimulus thus violent affects the  entire system, and, as we have al-
ready observed, has a peculiar sympathetic influence on the liver ;
producing, in many instances, a very diseased secretion of bile, and
altering it in a very short period not only in its quantity but in its
quality.  At the same time, every vessel is exhausted of its irrita-
bility, and the whole strength is so prostrated as occasionally to lead on
to obstinate faintings, convulsions, and death. The expressions and ges-
tures, are always violent and offensive, and are similar to those of
maniacal rage ; the  eyes are  red and inflamed, the countenance  is
flushed, swollen and distorted, and the person is ungovernable. Such
was the case in 1392 with Charles VI. of France, who being  violent-
ly incensed against the Duke  of Bretagne, and burning with a spirit
of malice and revenge, could  neither  eat  drink nor sleep for many
days together, and at length became  furiously mad as he was riding
on horseback, drawing his  sword, and striking promiscuously every
one who approached him.   The disease fixed upon his intellect and
accompanied him to his death.
  In jealousy, as in  ambition, there is a combination of irritating
passions, and the combination is still more complicated; for it is a
compound of suspicion, hatred, eager desire of revenge, occasionally
intermixed with  love.  To hot climates it appears to be endemic,
and there is not perhaps  an eastern dynasty  that  does not  offer
numerous examples  of its sanguinary phrenzy, and diabolical career.
  It is not often, however, that any of the varieties  of this species
terminate in permanent  insanity, although the case of Charles VI.
of France forms an exception to  the general rule.  As moral treat-
ment appears to be  of more  benefit in the  preceding  genus  than
medical, it  is almost the only treatment  that  can  be recommend-
ed in ungovernable passion : though  the violence  of  the excite-
ment should unquestionably be reduced by venesection  and purga-
tives.  After this, time and perfect quiet must be chiefly depended
upon: yet judicious conversation, and more  especially  a judicious

      * Of Mental Derangement,  Book m. Ch. n. 
GE. II.-SP. L]
NERVOUS  FUNCTION.
85
choice of subjects may accomplish much.  A deaf ear is generally
turned to the precepts of the moralist, but if attention'can  be ob-
tained for them, Epictetus  and  Mason's  Self-knowledge, Pascal's
Thoughts and Lord Bacon's Essays will furnish valuable remedies;
and so also, and of a much  more  powerful operation, will the still
better penned ethics of a book which in every Christian country
should be uppermost in the  mind  without any suggestion.   Moral
castigation, however, if not too sudden or severe, is that which ge-
nerally works most effectually ; and few madmen of this kind have
been able to meet a serious reverse of fortune  or  condition in life
without being the better for it, if  not destroyed by its  first shock.
Self-conceit, which is a mere product of self-ignorance, is best re-
moved by an acquaintance with the world, and especially with men
of real talents and genius, in which sphere the  man who labours un
der it will soonest learn his  own  emptiness, and the  means of re-
medying this defect.   And hence the advantage of a public educa-
tion over a private  one ; in which talents are brought into a fair
competition with  talents, and every one  learns to appreciate his
powers, not by the  standard of his own  vanity but by the. stamp  q'"
merit that has passed the mint.
                        SPECIES 11.


             EMPATHEMA  ATONICUM.



THE PREDOMINANT  PASSION ACCOMFANIED WITH DIMINISHED EXCITEMENT,
  ANXIETY AND LOVE  OF SOLITUDE: EYE FIXED AND rrNSlVK ;  COUNTE-
  NANCE PALE AND FURROWED.

The mental emotions productive of  these effects are at least as nu-
merous as those which harass  the frame by increased excitement.
The following may serve as examples:

    et Desiderii.         Ungovernable Love.
    £ Auri famis.       -------------Avarice.
    y Anxietudinis.-------------Anxiety.
    5 Mceroris.          -------------Heart-ache.
    i Desperationis.    -------------Despondency.

  As increased sensorial excitement produces various symptoms in
common, whatever be the nature  of the governing passion at the
time,  there are also  various symptoms common to decreased senso-
rial excitement under each  of these depressing passions: as a great-
er or less degree  of torpor in every irritable pari, especially in the 
86
NEUROTICA.
[CL. IV.-OR. 1.
circulating and absorbent systems; whence paleness of the counte-
nance, coldness of the extremities, a contraction and  shrinking  of
the skin, and general surface of the body:  a retardation and small-
ness of the  pulse, want of appetite, deficiency of muscular force,
and a sense of languor which overspreads the whole frame.
  The ardent desire which is distinguished by the name of i.okoing,
is directed towards objects of various  kinds that  are absent, and
equally relate to places and persons.  It is a painful and exhausting
emotion, as compounded of hope, love  and fear, and peculiarly agi-
tates the pra^cordia: and  hence the striking and beautiful apoph-
thegm of the wise man, " Hope deferred maketh the heart sick."
It is  felt by children  at a distance from home and who are eager
to return to the  embraces of their parents;  by foreigners  who
have a strong and inextinguishable love  for  their country,  and are
anxious to return to the scenes and the companions of former times :
and by the  jrouthful pair who have vowed an eternal attachment,
and are sure  that they cannot live without  each  other, but whose
union is opposed by bars that are  felt to be  insurmountable.   And
hence the present  variety includes the  three modifications of home-
sickness, country-sickness, and love-sickness.  The  first  is for the
most  part transitory; the second has sometimes, and  especially
among the Swiss, when their manners were simpler, and their do-
mestic virtues and feelings much stronger  than they seem  to have
been  of late years, produced not only a permanent melancholy but
hectic fever.  Yet  it  is to the third that our attention is chiefly
called on the present occasion, from the  greater frequency of  its
occurrence and the severer and more tragic effects to which it has
led, where obstacles have arisen in its progress.
  We have,  on the present occasion, nothing whatever to  do  with
the gross passion of concupiscence which is as different from that of
pure  and genuine love as light from darkness.   The man of lust
has indeed his love, but it is a love  that centres in himself and
seeks alone  his  own gratification: while  the passion we are now
speaking of puts self completely out of  the field, and would volunta-
rily submit to every pain and sacrifice,  even the loss of life itself in
promoting the happiness of the beloved object.   Yet,  constituted as
we are by nature for the wisest and best of purposes, a pure corpo-
real orgasm still inweaves itself with the sentimental desire, though
subordinate  to it in virtuous minds, and the flame is fed from a dou-
ble source.   " Nuptial love," says Lord Bacon, " maketh mankind ;
friendly love perfecteth it; but wanton love  corrupteth and emba-
seth it."*
   What  it is that first lights up this flame is of no importance to the
present subject.   A peculiar cast  of form or of features acknowledg-
ed  by all to be moulded according to the finesMltws of symmetry,
and productive of a high degree  of external grace or  beauty ;  or a
figure or a manner that to the eye of the enamoured beholder give^
"* Essays, No. X. 
GE. II.-SP. II.]        NERVOUS FUNCTION.
87
token  of a mind adorned  with all he  can wish  for; or  an  actual
knowledge, from long acquaintance, of the existence of  such inter-
nal cultivation and excellence, may be  equally causes of  the same
common effect.  And hence this is of  little or no account; for the
passion being once excited, the judgment runs a risk of being over-
powered by its warmth and violence ;  and the moment it is over-
powered, the new train of ideas that are let  loose  upon the  mind
are of a romantic character;  and as soon as any obstacle starts op as
a barrier in the vista of hope, instead of being damped or repressed,
they grow wilder and more vivid, till at length the sensorial system
is  worn out by the vehemence of its labour;  and though the excite-
ment is really less than  at first, because there is less vascular vigour
for its  support, it is still  greater than ever compared  with the
weakened state of the sentient organ.
   Yet love-sickness itself, whatever  mischief it  may work in the
corporeal frame, by sleepless nights, a feverish  pulse,  and loss of
appetite,* and however, from  the  exalted state of the imagination,
and the increased sensibility of the body, it may transpose the reali-
ty of life into a kind of visionary existence, and so far produce men-
tal derangement, rarely leads  to direct insanity so long as there is
the remotest hope of the  attainment of its  object.  But if hope be
suddenly cut off by an inexorable refusal, the intervention of a more
fortunate rival, the concealment of the object of adoration,  or any
other cause whatever, the  mind is sometimes incapable of resisting
the shock thus produced by the  concurrent yet opposite powers of
desire and despair; and in a moment in which the judgment is com-
pletely overwhelmed, the  love-sick  maniac calls to his aid the de-
moniacal  passion of revenge, and,  almost at hazard,  determines
upon a plan  of murder directed against his  rival, his mistress, or
himself.  The story of  Mr. Hackman  and  Miss Rae will at once,
perhaps, occur to the recollection of most of the author's readers in
proof of this assertion.   He himself had some acquaintance with the
former; and is convinced  from  what he knew of him that nothing
but a paroxysm of insanity could have urged him to so horrible an
act.
   The  operation of the passion of avarice when it has  once  ob-
tained  an ascendancy over the mind, is altogether of a different na-*
ture from that of the preceding  variety, though it often produces a
wider and more chronic alienation.  It  has not a stirring  property
of any kind belonging to it; but benumbs  and chills every energy
of the body as well as of the soul, like  the stream of Lethe ; even
the imagination is rendered cold and  stagnant; and the  only pas-
sions with which it forms a confederacy are the miserable train of
gloomy fear, suspicion, and anxiety.   The body grows thin in the
midst of wealth, the limbs totter though surrounded by cordials, and
* Schurig. Gyneaolog. p. 94.
  Horstius, An Pulsus aliquis amatorius concedendus ?
  Rilizer, De Natura Amoris. Gioss. 1611. 4to. 
88
NEUROTICA*
[CL. IV.-OR. 1.
the man voluntarily starves himself in the granary of plenty,  not
from a want of appetite, but from a dread  of giving way to it.  The
individual who is in such a state  of mind  must be estranged upon
this point, how much soever he may be at home upon others.  Yet
these are cases that are daily occurring, and have been in all ages:
though perhaps one of the  most curious is that related by Valerius
Maximus of a  miser who took advantage of a famine to sell a mouse
for two hundred pence aud then  famished himself with the  money
in his pocket*  And hence the madness  of  the covetous  man  has
been a subject of sarcasm  and ridicule by moralists  and dramatic
writers in every period, of which we have  sufficient examples in
the writings of Aristophanes, Lucian and Moliere.
   There is another mental feeling of a very afflictive, and, too often
like the last, of a chronic kind, which is  frequently found  to usurp
a dominion over the judgment, and to embitter life  with  false  and
visionary  ideas, and  that is  a habit of anxiety or preying care ;
which not only drives the individual who possesses it mad, but runs
the risk of doing  the same to all who are about him, and  are  ha-
rassed with his complaints and discontents.  This is  sometimes  the
effect of a long succession of misfortunes or vexatious  troubles ;  but
seems in some persons to depend on a very high degree of nervous
sensibility, united  with  a  choleric  or melancholic  temperament.
Their age,  wealth,  or situation in life  is  of no  importance,  and
though their digestive powers are good, and they are not hypochon-
driacs, they are always apprehensive and full of alarm, and flee from
every appearance of joy as they would from an apparition, or even
sooner.   In the language of Burton, who knew too well how to de-
scribe them, " The old are  full of aches in their bones, croups  and
convulsions; dull of-hearing, weak-sighted, hoary,wrinkled, harsh,
so much so that  they cannot  know  their own selves in a glass, a
burthen to themselves^and others.   If they be sound  they fear  dis-
eases ; if sick, weary of their lives.  One complains of want, a se ■
cond of servitude,  another of a secret or  incurable disease, of some
deformity of body,  of some loss, danger, death of friends, shipwreck,
persecution, imprisonment,  disgrace, repulse, contumely, calumny,
abuse, injury,  contempt, ingratitude, unkindness, scoffs, scouts,  un-
fortunate marriage, single life, too many children, no children, false
servants, unhappy children,  barrenness,  banishment, oppression,
frustrate hopes, ill  success ;

     Csetera de  genere hoc, adeo sunt multa, loquacem,
     Delassare valent Fabium.

In the mean time, continues the younger Democritus, " thus much I
may say of them, that generally they crucify the soul of man, atten-
uate eur bodies, dry them, wither them, rivel  them up like old  ap-
ples, and make them as so many  anatomies."!
Lib. vn. Cap. vi.
Anat. of Melancholv. Part T. Sect. n. Subs. x. 
GE. II.-SP. II.]
NERVOUS FUNCTION.
89
   Nothing can be more different than this constitutional pining, and
 the pains produced by heart-ache or the  reality of severe grief.
 The former is talkative and querulous;  the latter is dumb and flies
 from company.  The sensorial exhaustion  is  so  considerable that
 the mind,  with  its  attention upon  the full  stretch,  has  scarcely
 strength enough to collect the train of ideas on which alone it  re-
 solves to dwell; and  hence all conversation is irksome, the pres-
 ence of a friend disquieting, and the deepest  solitude is anxiously
 sought for.  And not unfrequently the discharge  of nervous power
 is so considerable and sudden as  to produce a general  torpor of the
 brain, which, if it do not happily terminate in quiet sleep, is the in-
 let of apoplexy.   Even in the former case  the inirritability of the
 nervous fibres continues to such  an  excess that the sufferer has no
 natural evacuation for perhaps several days,  feels no  hunger, can-
 not be persuaded to take food, is incapable  of sighing and sheds  no
 tears.   And hence the  appearance of  tears and  sighing are good
 omens, and are correctly regarded as such, since they show that the
 general  torpitude is giving  way  in the  organs that most  associate
 with this painful emotion of the  mind to a  slight  return of irrita-
 bility.  As soon as the flow of the sensorial principle  is a  little in-
 creased, the praecordia struggle with great anxiety, and the heart is
 overloaded and feels ready to break or  burst whence  the  name  of
 heart-ache,  so  appropriately applied  to this  variety  of suffering.
 Sometimes also, hysteric flatulency oppresses  the respiration, and
 convulsions, and, not unfrequently, death itself ensues.  Of this last
 effect Erndtl has given numerous instances.*  But if recovery should
 take place it is usually long before the judgment re-assumes its pro-
 per sway in the mind, and the temporary derangement altogether
 ceases.   At times, indeed, this never returns, and  the  pitiable suf-
 ferer only lives through the shock to endure the severer  evil  of
 confirmed insanity: of which Shakspeare has given us an admirable
 copy in the character of King Lear finely imagined to  be a result of
 filial ingratitude.
  Despair makes a near  approach to heart-ache in the overwhelm-
 ing agony it produces, and its pressing desire of gloom and solitude,
 but, generally speaking,  the feeling is  more  selfish, and  the  mind
 more hurried, and daring.   Despair, as it commonly shows itself, is
 utter hopelessness from  mortified pride, blasted expectations, or a
 sense of personal ruin ; heart-ache is either hopelessness from a sense
 of some social bereavement, or relative  ruin.  The gamester who
 cares for no one  but himself may rage  with  all the horror of des-
pair; but the heart-ache belongs  chiefly to the man  of a warmer
and more generous bosom, stung to the quick by a wound he feast
expected, or borne down, not by  the loss of fortune, but of a dear
friend or relation,  in whom he had concentrated all his hopes.   The
well-known  picture of  Beverley is drawn by  the hand of a master:
and he is represented as  maddened by the thought of the deep dis-
       *' Relatio de Morbis anno 1720 War«avije curati«.
VOL. III.                1- 
90
NEUROTICA.
[CL. IV.-OR. I.
tress into which his  last hazard  had plunged his  wife and family:
but if his selfish love of gaming had not  triumphed over  his rela-
tive love for those he had thus ruined he would not have been in-
volved in any such reverse.   While Beverley was in despair; it was
his wife who was broken hearted.
   The sources of this most agonizing emotion are enumerable, and
from the total shipwreck of all hope on which it is founded there i*
no passion of the mind that drives a man so readily to an act of sui-
cide.  To live is horror; the infuriated sufferer feels himself an
outcast from God and man, and though  his  judgment  may still be
correct upon other subjects, it is completely overpowered upon that
of his actual distress, and all  he thinks of and aims  at is to with-
draw with as much speed as possible from the present state of tor-
ture, totally regardless of the future, or falsely satisfying himself by
a perversion of his  judgment, that  there is no crime  in his doing
so.
   One of the severest causes of despondency is a conscience la-
bouring under a deep sense of guilt for some

                        undivulge'd crime
          Unwhipt of justice.

And so severe has the  anguish been, in many cases,  that the tor-
mented wretch thus  haunted by himself, and hating  the  light of
heaven,  has  been compelled, as the less evil of the  two, to sur-
render himself to the laws of his country,  and court  the disgrace
of a public execution.  Yet the same miserable feeling has some-
times followed from  an ideal cause, especially in  a mind of natural
timidity, or constitutionally predisposed to a gloomy view of nature.
For such, by a mere exercise  of their own  meditations, but far oft-
ener by the coarse, but impassioned oratory of itinerant preachers,
are induced to believe that the Almighty .has shut them out for ever
from the pale of mercy, and that the bottomless  pit is yawning to
receive them.  And under the influence of such an impression they
too frequently work  themselves up into a state of permanent insani-
ty, or hurry themselves by their own hands into the horrors of a fate
from which they feel assured that no repentance 6r power  of reli-
gion can save them.
   In all these varieties of empathema the art of the  physician can
do but little, and in  many of them  nothing whatever.  Yet where
the heart suffers acutely and the mind is deeply  dejected, sedative*
and antispasmodic cordials may occasionally be found  useful; and,
as the abdominal viscera are greatly liable  to be affected, the appe-
tite to fail, the liver to be congested, and the bowels  rendered cos-
tive, these organs must be watched, and such relief be afforded at
they may stand in need of.  When aperients are required the warm
and bitter resins  will generally answer the  purpose best, alone or
combined with rhubarb.  Where love is the  cause of disease, and
the fair patient is young and delicate, suppressed  menstruation, or
even chlorosis is by  no means unfrequent, followed by  hysteria and
other nervous affections that produce considerable trouble. 
GE. n.-SP. II.]
NERVOUS FUNCTION.
91
    In all cases of mental  dejection, however, a kind  and judicious
 friend is  by far the best physician:  medicines  may do a little,
 change of scene and country,  of custom and  manners, a little also;
 but the soothing of tenderness and indulgence, and the voice of that
 friendship which knows how to discriminate opportunities, and  sea-
 sonably to alternate  admonition  with consolation  will accomplish
 more in the way of cure than all the rest put together.   The  des-
 pondency produced by the  real sense of a guilty conscience or  the
 visionary belief of eternal  reprobation,  may  derive important  and
 most salutary advantage from religious instruction   when conducted
 with a judicious attention to the exigency of the  case.   But much
 circumspection and adroitness are requisite upon this  point, for so
 rooted is the feeling to be  extirpated that no ordinary  means will
 suffice for its eradication, while, if it be forcibly snapped off, it will
 shoot out the wider and grow*ranker than ever.
    The excitement of an opposite passion, or train  of feelings, has
 sometimes been accompanied with success : for there  are instances
 in which the slave of imaginary pain and misery has  for ever  for-
 gotten his sense of visionary grievances under the stroke of poignant
 and real affliction; and the miser,  when reduced b}'  a  sudden  re-
 verse of  fortune to actual beggary, and thus completely disencum-
 bered of the load that has hitherto so much oppressed  him, has re-
 turned to his sober senses, and learned a juster estimate of worldly
 possessions.
   The same attempt  has often been recommended in  disappoint-
 ments under the passion of love; and, according to  the  concurrent
 report of  the poets of ancient and  modern times,  many of whom
 profess to be well versed in this kind of discipline, it has very  ge-
 nerally been attended with success.  Where the emotion has more
 of a corporeal than a sentimental origin, this  may  easily  be con-
 ceived ; and it is possible that it may also sometimes have occurred
 under a purer feeling: though, for the honour of the human heart, I
 do not think this is much to be trusted to.  Where the  choice between
 two young persons of fair character is  really imprudent,  yet  the
 affections are so  rivetted as to bid defiance  to all forcible attempts
 to unfetter them, a promise of consent on the part of the  reluctant
 parent at the distance of a given period of time, as  a  year and  a
 half or two years, with an  undertaking on  the  part of the lovers
 neither to see or correspond with each other in the mean time, an
 engagement  easily  fallen into, has answered in many instances to
 which I have been privy.   The ardour has gradually cooled on the
 one side or the other, the judgment has been more  impressed with
 the nature of the imprudence, or a more attractive  form has inter-
 posed, and settled the question  irretrievably.  While,  on  the con-
 trary, if the fidelity should  hold  on both sides to the end, and the
 passion be heightened instead of depressed, as in this  case  there is
 most reason to suppose it would be, hard, indeed, must be the heart
 that would extend the  restriction farther, and  that would  not wish
joy to so deserving a couplp. 
92                     NEUROTICA.              [CL.IV.-OK. I.


                        SPECIES III.

                EMPATHEMA INANE.

                  Hare=brafurtr ftasston.

WAYWARD  AND UNMEANING  PASSION, URGING TO INDISCRIMINATE ACTS  Of
  VIOLENCE :   AIR HURRIED AND TUMULTUOUS ;  COUNTENANCE  FLUSHED J
  EYES GLARING AND PROMINENT.

This is  the manie sans delire of M. Pinel: a case of frequent occur-
rence but  incorrectly named in this manner since, in the opinion of
all other nosologists, and perhaps all other pathological writers, the
character  of delirium (that is of diseased judgment, diseased percep-
tion or both) is essential to mania.
  M. Pinel ascribes this species principally, and with great force of
reason, to  a neglected or ill-directed education upon a mind natural-
ly perverse or  unruly : and gives the following striking example :
An only son  of a weak and indulgent mother, was encouraged in the
gratification  of every caprice and passion of which an untutored and
violent temper was susceptible.   The impetuosity of his disposition
increased  with his years.  At school he was  always embroiled in
disputes and quarrels; and if a dog or a horse  offended him he in-
stantly put it to death. This wayward youth, however,  when un-
moved by passions, possessed a perfectly sound judgment.  When
he came of age, he proved  himself fully competent to the manage-
ment of his family  estate as  well as to the discharge of his relative
duties, and even distinguished himself by acts of beneficence and
compassion.   But his deep-rooted propensity to quarrel still haunted
him, and wounds, law-suits,  and  pecuniary compensations were the
general consequence.  At last an act  of notoriety put an end to hi6
career of  violence.  Enraged at a woman who had  used offensive
language to  him, he tumbled her into a well.   A public prosecution
followed,  and, on the  testimony of a great many witnesses who de-
posed as to his furious deportment, he was condemned to perpetual
confinement at the lunatic asylum of Bicetre.
  On the  commencement of the  French revolution,  when the mob
broke  open the doors of the prisons and the lunatic hospitals, to
liberate all  whom they  thought unjustly confined  and  under re-
straint, a patient labouring under the present species in the Bicetre
asylum, pleaded his own  cause so  rationally,  and pathetically, and
so artfully accused the governor of  the asylum of cruelty, that the
armed rabble commanded him to be instantly liberated, and scarcely
suffered the governor to  escape with impunity.  The patient thus
restored to freedom was led about in triumph amidst the reiterated
shouts of  vive la republique.  The  sight  of  so many armed  men,
their loud and confused noise and  tumultuous  conduct, soon roused 
GE. II.-SP. HI.]        NERVOUS FUNCTION.                  93

the visionary hero to a fresh paroxysm of fury.  He seized, with a
vigorous grasp, the sabre of his next neighbour, brandished it about
with great violence, and wounded  his liberators indiscriminately.
Fortunately he was  soon mastered ; when the savage  mob thought
proper to lead him back to his cell, and with shame and reluctance
acknowledged their own ignorance and misconduct.
   The  mode of treatment  may be collected from the preceding
pages.
                     GENUS  III.

                         ALUSIA.

                 Xllusum.   f^aliuctuatum.

THE JUDGMENT  PERVERTED OR  OVERPOWERED  BY THE  FORCE OF THE
  IMAGINATION ;  THE SPIRITS PERMANENTLY ELEVATED OR DEPRESSED ;
  THE FEELINGS  OF THE MIND DEPICTED IN THE COUNTENANCE.

Aiusia  is here  derived from the  Greek aAwnj, "oberratio," from
aXvu,  " errabunda mente  afficior,"—" inquietus oberro:" whence
the Latin term  allucinatio or hallucinatio.   According to the rule
which renders the Greek v, by the Latin y, the name of this genus
«ught rather perhaps to be alysis; but as the Latins have themselves
retained the v in allucinatio, it is here suffered to continue in aiusia,
making a similar exception  to that already observed in lues.   The
Greek term is preferred to the Latin, as the name of the genus for
the sake of uniformity.   Sauvages, and after  him Sagar, have em-
ployed hallucinatio as the name of an order ; Darwin and Crichton as
that of a genus,  and, consequently,  running parallel with the genus be-
fore us.  Whenever the genus exists, hypochondrias or hypochon-
driasis is usually placed under it.  It is so by Sauvages, Sagar, and
Crichton; and it occupies  the same place in Linne'us, who has mere
ly adopted  the term imaginarii instead of hallucinationes.
  Aiusia embraces the two following species:

1. ALUSIA ELATIO.                       SENTIMENTALISM.
                                      MENTAL EXTRAVAGANCE.
2.------HYPOCHONDRIAS.                HYPOCHONDRISM.
                                      LOW SPIRITS. 
94                       NEUROTICA.            [CL. 1V.-OR. I.


                         SPECIES r.

                    ALUSIA  ELATIO.

        Scnttmcntalfsm.   Rental 33*tt:abaflaucr

ROMANTIC IDEAS OF  REAL  LIFE ;  ARDENT  AND EXALTED FANCY ;  PLEA-
  SURABLE  FEELINGS ;  FREQUENT PULSE ; GREAT ACTIVITY ;  EYE KEEN
  AND LIGHTED UP ;  COUNTENANCE CONFIDENT AND ANIMATED.

The merit or  demerit of this species, named from the  rhetoricians
elatio, and  with  them  importing " elevated, exalted, magnificent
style  or imagery," must,  I fear, mainly rest with the author himself.
It is, however, strictly derived from nature, and  is  intended to fill
up what has hitherto been left as a vacant niche by  the nosologists.
Aiusia, or hallucination, like ecphronia or insanity, comprises a list
of affections that are characterized  by two opposite states of ner-
vous action, entonic and atonic, or in the language  of Dr. Cullen ex-
citement and collapse ; elatio is intended  to include the former of
these, as hypochondrias,  the ensuing species, is,  the latter.  They
stand  in the same relation to  each other as elevated and  dejected
madness or melancholy.   Both are united with a peculiar modifica-
tion of the  digestive function, but possessing  opposite bearings;
being in the former strikingly active and energetic, and in the latter
strikingly sluggish and languid.  Hence under the first species the
patient is able to endure enormous fastings, and to  support life upon
the scantiest and least nutritive diet, either of which would be de-
structive under the second.
  This species embraces the following varieties :—

    m Heroica.                   Chivalry.  Romantic gallantry.
    £ Facetosa.                   Crack-brained  wit.
    <y. Ecstatica.                  False Inspiration.
    3  Fanatica.                   Fanaticism.

  The age of  the first of these varieties, that of chivalry or roman-
tic gallantry, has nearly, if  not  altogether,  departed.  It may be
regarded a generous and  high spirited flight of the imagination that
gives  a visionary colouring to the  external  world, and combines,
without a due  degree of  discrimination, ideas of fact with those of
fancy.   Like many of the varieties of empathema or ungovernable
passion it may lead to or  be combined with ecphronia or insanity.
  1 have  sometimes had to attend patients who  having  spent the
greater part of their days and nights over the most captivating novels
of the present day,  had acquired so much of this falsity of percep-
tion as  to startle  their friends around  them, and to give evident
proofs that they were of a mind occasionally deranged, though,  when
the attention  could  once be  seriously engaged,  capable of being 
GE. IH.-SP. I.]
NERVOUS FUNCTION.
95
brought down to the soherness of external  objects and real  life.
These have commonly been ladies unmarried, or without a family,
about the middle or a little beyond the middle of life, of a nervous
temperament, fine taste and fancy, but  whose education had been
directed to subjects of superficial or external ornament rather than
of intrinsic excellence.  Their manner has been peculiarly courte-
ous, their conversation sprightly and  figurative, and  their hand
ready to aid  the distrest.   But it has been obvious that in all thev
were saying or doing they had some ideal character in their minds
whose supposed  air, and  language, and manners,  they  were copy-
ing ; and the distrest were always most sure of relief and of a relief
often beyond  the necessity of the case, whose story was combined
with some perilous adventure, or sentimental catastrophe.
   In former times,  however,  when  the  wild and daring spirit of
romance formed the subject of popular study and

           The spinsters and the knitters in the sun,
           And the free maids that wove their threads with bones
           Were won* to chaunt it.

this bewildering triumph of the imagination over the judgment
was <ar more common and carried to a much higher  pitch.  The
high-toned  and marvellous stories of La  Morte d'Arthur,  Guy of
Warwick, Amadis of Gaul, The Seven Champions of Christendome,
and The Mirror of Knighthood; the splendid and agitating alterna-
tions of magicians, enchanted castles, dragons, and giants, redoubta-
ble combatants, imprisoned damsels, melting minstrelsy,  tilts  and
 tournaments, and all the magnificent imagery  of the same  kind,
 that so  peculiarly distinguished the  reign of Elizabeth, became a
 very frequent source of permanent hallucination.  The historian of
 Don Quixote adhered strictly to the tenor of his times in represent-
 ing the library  of this most renowned knight as filled with romances
 of this description, and himself as being  permanently  crazed by an
 uninterrupted perusal of them.   And that the same morbid effect was
 not confined to  Spain, and was, indeed, common to our own country,
 we know from the severe, but just invectives of Ascham against  this  »
 class of writings, and his complaints of the disordered  turn they  had
 given to the public mind : and still more from the necessity Shakes-
 peare  felt  himself under in making all his maniacal  characters,
 whether really or  but  pretendedly so, deeply versed  in the prose
 or poetical romances of  the day, and throwing  forth fragments of
 exquisite force  or beauty in  the midst of their wildest and most  dis-
 cordant ravings ; Lear, Edgar, and the heart-broken Ophelia are in
 this respect alike gifted, and show to what sources  their  reading
 had been directed.  Without an attention to these casual glances it
 is impossible to understand the  meaning of the sentiment,  and its
 force  or feeling is lostfupon us; as in  the following burst of Ophelia,
 which consists of a string of quotations or allusions to picturesque
customs: 
 96                      NEUROTICA.             [CL. IV.—OR. I.

      " You must sing Down a-doim an you call him adown-a.  O, how the
        wheel becomes it! It is the false steward that stole his master's daughter."

 We have not space for the explanation, but it may be found in the
 commentators, or in the interesting and elaborate history of" Shaks-
 peare's Times," by my early and valued friend Dr. Drake.
   The second variety of the present species, that of crack-brained
 wit, is derived rather from  the peculiar temperameut of the indi-
 vidual,  than  from  any  particular habit or train  of  reading; for
 in  general  few persons  have given themselves less time to read,
 study or even think, than those who are  possest by it.   It is charac-
 terized by high spirits,  a sportive and rampant imagination, and a
 flow of facetious ebullient wit incapable of restraining itself.  It is
 hence often poured forth on  most improper occasions,  and hesitates
 not to «acr.fice a friend at the shrine of a jest.
   There are some  persons who possess by nature so  perpetual  a
 tide of excitement that their high spirits seem seldom or never to
 ebb, and so irresistible  a  propensity to this kind of verbal merri-
 ment that  no  change of circumstances can deprive  them  of it.
 Sir Thomas More, who perhaps  overflowed with  this  disposition in
 a very high degree, is well known to  have been facetious on his
 own scaffold.
   It is not  always however, nor as we  have just observed, even for
 the most part,  that the man of ready wit, is like Sir Thomas More,
 a  man  of ready judgment, or sound learning.  The apprehension
necessary to constitute the one is widely different from that neces-
sary to constitute the other, as we had occasion  to remark under  a
former  genus: and hence vivacious  sallies,  taunts, and repartees
not only may co-exist with a deranged  condition  of mind, but are
frequently  a result of it.   And on this account the court jester of
former  times,  whose  office  succeeded  to that  of minstrel, was
commonly  denominated  the  king's fool, as uttering from  the un-
bridled liberty of speech that wis allowed  him, humorous flashes of
rebuke  which no man in  his sober senses  would have ventured upon ;
and  which  seemed,  to adopt the language of Jaques,  who was
himself not unjustly accused  of wearing the same liverv, to show
that
                      in his brain
           Which is as dry  as the remainder biscuit
           After a voyage, he hath strange places crarnni'd
           With observations, the which he vents
           In mangled forms.

   The  third  variety, or ecstatic illusion, is  also a  pleasurable
hallucination:  and  consists in a  sense  of false  inspiration, or a
visionary boast of some preternatural endowment, in the course of
which the judgment is so far perverted as  to mistake the energetic
notions  of  the  imagination for realities; *o that the victim  of the
delusion believes in apparitions,  affects an intercourse  with the
world of spirits, or lays claim to  a power of working miracles. 
OE. III.-SP. I.]
NERVOUS FUNCTION.
97
   This morbid afflatus has often been aped by cunning impostors tn
serve their own interests with the multitude :  and there is no great
difficulty in conceiving that it is in  many cases a real and  serious
hallucination, when we reflect on the ease with which such  impos-
tors themselves are capable of deluding the populace, and working
them up into false ecstasies,  and  especially of inveigling them into
a hearty belief of their own miraculous powers.   When the passions
of men are  once set afloat, and the subject presented to them is full
of the marvellous and the terrible, they are too apt to confound the
false with  the real, and are prepared  to proceed to  whatever
extremities the magician may choose to  lead them.   We are told
by Lucian  that when Archelaus, a celebrated Greek actor, perform-
ed the  part of Andromeda in the tragedy of Euripides, several of
the spectators were  seized with delirium ; some at the time of
performance,  others a  day or two  afterwards;  during which  they
did nothing but declaim in a  theatrical manner, and  piteously
lament the  fate of the persecuted princess.  Burton, therefore, has
some reason for remarking that  what the impostors before us, or
the brain-sick enthusiasts whom they imitate,  once broach and set
on  foot, " be it never so absurd, false, and prodigious the common
people  will follow and believe.   It will run like murrain  in cattle,
scab in sheep.  Nulla  scabies superstitione scabior; as he that is
bitten by a mad dog bites others, and all in the  end become  mad.
Either out  of affection of novelty, simplicity,  blind zeal,  hope and
fear, the  giddy headed multitude will  embrace it,  and without
farther examination approve it."*
   The genuine enthusiast is always possest of a warm imagination,
and generally of a nervous temperament, and delicate frame;
and a long series  of elevated  abstraction on  religious subjects
combined with protracted fasting has  ordinarily been the harbinger
of  the  fancied  afflatus.   Such was the  discipline by which  the
lovely and  blooming  and sincerely devout Saint Teresa  was pre-
pared for ecstacies and visions, and led to  impose upon herself and
all  that beheld her; and seriously to  believe, in the fervour of her
mind, that her body was lifted from the earth : and that she heard
the voice of God, saw our Lord with St. Peter  and St. Paul standing
on her left hand; by the first of whom the cross  which was at the
end of her beads was miraculously transformed into four large gems,
incomparably  more  precious than diamonds;  with  many  other
marvellous revelations which we cannot find room to detail.  Though
it should be noticed that devils  appeared to her as well as  blessed
spirits,  whom she always kept  at a distance by  sprinkling  holy
water;  and that she was an  eye-witness  to the joyful escape from
the flame of purgatory of the purified souls of father Peter of Alcan-
tara, father  lvagnez, and a Carmelite  friar.t
  It is not necessar}' to produce other examples, though many might

        *  Anatomy of Melancholy.  Part m. Sect. iv.  1. 3.
        t Butler's Lives of the Saints, in loco.
  VOL. III.                     13 
  98                      NEUROTICA.            [CL. IV.-OR. I.

  be brought from our own times.  A  cure  is extremely difficult to
  be  obtained;  and I am afraid that  even  Mr. Locke's admirable
  chapter  on Enthusiasm would be  read to no  purpose.   In one
  instance the enthusiast seems to have been brought home to himself
  by  a pleasant and  ingenious  stratagem  of his  superintendant  at
  Venice.  This  visionary had  conceited  himself  to be  Elias, and
  like the  prophet, had determined upon fasting  forty days.  The
  keeper fearful that he  would  never hold  out, and that he should
  lose his patient,  dressed up a  man in the  attire  of an angel, who
 was  introduced to him  fti no  ordinary manner, and informed him
 that he was commissioned from heaven to bring him food.  The
 supposititious Elias took it,  was afterwards allowed to find out the
 trick, and thus, at the same time, found out his own imposition upon
 himself.
   From the influence which  we have seen  such enthusiasts, or
 even pretended enthusiasts, capable of producing upon the mind of
 the multitude when roused by the solemnity and  awfulness of the
 revelations that are supposed to be disclosed to them, we can easily
 see how fanaticism, constituting the fourth variety of the present
 species, may obtain  an  ascendancy,  and  even rage  with all the
 ramifying power of an epidemic: consisting of religious flights of
 the imagination, predominant  over the  natural feelings as well as
 the judgment, excited by the calls or doctrines of those who  affect
 to  be preternaturally gifted, or who possess  an  equal  influence
 over the mind by the high sanction of priesthood, profound learning,
 or  any other respected authority : and often urging to a voluntary
 and inappropriate  submission  to severe privations, mortifications,
 and tortures; or to the torture  and massacre of those who profess
 different creeds.
   Examples as in the last variety, may be found in every age and
 religion, but chiefly  in  times  of  gross ignorance and barbarism ;
.where the general mind has been too little informed to distinguish
 between truth  and sophistry, and the passions have  been  undisci-
 plined to restraint.   It is hence  of no importance  what religion or
 superstition is  to be inculcated^ for those  that are true and  those
 that  are false  have been  equally laid hold of by enthusiasts and
 impostors to produce the same  end, and effect the same triumph by
 means and machinery that could only be furnished from the infernal
 regions.  Hence  the blood and raving  of  the prophets  of Baal;
 the Curetes or Phrygian priests, and the delirious votaries of the
 Indian Juggernaut; the cruel and senseless penances  and  punish-
 ments sustained in many  of the convents and nunneries of Lamism,
 and s^till more so in those  of many catholic countries.  Hence the
 terrible sufferings of the  Waldenses, the furies of St. Bartholomew's
 day, the fires of Smithfield, and  the dark and doleful cells, the whips,
 and wires, and pincers, and pullies, and all the infernal parapher-
 nalia of the Inquisition.   Hence,  in ancient times, the matrons of
 Canaan and of Carthage were instigated to throw their own children
 into the flames, and sacrifice them to the  gloomy deity  whose anger 
GE. HI.—SP. I.]        NERVOUS  FUNCTION.                  99

it was held necessary to appease ; and hence in more modern days,
Philip II. of Spain, was goaded to impeach a son, of whom he  was
little worthy,  before the Chamber of Inquisitors, to bespeak their
condemnation  of him,  and to take effectual care that he should be
poisoned, as soon as his sentence had been pronounced.
  The cure of these diseases belongs rather to colleges of general
instruction than of medicine.  Individual  cases -of enthusiasm  and
fanaticism have existed, and will probably continue to exist, in all
ages; but  when the general  mind is well informed, and the social
feelings and virtues, are duly estimated and widely cultivated, the
wild-fire will burn in vain, and meet with little or no fuel to support
its rage.
                         SPECIES  II.

            ALUSIA  HYPOCHONDRIAS.

             H?gjiocfiottTrrtem.   SLoto Sjrtrfts.

OLOOMY IDEAS OF REAL LIFE ; DEJECTED SPIRITS J ANXIETY ;  DYSPEPSY J
  LANGUID PULSE ; INDISPOSITION TO ACTIVITY ; EYE OBLIQUE AND SCOWL-
  ING J COUNTENANCE SAD AND SULLEN.

The term  hypochondrias  is taken from the anatomical compound
hypochondria, to which region the disease was formerly supposed to
be  altogether  confined.   Hypochondrias  is here  used instead of
hypochondriasis, the common name, because, as already observed
on various occasions, iasis as a termination is  limited, nearly with
this single exception, to denote in the medical vocabulary a peculiar
family of cutaneous diseases, as pityriasis, psoriasis, ichthyiasis, and
many others.  The author has felt the less difficulty in proposing
this change, as hypochondriasis is of comparatively modern invention,
and is not to be met  with  in theGreek or Latin writers;  by whom
the complaint  is usually  alluded to or described  as a species of
melancholy, or rather as a disease of the melancholic temperament.
  It constitutes the third sort or species of this malady described by
Galen, and which he regards as connected  with  a  peculiar state of
the stomach ; though, from its mental symptoms, he does not incline
to contemplate it as Diocles, a contemporary physician of reputation,
had done in his Book on Gastric affections, as a simple disease of
this organ.   The controversy has been in different times  continued
to our own day; and it  does not seem  to  be even yet universally
settled whether hypochondrias should  be regarded as a mental or a
dyspeptic malady.  In Pinel the disease  seems to be included under
alitnation mentale, and its different varieties to be  distributed, though
without particular remark, amidst the five species into which he has
divided that genus. 
100                     NEUROTICA.           [CL. IV.-OR. I.

  The present species bears so near a resemblance to several of the
varieties of genuine melancholy as to be often distinguishable from
them  with great difficulty;  and the more so as it is no uncommon
thing  for hypochondrias to terminate in melancholy, or for melan-
choly to be combined with hypochondrias.   Both may be the result
of a predisposing constitution, or may be primarily induced by acci-
dental causes where no such constitution exists: and the predisposi-
tion and  the accidental causes of the one may become those of the
other: for the temperament known  by the common name of melan-
cholic, and characterised by a lean and dry corporeal texture, small
and rigid muscles, a sallow skin, brownish-yellow complexion, little
relieved by redness of any kind, deep-black  and  coarse hair,  eyes
sunk in hollow  sockets,  large prominent  veins,  especially  in the
hands and arms, with  a tendency to  solitude  and private musing,  is
a common precursor of both.  And  in like manner a sedentary life
of any kind, and especially severe  study protracted to a late hour
in the night, and rarely relieved by  social intercourse,  exercise,  or
nugatory amusements ; a debauched  and dissolute habit, or excesses
in eating and drinking, may become causes of either of these mala-
dies,  from accessory circumstances  that cannot be traced out even
where the predisponent  temperament does not seem to exist.  But
it is  very justly observed by Sir A. Crichton, that even in  those
" whose  health is much deranged, true  melancholy seldom  arises,
except mental  causes of grief and  distress  join  themselves to the
corporeal ones : and this constitutes one of the characters  which
distinguishes  melancholia vera from hypochondriasis.  The former
may be said to be always excited by mental  causes, and consists in
various  phaenomena of grief,  despondency,  and  despair;  whereas
the latter most commonly arises from corporeal causes, and its men-
tal phaenomena consist  of erroneous ideas  entertained about the
patient's  own make or body."*
  The corporeal causes are usually a diseased emotion of one  or
more  of the digestive organs,  and especially, as we shall presently
have  to observe, a displacement of  some part of the  colon.  It is
also not unfrequently a result of the  sudden cessation  of some perio-
dical  or other habitual discharge, as that of an issue,  or of a hemor-
rhoidal flux, a chronic ulcer, or some external eruption.
  The melancholy man seldom lives long,  and his disorder often
commences  in the meridian of life.   He frequently  terminates  his
days  by  violence,  or at  the  utmost never  attains  old  age.   The
hypochondriac  seldom becomes affected till after the  meridian of
life, and  very generally  continues to the stage of longevity.
  The common corporeal symptoms are a troublesome flatulency in
the stomach or bowels, acrid eructations, costiveness, a copious dis-
charge of pale urine,  spasmodic pains in the head and other parts
of the body, giddiness, dimness of sight, palpitations, general  sleep-
lessness,  and an utter inability of fixing the attention upon any sub-
* Of Mpntal Derangement, Vol. in. p. 2D5. 
GE. III.-SP. II.]
NERVOUS FUNCTION.
101
 ject of importance,  or engaging in any thing that demands vigour
 or courage.   The mental feelings, and peculiar trains of ideas that
 haunt the imagination and  overwhelm the judgment, exhibit an in-
 finite  diversity, and lay a foundation for the three following varie-
 ties :
          « Autalgica.             Vapours.
          C Pertaesa.              Weariness of life.
          y Misanthropica.         Misanthropy.  Spleen.

   In the  first variety, which is commonly distinguished by the
 name of vapours, or  low spirits,  the patient is tormented with a
 visionary or exaggerated sense  of pains or some concealed disease;
 a whimsical  dislike of particular persons,  places,  or things; or
 groundless apprehensions of personal danger or poverty.
   Greding- gives an account of a medical  practitioner who applied
 to him for assistance, under an impression  that his stomach w as filled
 with frogs, which had been successively spawning ever since he had
 bathed, when a boy, in a pool  in which he  had perceived a few
 tadpoles.  He had  spent his life in trying to expel this  imaginary
 evil, and  had  travelled to numerous places to consult the first phy-
 sicians of the  day  upon his obstinate malady.  It was  in vain to
 attempt convincing  him that the gurglings or borborygmi he heard
 were  from extricated and erratic wind.*  He argued himself, says
 M. Greding,  into a great passion in my presence, and asked me if I
 did not hear the frogs croak.
   I have at this moment under my care, a hypochondriac  of about
 fifty years of age,  who  affords sufficient proof that Moliere drew his
 Malade  Imaginaire from nature, and hardly added an exaggerating
 touch.  His profession is that of the law; his life has been uniformly
 regular, but far too sedentary and studious; without having any one
 clearly marked corporeal affection, he is constantly dreading every
 disease in the bills of mortality, and complaining one after another
 of every organ in his body; to each of which he points in succession
 as its seat: especially the head, the heart, and the testes.   He now
 suspects he is going to  have a cataract, and now frightens himself
 with  an  apprehension  of an involuntary seminal emission.   It is
 rarely that I  have left him half an hour, but I have a note  to inform
 me of some symptom he had forgotten to mention, and I have often
 five or six of these in the course of the day.   The last was to  state
 that shortly after my visit he had had  a discharge of three drops of
 blood  from the nose—a change which he thought of great impor-
 tance,  and requiring immediate attention.  His imaginary symptoms,
 however, soon  disappear, provided they are listened to with gravity
 and pretended to be prescribed for; but not otherwise.  Yet in disap-
 pearing  they only yield to  others that can  only be surmounted in
 like  manner.   His head is too much confused to allow  him to en-
 gage in any serious study, even if it were prudent to recommend it
 to him : but on all common subjects he is  perfectly clear, and will
converse  with  shrewdness and a considerable extent  of knowledge. 
102
NEUROTICA.
[CL. IV.-OR. I.
His  bowels' are sluggish:  his appetite not good, though he eats
sufficiently; his sleep  is  unquiet, but he has  enough  of it with-
out opiates ; his pulse is variable, sometimes hurrying on  abruptly,
and  without any obvious  cause, to a hundred strokes in a minute,
but often very little quicker than in  a state of health.  His tongue
varies equally, and is irregularly clean, milky,  and brownish, and
then  suddenly clean again.  He is irritable in his temper, though
he labours to be calm;  and is so rooted to his chamber that it is diffi-
cult to drag him from it.  He has now been ill about ten weeks, but
it is during the winter, and the season is too severe and inclement
for him to venture abroad.  I look forward to his restoration in the
spring from exercise, change of air, and a course of tonic medicines.
1 have not found him  complain of dysphagia globosa,  or that sense
of suffocation from the feeling of a constringing ball in the throat
which is so common to hysteric patients,  and which, from its being
often also traced in the present disease, has been called by Pechlin
suffocatio hyochondriaca ;*  but his spirits are in a state of almost
perpetual depression.
  The whims that are sometimes seriously  entertained under this
variety of the disease, are so truly ludicrous that " to be grave ex-
ceeds all power of face."   One thinks himself a  giant, another a
dwarf; one is as heavy as lead, another as light as  a feather.  Mar-
cellus Donatus makes  mention of a baker of Ferrara  who thought
himself a lump of butter, and durst not sit in the sun nor come hear
the fire for fear of being  melted.  They are all extremely timid,
and their fears are exercised upon trifles, or are altogether ground-
less.  Some suspect  their  nearest and dearest friends of designing
to  poison them : others dare  not be alone in the dark lest they
should be attacked with ghosts or hobgoblins.   They dare not  go
over a bridge or near a pool,  rock, or steep  hill,  lest they should
be tempted to  hang,  drown, or precipitate themselves :  and if they
come to  a place where a robbery or  a murder has  been  committed,
they instantly fear they are suspected.  Trincavellius had  a patient
that  for  three years together, could not be persuaded  but that  he
had killed a man,  and  at length sunk into a confirmed melancholy,
and made away with himself for fear of the gallows.T
  It is a  melancholy  reflection that the wisest and  best of mankind
are as open to this affliction as the weakest, and perhaps  more  so.
Pascal himself was at one time so hallucinated with hypochondrism,
as  to believe that  he was  always on the verge of an abyss into
which he was in danger of falling.   And under the influence of this
terror, he would never sit down till a chair was placed on  that side
of him on which he thought he saw it, and thus proved the floor to
be substantial.
|i. Under the second, variety we meet  with a totally distinct set of
morbid feelings and ideas;  for the patient is here oppressed with a
* Lib. I. Obs. 31.
t Consil. an. Lib. I. 
GE. IH.-SP. II.]
NERVOUS FUNCTION.
103
general  listlessness and disgust: an irksomeness and  weariness of
lite, often without any specific reason whatever.   This is the me
lancholia Anglica of  Sauvages, who describes it as common to our
own countrymen under the attack of which, says he, " languid, sor-
rowful,  tired of remedies of every  kind, they settle  their affairs,
make  their  wills,  take leave of their friends by letters,  and then
put an end to their lives by hanging, poison, or some other means:
exhibiting a wish to  die, not  from insanity,  or  severe grief, but
tranquilly, from a mere taedium vitae, or irksomeness of existence."
This may occasionally be the case; but  by far the greater number
of suicides in our own country proceed, not from  hypochondrism,
but a despondency  produced by real losses, and belong, therefore,
as I have already  observed, to  the genus empathema.  Yet this
miserable upshot occurs in a few instances  from the feeling, or
rather the  want of feeling here assigned :  the perpetrators  of the
horrid deed being generally those who having  been actively en-
gaged in the heigh-day and meridian  of  life, have  retired upon
their fortunes with a view of enjoying them in quiet; but who un-
happily  find themselves fitted for any thing rather than for quiet;
who have no taste for reading, reflexion,  or domestic tranquillity,
and are too proud to return to the bustle of the world  and the ex-
citement of Mcely balanced speculations.  There is here a want of
the habitual stimulus to a secretion of sensorial  power ; in conse-
quence of which, the individual sinks into  a state of low spirits and
becomes unhappy.  A like  issue frequently follows upon a life de-
voted to all the  pursuits of sensual gratification, in the  course of
which the individual  has exhausted his stock of enjoyments, and
worn out his powers of body and mind before he  has reached little
more than the midway of his existence.   Every thing now palls up-
on his senses, and he  has neither taste nor energy to engage in more
rational pursuits.  " A ride out in the morning, and a warm parlour
and a pack of cards in the afternoon are  all that life affords," said a
patient of Dr. Darwin's to him, a man of  polished manners,  about
fifty years of age.  He got tired of these in a few months, and hav-
ing no other resource, shot himself.*
   Burton has well described the state of mind of many that are tor-
.mented with this most wretched  malady :f  but still more so those
affected  with the third  variety, which is strikingly accompanied
with peevishness, general malevolence, and an abhorrence of man-
kind.   " They are soon tired with  all things; they will now tarry,
now be gone; now in  bed they will rise, now up, then go to bed;
now pleased, and then again  displeased; now they like,  by and by
dislike all, weary of all; sequitur nunc vivendi nunc moriendi cupi-
do, saith Aurelianus :\ discontented, disquieted;  upon  every light
* Zoonom. Vol. iv. p. 90. Edit. Svo.
t Analysis of Melanch. Part I. Sect. Hi. i. 2.
i Lib. i. Cap. vi. 
104
NEUROTICA.
[CL. IV.-OR. I.
 occasion or no occasion object; often tempted to make away with
 themselves; they cannot die,  they will  not  live: they complain,
 weep, lament, and  think they lead  a most miserable  life :  never
 was any man so  bad.  Every poor man  they see  is most  fortunate
 in respect of them : every beggar that comes to the door is happier
 than they are ; jealousy and suspicion are common symptoms in the
 misanthropic variety.  They are testy, pettish, peevish, distrustful,
 apt to mistake, and ready to snarl upon  every occasion, and without
 any cause with their dearest friends.  If they speak in jest the hy-
 pochondriac takes it in good earnest; if the  smallest ceremony  be
 accidentally omitted he is wounded to  the quick.  Every tale, dis-
 course, whisper, or gesture he applies to himself.  Or  if the con-
 versation be openly addressed to him, he  is ready to  misconstrue
 every word; and cannot endure that any man should look steadfast-
 ly at him, laugh, point the finger, cough or sneeze.  Every question
 or movement  works upon him,  and is  misinterpreted, and  makes
 him alternately turn pale and red, and even sweat with distrust, fear
 or anger."
  As in this species the body is more affected than  in any other di-
 vision of mental alienation, more  may  often  be accomplished  by
 medicine ; though we must by no means be inattentive  to moral dis-
 cipline.  The skin is very frequently cold and without  a free secre-
 tion, and hence,  general friction with rubefacients and  the warmer
 diaphoretics have often been found serviceable.   The digestive or-
 gans are almost always torpid, and  several  of them, especially the
 stomach  and liver, secrete their respective fluids not  only in too
 small a quantity, but of an unhealthy quality, so as to be too viscid,
 too dilute or morbidly stimulant.  Some kind of acrimony, indeed,
is almost always  found in the stomach, and particularly that of aci-
 dity.   And hence aperients,  carminatives, and particularly the tonic
plan which has already been recommended under limosis Dyspepsia,
 are manifestly called for and will often be found serviceable.
  Post-obit examinations  have also frequently pointed  out another
 local cause which otherwise we should little expect: and  that is  a
 displacement of the transverse colon.  M. Pinel, as we have already
 observed, regards this as a very common cause of insanity  in  all  its
forms : but there can be no question that it is a powerful and ready
cause of the present species  of mental alienation.  M. Esquiral, who
has found it as frequently as M. Pinel, tells us that this displacement
sometimes consists in an oblique, and sometimes in a perpendicular
direction of the intestine, so that its  sinister  extremity lies  behind
the pubes ; whilst it has sometimes descended into the  form of an
inverted aorta even below the pubes and into the pelvis. No disease
of the  organization has been found  in any instance, and hence the
change of place must proceed  from relaxation  and debility  alone,
where the  misposition is not connate ; on which account it may, in
some instances, be an effect,  as it is certainly a cause in others.  It
is under  these circumstances that we chiefly meet with that pain in
the epigastrium  to  which we have already adverted, and which 
GE. III.-SP. II.]       NERVOUS FUNCTION.
105
gives the feeling of a tight cord surrounding the body in the line of
distress;  and when a such symptom, therefore, occurs, we have rea-
son to suspect the cause  of the disease to be produced by some de-
rangement of the colon in respect to position.  Under the operation
of such a cause the  art of medicine  can do but little : temporary
ease, however, may  be obtained by  the  pressure  of a belt broad
enough to support the whole of the lower belly ;  and it is possible
that the intestine may gradually right itself under a course of the
warmer tonics, as columbo, canella alba and cassummuniar, or lose
its morbid irritability by  habit.  But  these  are  rare  terminations;
for more generally the displacement increases and the disease itself
gains ground and becomes  more incurable.
   Congestions from  weakness of vascular action in one or more of
the abdominal viscera, are a  frequent result  of the  present com-
plaint, and not unfrequently a primary cause : and hence we may
see why the bleeding piles should  be serviceable  in so many  in-
stances as to obtain from Alberti the name of medicina hypochondria-
corum,* and why leeches repeatedly applied to the anus, as recom-
mended by Schoenheyder^  should often have  a  like  beneficial  ef-
fect.?  This is of the greatest  importance  where the  disease has
been preceded by a  periodical flow of blood from the hemorrhoidal
veins : and should point  out to us the necessity of renewing any
other discharge  or external irritation to which the system may have
been accustomed.
   Opium is a very doubtful medicine, though strongly recommend-
ed by Deidier and other respectable  writers; and  readily had  re-
course to by hypochondriacs themselves  to  relieve their distressful
sensations.  Dr.  Cullen  asserts peremptorily  that he  has  always
found a frequent use of opiates pernicious in hypochondriacs :| and
in many instances in which I have myself been  tempted to employ
it, I have been compelled to withhold its further  use from its doing
more mischief than good.  It  has  often, in such cases, been ex-
changed for other sedatives, but rarely with any decided advan-
tage.
  Exercise  of all kinds should be encouraged in  every modification
of the disease, but especially  exercise on horseback, though it is
seldom in the first and third variety we can succeed in getting a pa-
tient to  try it.  The  diet should be governed  by the principles
already laid down for treating indigestion.
  In the moral management, assiduous kindness and  consoling con-
versation produce a  deeper effect than they seem to do.   Loquacity
is always  hurtful, but  a  talent for cheerful discourse,  intermixed
with interesting and  amusing  anecdotes,  frequently draws away the
patient's attention from himself, and becomes  a  most useful pallia-

          * Dissert, de Haemorrhoidibus. Halle. 1716.
          t Act. Soc. Med. Hafn. n. p. 313.
          X Mat. Med. Vol. n. p. 245. Edit. 4to.
  VOI* HI;                  14 
 106                     NEUROTICA.            [CL. IV.-OR. L

 live.  In the  antalgic variety in which he is perpetually haunted
 with a feeling of some dreadful disease which exists no where but
 in his own fancy, the hallucination, when we possess his confidence,
 should be removed  by a candid statement of the fact, and if necessa-
 ry, friendly expostulation : but the moment we find the preposses-
 sion is too strong to be removed by argument, it is better to humour
 the conceit and  to pretend to prescribe for it.  It is sometimes ne-
 cessary,  indeed, for the hypochondriac is  often possessed; of great
 cunning, to drop all pretensions whatever,  and to put him in good
 earnest upon a course of medicines for a disease  we know he is  as
 free from as ourselves.   Thus, a  firm, belief that  he has an invete-
 rate itch is a common delusion with  a patient of this  kind, and  it
 will be often found  impossible to  persuade  him that he  is cured till
 his whole  body has  been repeatedly rubbed  over with sulphur  or
 hellebore ointment.   I had lately under my care  a special pleader
 of considerable eminence, who in the course of this affection  would
 have it that he had the pox.   I at first argued the point  with him
 day after day, but to no purpose ; he  felt certain that he should ne-
 ver be well till he  was not only salivated, but had used tonic injec-
 tions for  a gleet which  he said accompanied it, though he  had no
 discharge whatever.  It was  in vain to deceive him by suppositious
 medicines,  for he was a man  of considerable learning, and well ac-
 quainted with medical preparations, and I  hence  allowed him his
 heart's desire; he  rubbed in mercurial ointment every night, and
 for an injection used a solution of zinc,   In  a  week he persuaded
 himself he was well, and begged  permission to desist from  a far-
 ther use  of the  remedies: a permission which was readily granted
 him.
  In the second variety, or taedium  vita?, where the time seems to hang
 intolerably heavy on the patient's hands,from his having, in a mstaken
 search after happiness,  relinquished a life of constant  excitement
 and activity for the fancied delights of rural retirement and  quiet,
 the best  and most radical  cure would be a return to  the situation
 that has been so unfortunately abandoned: but if this cannot be ac-
 complished the patient must be put into a train of pursuits  of some
 other kind.  If he be fond of the sports of  the country, he should
 weary himself in the  day  time with  hunting or shooting, or  even
 horse-racing rather than  be  hypochondriacal  from idleness; and
 spend his evenings in the  bustle of dinner-parties  or cards.  And  if
 he be capacified for higher  and  more useful  occupations,  let  him
 plunge headlong into the  public concerns of the parish and its neigh-
 bourhood, become a member of its select vestries, a trustee of the
highways, or a magistrate of the district.  The habit of excitement
must for  some  time  be maintained though it be  afterwards let down
by degrees; and the intermediate steps are  of no  great  importance
so far as  they answer their purpose    We are not   at present argu-
ing the case upon a  principle  of ethics or of religion ; but merely
upon a principle of  moral  medicine.    Yet I have often  known per-
sons of the above description broken in by degrees to a  love of do- 
GE. III.-SP. II.]
NERVOUS FUNCTION.
107
mestic quiet, for which they were  by no means fitted  when  they
first entered upon it:  and who with a love  of domestic  quiet  have
settled also, as a soberer stage of life has  advanced, and reflexion
has gained ground upon them, into a love of strict moral  order, and
the higher duties of a conscientious Christian, to which at one  time
they seemed as little disposed.
                     GENUS  IV.


                        APHELXIA.



INACTIVITY OF THE ATTENTION  TO THE  IMPRESSIONS OF SURROUNDING
                  OBJECTS  DURING WAKEFULNESS.

Aphelxia is  derived from hQiXku " abstraho, retraho, avoco,  abdu-
co;"  and is in use among the Greek writers.
  The subject is almost if  not altogether new to nosology, and  has
seldom been dipt into by physiologists.  Dr. Darwin occasionally
touches upon it in various parts of his " Zoonomia," and  Dr.  Crich-
ton in his " Inquiry into the Nature of Mental Derangement,"  and
it is well  described and illustrated by La Bruyere in his " Charac-
ters ;" but it yet remains to be analyzed and reduced to a nosologi-
cal method, and examined  in a pathological view.  A few leading
ideas  upon this subject have already been thrown  out by the  author
in his comment upon the present definition  in the volume of No-
sology ; and of these he will avail himself  in treating of it more at
large.
  In  order  to our becoming acquainted  with the existence of sur-
rounding objects, or of an external world as it is called by psycholo-
gists,  three  things are necessary ; sound external senses;  a secretion
of the nervous fluid, apparently under different modifications, where-
by they are  made capable of being roused or excited by the different
objects addressed to them;  and an exercise of the faculty  of atten-
tion to the impressions which are thus produced.  The will has, or
ought to have, a power of calling this, as well as every other facul-
ty of  the mind into a state of exertion or  of allowing it to be indo-
lent ;  and it  is chiefly upon this want of power, or the same power
intensely exerted, that the  phenomenon  of revery depends; thus
giving rise to  three following species of mental aberration:

  1. APHELXIA SOC0RS.           ABSENCE  OF MIND.
  2. -------- INTENTA.          ABSTRACTION  OF MIND.
  3. ---<----- OTIOSA.           BROWN STUDY. 
108                    NEUROTICA.             [CL. 1V.-OR, h

  In the first of these, the attention  is truant and does not yield
readily to the dictates of the will :  in the  second,  it is rivetted at
the instigation of  the will itself to  some  particular theme uncon-
nected with surrounding objects :  and in the third, it has the consent
of. the will to relax itself, and give play to whatever trains of ideas
are uppermost or  most vivacious  in the sensory.




                        SPECIES I.

                 APHELXIA  SOCORS.

                    Absence of WCntr.

TRUANT ATTENTION ; WANDERING FANCY; VACANT OR VACILLATING COUN-
                           TENANCE.

This is an absence or vacuity  of mind too common at schools and
at church;  over tasks  and  sermons;  and there are  few readers
who have not frequently  been sensible of it in  some degree or
other.
  In reading books in which we are totally uninterested, composed
in a tedious  and repulsive style, we are almost continually immersed
in this species of  re very.  The will  does  not exert its  power ; the
attention is suffered to wander to something of stronger attraction ;
or the imagination is left to  the play  of  its  own  nugatory  ideas;
and, though  we continue to read, we have not  the smallest know-
ledge of the argument before us: and if the subject  to which the
train  of our thoughts is really directed be of  a  strikingly ludicrous
character, we may possibly  burst  into a laugh in the  middle of a
discourse of great gravity and seriousness, to the  astonishment of
those around us.
   This is a  common case,  and may  lead  to great embarrassment.
We have nevertheless thus far supposed that the will does not ex-
ert its power, and sufficiently rein in the  attention to  the subject
addressed  to it.  It not unfrequently happens, however, that the will
for want of a proper habit, has lost its power either wholly or in a
very  great degree, and  cannot with  its utmost energy exercise a
due control  over the attention ; and it also happens in other cases,
from a peculiarity of temperament,  or morbid state  of body,  that
the faculty of the attention itself is so feeble that it is incapable of
being steadily directed for more than a few minutes  to  any  object
of importance whatever, with all the effort of the will to give it
such  direction.
   The mind under either of these  conditions is in a deplorable state
for all the  high purposes of reflexion and knowledge lor  which
by its nature it is intended; since it is upon the faculty of  attention 
GE. IV.-SP. I.]
NERVOUS FUNCTION.
109
that every other faculty is dependent for its vigour and expansion ;
without it the perception exercises itself in vain ; the memory can
lay up no store of ideas ; the judgment draw forth no comparisons ;
the imagination must become blighted and barren : and where there
is no  attention whatever  the  case  must necessarily verge upon
fatuity.
   In early life the attention, like every  other faculty of the mind,
is weak and wandering, is often caught with difficulty and rarely
fixed upon  any thing.  Like every  other faculty, 'however, it is
capable of being strengthened and concentrated ; and may be made
to dwell upon almost  any object proposed.   But this is a work of
time, and forms one  of the most important parts of education :  and,
in the course of this  discipline, it should not be forgotten that the
faculty of attention, when it  first  shows  itself, is  more readily
arrested by some subjects than by others, and that  it is hence of
great moment to ascertain  those subjects, and to select  them in the
first instance.  The  habit is what is chiefly wanted, and the quicker
this is acquired the more time we gain for  transferring the same
habit to other and perhaps more valuable purposes afterwards.
   This is  a point seldom sufficiently considered in the course of
education ;  and for want  of such consideration, far more than half
the time of many boys becomes an entire blank and is lost, and not
a few  are suffered to  remain blockheads in the particular depart-
ment to which their hours of study are  directed, who might discover
a considerable capacity and genius if the department were changed
for one  more  adapted to their  own  taste, or in other  words more
attractive to their attention.
   There is a very singular instance of habitual absence  of mind
related by Sir A. Crichton, in  a young  patient under the care of
Dr.  Pitcairn and himself, which, though  some other circumstances
appear to  have  combined with it, is  ascribed considerably to the
error  of education  we are  now speaking  of, that of  not  duly
studying the peculiar  bent of a mind in many respects singularly
constituted,  and  drawing  forth and  strengthening the  faculty of
attention, which was  in an especial degree  weak and truant,  by
an employment of such objects  and pursuits as were most alluring.
This patient was a young  gentleman of large fortune, who, till the
age  of twenty-one, and he does not  seem to  have been much more
at the time  of describing his case, had enjoyed a tolerable share of
health, though of a delicate frame.  In his disposition he was gentle
and  calm but  somewhat  unsociable.   His  absence of mind  was
extreme, and he  would sometimes  willingly sit for a whole  day
without  moving.  Yet he  had  nothing of melancholy belonging to
him; and it was easy  to discover by his countenance that a multi-
plicity of thoughts  were constantly succeeding each other in his
imagination, many of which were gay and cheerful; for he would
heartily laugh, at times not with  an  unmeaning countenance, but
evidently from mental  merriment.  He was occasionally so strangely
inattentive that,  when pushed  by some  want  which he wished to 
110
NEUROTICA.
[CL. IV.-OR. I.
express, if he had begun a sentence, he would  suddenly stop short
after  getting half way through it, as though he had forgotten what
else he had to say.  Yet when his attention was roused and he was
induced to speak, he  always  expressed himself in good language
and with much propriety ; and if a question  were proposed to him
which required the exercise of judgment,  and he could be made to
attend to it, he judged correctly.   It was with difficulty he could be
made to take any exercise :  but  was at length, prevailed  upon to
drive his curricle,  in  which  Sir Alexander at  times accompanied
him.   He at first could not be prevailed upon to go beyond half a
mile :  but in succeeding attempts  he consented  to go  farther.
He drove steadily, and  when about to pass  a carriage took  pains to
avoid it: but when at last he became familiarized with this exercise
he would often relapse into  thought, and  allow the reins  to hang
loose  in his hands.   His ideas seemed to  be for ever varying.
When  any one  came across  his mind which excited  anger, the
horses suffered  for it;  but the spirit  they exhibited at  such an
unusual and unkind treatment made  him soon desist, and re-excited
his  attention to his own safety.  As soon as they were quieted, he
would  relapse into thought;  if his ideas were  melancholy the
horses  were allowed to  walk slow;  if they were gay and cheerful
they were generally encouraged to go fast.*
  Something may in this  case perhaps  be owing, as supposed by
Sir A. Crichton, to an error in the mode of education: but the chief
defect seems to  have been in  the attentive faculty itself and its la-
bouring under  a natural  imbecility  which  no mode of education
could  entirely  have removed.  We  have had frequent occasions to
observe that the powers of the mind vary in different individuals as
much as those of the body: and we have already offered examples
of weak or diseased judgment, weak or diseased  perception, and
weak or vehement imagination.  In the case before us, the mental
disease seems to have been chiefly confined to the faculty of atten-
tion ;  and we shall presently have to notice a similar imbecility of
the memory, and even of all the mental faculties conjointly.
* Of Mental Derangement, Vol. I. p. 281. 
GE. IV.-SP. II.]        NERVOUS FUNCTION.                Ill


                        SPECIES II.

                APHELXIA INTENTA.

                   Slustractfou of Jtttutr.

THE ATTENTION  WOUND UP AND  RIVETTED TO  A PARTICULAR SUBJECT J
   WITH SYMPATHETIC EMOTION OF THE MUSCLES AND  FEATURES CONNECT-
   ED WITH ITS  GENERAL  DRIFT.

In this species  the faculty of attention,  instead of being feeble, or
contumacious to the will, is peculiarly strong, and  vehemently ex-
cited, and acts in perfect co-operation with the will itself.  And in
many instances the  sensorial energy maintained is so great, and de-
mands so large a supply of sensorial power, as apparently to ex-
haust the entire stock, except indeed the reserve which is in almost
all cases instinctively kept back for the use of the vital or involunta-
ry organs.   And hence,  all the external senses remain in a state of
torpor,  as though drawn upon for their respective  contributions of
sensorial power in support of the predominant meditation : so that
the eyes do not see, nor the ears hear, nor the flesh feel; and the
muser may be spoken to or conversation may take place around him,
or he may even be  struck  upon the  shoulders without  any know-
ledge of what is occurring.
   Abstraction of mind may be produced by various causes,  but the
following are the chief,  and form two  distinct varieties.

«  Aphelxia  a pathemate.       From some overwhelming passion.
C  Aphelxia a studio.           From intense study.

   Of the first variety we have already offered abundant examples
in the two  preceding genera: and especially in the cases of un-
governable joy or rapture, grief and despondency;  under the  influ-
ence  of which the affected person is often as  much, lost to the world
around him  as if he were  in a profound sleep and dreaming; and
only hears, sees and feels the vivid train of ideas that possess them-
selves of his mind, and rule it as a captured citadel.   To these  alone
the attention is directed, here it exhausts all its power and the will
concurs in the exhaustion: insomuch that the  patient is said in some
cases to have stared at the meridian sun without pain ;* and in others
to have been undisturbed by the discharge of a cannon.t
   We meet  with like proofs of this variety of revery in many cases
of intense study, and especially upon abstract subjects,  as those of
pure  mathematics in which all  the  reasoning  and more  serious
faculties of the mind, as the perception, the  memory, and the judg-
* Blumcnb. Bibl. i. p. 736.
t Darwin,  Zoonom. in. r. ii. 2. 
112                      NEUROTICA.           [CL. IV.-OR. f.

ment, as well as the attention, are jointly called into action and kept
equally upon  the stretch.   Of the power of this variety of revery
in rendering an individual torpid and  almost dead to all around him
we have a decided instance in Archimedes at the time of his arrest.
When the Roman army had at length taken Syracuse by stratagem,
which the tactics of this consummate engineer prevented them from
taking by force,  he was shut up in his  closet, and so intent on a
geometrical demonstration, that he  was equally  insensible to the
shouts of the victors, and the outcries of the vanquished.  He was
calmly drawing the lines of a diagram when a soldier  abruptly en-
tered his room, and clapt a sword to  his throat.  "Hold, friend,"
said Archimedes, " one moment, and my demonstration will be finish-
ed."   The soldier, surprised at his unconcern at a time of such ex-
treme  peril,  resolved  to carry him before Marcellus;  but as the
philosopher put  under  his arm a  small  box full  of spheres, dials,
and other  instruments,  the soldier, conceiving the box to  be filled
with gold, could not resist the temptation and killed him on the spot.
                        SPECIES  III.

                 APHELXIA OTIOSA.



Leisurely listlessness ; voluntary surrender of the attention and
  the judgment to the sportive vagaries of the imagination j quies-
  cent muscles ; idle gravity  of countenance.

The attention is equally summoned into action, and dismissed at the
command of the  will.  It is summoned in the last species;  it is dis-
missed when a man voluntarily surrenders himself to ease  and list-
lessness of mind; during which  period, moreover, in  consequence
of this indulgence in general indolence, the external  senses them-
selves unite in the mental quiescence, and a smaller portion of ner-
vous fluid  is probably secreted for the very reason that a smaller
portion is  demanded; and hence  the active senses without  are as
vacant and  unstrung  as the active senses within,  and  as blunted to
their respective  stimuli.  The first playful ideas that float over the
fancy in this case take the lead, and the  mind relaxes itself with
their easy and sportive flow.  It is the studium inane of Darwin,*
who seems, however, to have in some degree misapplied the name,
or to have  confounded  the aberration  with that of  ecphronia or
aiusia.  Cowper has  admirably described it in the following verses:
* Zoonoin. m. «. ii. 2. and again iv. II. iv. 2. 
GE. IV.-SP. III.]
NERVOUS FUNCTION.
113
           Laugh ye who boast your more mercurial powers,
           That never feel a stupor, know no pause,
           Nor need one; I am conscious, arid confess,
           Fearless, a soul that does not always think.
           Me, oft, has fancy ludicrous and wild,
           Sooth'd with a waking dream of houses, towers,
           Trees, churches, and strange visages,  express'*)
           In the red cinders, while with poring eye
           I (?az'd, myself creating what I saw.
           Nor less amus'ri have I quiescent watch'd
           The sooty films that play upon the bars
           Pendulous, and foreboding, in the view
           Of superstition, prophesying still,
           Though still deceiv'd, some stranger's near approach.
           :Tis thus the understanding takes repose
           In indolent vacuity of thought,
           And sleeps, and is refreshed. Meanwhile the face
           Conceals the mood lethargic with a mask
           Of fleepdelibeiation, as the man
           Were task'd to his full strength, absorb'd and lost.

   In the indolent mind such indulgence is  a disease, and if not studi-
 ously  watched  and  opposed  will  easily  become a  habit.   In the
 studious and active mind it is a wholesome relaxation;  the sensory,
 in the correct language of the poet " sleeps and is refreshed," grows
 fertile beneath the  salutary fallow and prepares itself for new har-
 vests.
   This is more particularly the case where, in conjunction with an
 attention " screwed up to  the sticking  place" and long  continued
 there, a spirit of ardent emulation is at  the same time  stirring, and
 distracted between the  hope and fear of gaining or losing a distin-
 guished honour  or reward.   I have  seen this  repeatedly in young
 men who have  been striving  night and day, and  week after week,
 for the first prizes of our  English universities; some of whom have,
 indeed,  succeeded, but with a hectic exhaustion that  has been  re-
 covered from with great difficulty; while others in the full prospect
 of success have been compelled  to relinquish the pursuit and to de-
 grade.
   Yet even  without this  conflict of  feeling, where  the attention
 alone has been too long directed to one  or to a variety of recondite
 subjects  without  relaxation, the  mind suffers  considerably and its
 powers become  shaken and confused ;  of which we have an inter-
 esting example in the case of Mr. Spalding, a scholar of considerable
 eminence in Germany, as drawn by himself and  communicated to
the editors of the  Psycological Magazine.*  His attention, he tells
 us, had been long kept upon  the  stretch and had been  still  more
distracted by being continually shifted from one subject to another.
 When being called upon to write a receipt for money paid  him on
 account of the poor, as soon as he had  written the two first words
he  found himself incapable of proceeding farther.   He strove all
he could, and strained his attention to the utmost,  but to no purpose :
         * Crichton's Inquiry into Mental Derangement, i. 2"?
VOL. III.                    IS 
114
NEUROTICA.
[CL. IV.-OR. r.
he knew the  characters he continued to make  were not  those he
wished to write, but could not discover  where  the  fault lay.   He
then desisted, and partly by broken words and syllables, and partly
by gestures, made the person who waited lW- the receipt understand
that he  should  leave him.  For about half an  hour, a  tumultuary
disorder reigned in his senses, so that he  was incapable of remarking
any  thing very particular, except that one series of ideas of a tri-
fling nature and confusedly intermixed,  forced  themselves involun-
tarily in his mind.  At the same time  his external senses continued
perfect  and he saw and knew every thing around him.   His speech,
however, failed in  the same manner as his power of writing,  and he
perceived that  he  spoke other words than those he intended.   In
less than an hour he  recovered himself from this confusion, and felt
nothing but a slight head-ache.  On examining the receipt on which
the  aberration  first  betrayed  itself,  he  found  that instead  of the
words " fifty  dollars, being one half year's rate ;" he  had written
" fifty dollars through the salvation of Bra—" the  last word  being
left unfinished, and without his having the least  recollection of what
it was intended to be.
                      GENUS V.

                      PARONIRIA.

                    Slee^fsturfcance.

THE VOLUNTARY  ORGANS CONNECTED  WITH THE PASSING TRAIN OF IDEAS.
  OVERPOWERED  BY THE FORCE  OF THE IMAGINATION DURING DREAM-
  ING, AND INVOLUNTARILY EXCITED TO THEIR NATURAL OR ACCUSTOMED
  ACTIONS; WHILE THE OTHER ORGANS REMAIN ASLEEP.

Paroniria, from ?r*pa and *wfn signifies,  " depraved,  disturbed or
morbid, dreaming."  So  in  Dioscorides,* Zvcwufos, signifies,  " tu-
multuosis  et malis somniis molestans."
  In treating of the genus efhialtes, or night-mare,t I endeavoured
to explain its course and nature ; and hereby pointed out the essen-
tial distinction  which exists between  that disease and  the present,
and the impropriety of uniting the species  which belong to both of
them under one head, as Dr. Cullen has done in his genus oneirody-
nia, since, with the exception of their occurring in the  night and
during  sleep, and therefore involuntarily,  they have little  or no
connexion or resemblance in cause, symptoms, or  even mode of
cure.
* Vol. ii. p. 127.
1 Vol. i. Ord. ii. Gen. v. p. 388. 
«E. V.]                 NERVOUS  FUNCTION.                115

  The three following species are so clearly and decidedly of one
and the same family, as to prevent all dispute in their present posi-
tion.  They are  here, however, associated for the first  time in a
genus distinct from ephialtes.
     1. PARONIRIA AMBULANS.                    SLEEP-WALKING.
     2.---------LOQt'ENS.                     SLEEP-TALKING.
     3.---------SALAX.                       NIGHT-POLLUTION.
  The nature of these singular affections, and the means  by which
they are produced, have never yet been  explained, and rarely, so
far as I know, has any explanation been attempted.   To understand
them fully, it would be necessary for us to enter into a minute de-
velopement of the physiology of sleep and dreaming, which the
limits of the  present work will not allow.  On some future occasion
the author may,  perhaps, follow it up into such a detail:  but a few
general remarks must suffice for the occasion before us.
   In sleep, accompanied with dreaming, the faculties of the mind
bear a pretty close parallel with those of the body as to  the effect
produced  upon them.   Some of them, as the will,  the  perception,
the judgment, are in a state of general torpitude like the  voluntary
organs of  the body; while the memory and the  imagination,  like
the vital or involuntary organs of the body, are in as high activity
as ever.  The sensory is hence as much crowded  with  ideas as at
any time ;  but, destitute  of a controlling power, they rush forward
with a very  considerable degree of irregularity, and would do so
with the most unshapeable  confusion, but that the habit of associa-
tion still retains some degree of influence, and produces some degree
of consonance and proportion in the midst of the wildest and most ex-
travagant vagaries. And hence that infinite variety that takes place in
 the character of our dreams ; and the greater regularity of some, and
 the greater irregularity of others.  Hence a combination of thoughts
 or  ideas sometimes only in a small degree incongruous, and at other
times most frantic and heterogeneous ; occasionally, indeed, so fearful
and extravagant, as to  stimulate  the external senses themselves
into a sudden renewal of their functions, and consequently to break
off abruptly the  sleep  into which they were thrown.
  Now as  the stimulant force of our ideas in dreaming,  is often suf-
ficient to rouse the external senses generally, and  to awake  us all
of a sudden ; it may be of such a kind, and just of such a strength,
as to excite into  their accustomed action the muscles of  those  or-
gans or members only, which are more immediately connected with
the train of our dreams or incoherent thoughts; while every other
organ may still remain torpid.  And hence  the muscles chiefly ex-
cited being those  of  speech, some persons talk,  or the muscles
chiefly excited being  those of loco-motion, Other persons walk,  in
their sleep, without being conscious, on their waking, of  any such
occurrence.*  And by the  same  means we may  easily  account for
  * Hcnnings, Von den Traumern uud Nachtwandlern. Weimar 1784.
    Horst, De Natura, Diffoientiis et ^ausis norum qui dormientes  ambulant.
&c.  I.cips. 1 "0;-\ "v<». 
116                    NEUROTICA.            [CL. IV.-OR. L

the third species of the genus, or that which  consists in dormant
and involuntary salacity.
                        SPECIES I.

              PARONIRIA AMBULANS.

            Somuamtiulfsm.   SIeqj=foalfctnfl

THE MUSCLES OF LOCO-MOTION EXCITED INTO THEIR ACCUSTOMED ACTIOA
  BY THE FORCE  OF THE IMAGINATION DURING DREAMING.

In profound sleep all the faculties of the  mind  as well as all  the
voluntary organs of the  body, are in a state of inactivity or lorpi-
tude, and the only organs that preserve their active tenour are  the
involuntary ones: so that in this state there is neither thought  nor
idea of any kind.   In dreaming, some of the mental faculties only
sleep or are torpid, while the  others, like the  involuntary organs
of the body, continue wakeful or active : the somnolent faculties,
we  have  alreadj' observed, are the will, the  perception, and  the
judgment; the wakeful are the memory and the imagination.
  It would not be difficult, if we had time, to show why the involun-
tary organs do not  require rest, or  in other words become torpid
like the  voluntary; nor why the  will and the judgment sooner
associate in the general  sleep of  the external  senses than the ima-
gination, but this would  carry us  too far into the subject of animal
physiology.  There are  two physiological remarks, however, which
it is necessary to make in explanation of the  morbid affection  im-
mediately  before us.  The first is, that sleep is a natural torpitude
or inertness induced upon the organs of the body (with  the  excep-
tion of the involuntary) and the faculties of the mind by fatigue
and exhaustion.  And the next is that, in the  production of sleep,
it is not necessary that all these  powers  of body and mind should
have been equally  exposed to exhaustion: for, such is the  effect of
association and habit, that as soon as one  faculty or organ feels fa-
tigue, or becomes exhausted,  the rest participate in the same con-
dition, and  the sleep  or torpitude  becomes common to the whole.
It is hence the body is made drowsy by  mental  study <nd the mind
by  corporeal labour; that muscular exercise wearies all the senses,
and the exertion of the  senses wearies the muscles :  though there
can be no  doubt that the general tendency  to sleep is aiso part-
ly  superinduced by the indirect exhaustion  sustained by the  or-
gans or faculties that  have been  less employed,  in consequence
of  the share  of sensorial power which, as from a  common stock,
they  have  themselves   contributed towards  the  support of  the
more active and hence more debilitated powers.
  Now it sometimes happens, either from disease or peculiarity of 
©E. V.-SP. I.]       NERVOUS FUNCTION.
117
constitution,  that all the external organs of sense do not associate
in the general action that  has taken place, or yield alike to the.
general torpor to which it gives rise ; and  that  the auditory, the
optical  or some  other sense, continues awake or in vigour, while
all the rest are become inert; as it does also, that such particular
sense, like  the muscles of particular members, as observed a page
or two  above, is awoke or re-stimulated into action in the midst of
the soundest sleep by the  peculiar force  and  bent  of the dream,
while the rest stilt sleep on and are unaffected.
   If the external organs of sense thus stimulated be that of sight,
the dreamer may perceive objects around him, and be able to dis-
tinguish them : and if the tenour of  the dreaming ideas should  as
powerfully  operate upon  the muscles of loco-motion,  these  also
may be thrown  into their accustomed state of action, and  he may
rise from his bed and make his way  to whatever place  the drift of
his dream may direct him, with perfect ease, and free from danger.
He will see  more or less distinctly in proportion as  the  organ of
sight is more or less awake:  yet  from the increased exhaustion,
and of course, increased torpor of the other organs, in consequence
of an increased demand of sensorial power from the common stock,
to supply the action of the sense and muscles immediately engaged,
every other sense will  probably be thrown into a deeper  sleep  or
torpor than if the whole had been quiescent.   Hence the ears may
not be  roused even by a sound that might otherwise awake  the
sleeper.  He may be  insensible, not only to a slight touch, but a
severe  shaking  of the  limbs; and may even cough violently with-
out being recalled from his dream.  Having accomplished the ob-
ject of his visionary  pursuit, he may safely return,  even over  the
 most dangerous precipices, for he sees them  distinctly, to his bed i
 and the organ of sight being now quite exhausted,  or there  being
 no longer  any occasion for its use,  it may once more associate in
 the general inactivity,  and the dream take a new turn, and consist
 of a new combination of images.
   Somnambulism occurs in many persons without any manifest predis-
 ponent cause, though it is generally connected with a considerable ir-
ritability of habit.  A morbid state of the stomach, where this habit
 exists,  has very frequently  proved an exciting cause : of which
Dr. Yeates has  given us an example in the case  of a young gentle-
man of ten years of age related in the Medical Transactions.*   He
was of a delicate frame,  often  troubled with sickness; sometimes
rejected his food undigested, after having  lain two days in his  sto-
 mach ;  his bowels were costive, and the stools  were dark, offen-
sive, and ill-formed.   The  sympathetic  symptoms were  frequent
 head-aches with occasional stupor, general coldness of the skin and
 limpid  urine.   After being in bed for about two  hours, he was wont
 to start up  suddenly as in a fright,  dart rapidly into the middle of
 the chamber, or of the room adjoining, and walk about with much
*•• Vol. v. *Wt. xxvm. p. 441. 
118
NEUROTICA.
[CL. IV.-OR. I.
agitation.   In this state he would run over quickly, but incorrectly,
the transactions of the day ; and he  once attempted to spell a word
which in the day time he had spelt wrong, in doing which he jum-
bled a number of letters together.   When spoken to he would make
a rational reply; and in one of his sleeping perambulations be call-
ed for an epitome of the History of  England which he  was in the
habit of reading: the nurse brought him  a book, but not the  one
called for:  on perceiving the  difference he immediately threw  it
from him with great violence, and with  expressions  of auger and
disappointment.  On these occasions  his  eyes were wide open,
though he did not seem conscious of seeing, nor of his situation at
the time.   It was, says Dr. Yeates, a perfect state of dream through-
out, though partaking of the acts of the waking state, for he would
avoid objects walking about the room.   His face was quite pallid at
the time.
  In this case  much of the nervous hurry and agitation seems to
have depended upon the debilitated and irritable state  of the pa-
tient's frame.  But where the  affection proceeds from idiosyncracy
or there is  no disturbance of the general health, the dreamer often
proceeds far more cooly  and  collectedly : and the eye-lids, instead
of being wide  open as though  staring, are often not more than half
unclosed, in some cases even less than  this; which has given occa-
sion to marvellous  stories  of somnambufists walking over dangerous
places, or avoiding dangerous objects  with  their  eyes completely
shut all the time.
  The remedial treatment it may be necessary to  pursue, we shall
defer till we have  briefly noticed  the succeeding species, as the
same treatment will apply to the  whole.
                       SPECIES  II.

               PARONIRIA  LOQUENS.

                       Sleej>=talfcfns.

THE MUSCLES OF SPEECH EXCITED  INTO  THEIR ACCUSTOMED  ACTION BY
         THE FORCE OF THE IMAGINATION DURING DREAMING.

It is not necessary to dwell upon this species, as we  have already
explained the general principles of the inordinate action in the pre-
ceding pages.  As the train of ideas  which form the  dream, when
peculiarly lively and immediately connected with the organs of lo-
comotion, may stimulate those organs into  their accustomed activi-
ty, and thus give the dreamer a  power of walking without conscious-
ness;  in like manner if a similar train of  dreaming ideas be imme- 
GE. Y.-SP. II.]      NERVOUS FUNCTION.                  119

diately connected with the organs of speech, these may also be
equally influenced, and the dreamer be able to talk without  being
conscious of it, or having any recollection of such exertion when he
awakes.  And as, for reasons already specified, the organ of sight is
sometimes, in the same way, roused from a state  of sleep  or  torpi-
tude to a state of wakefulness,  while all  the other  external senses
continue somnolent, or,  from  idiosyncrasy or some local or acci-
dental cause, does not join in the general repose, but continues vi-
gilant during its  dominion ;—the organ of hearing may be  roused in
the same manner or exhibit the same  anomaly; and, in this case,
the dreamer,  who  under the influence of the last species  of  affec-
tion, is able to see as well as to walk, is  able, under the present, to
hear as well as to speak.   Examples, indeed, are given  in which a
byestander obtaining some clue into the train of thoughts  of which
the dream is composed, has been able, not only to keep up an irre-
gular conversation, but, by dextrous management and  the  artful as-
sumption of a character which  he finds introduced into the dream,
to draw from the dreamer the profoundest secrets of his bosom, the
dreaming ideas generally consisting of those on which the dreamer
is most employed when awake, or  which  lie  nearest his  heart.  I
have never met  with a case of this kind in my own practice,  but it
is given as  a fact  by various physiologists frum the* time of the
Greeks and Romans to our own day.
                        SPECIES  III.

                 PARONIRIA  SALAX.

                      &fsht~iu>Uuttoif.

 THE SEXUAL ORGANS EXCITED INTO  VENEREAL ACTION BY THE  FORCE OF
                THE IMAGINATION DURING DREAMING.

By Sauvages this affection is absurdly placed among the species of
gonorrhoea, which, with great looseness of generic  character is de-
fined  " passio cujus praecipuum symptoma  est fluidi puriformis vel
seminiformis effluxus stillatitius ex urethra."  This definition is, in-
deed, wide enough to embrace the affection before  us ;  but the ab-
surdity consists in intermixing a natural discharge produced by the
ordinary orgasm with morbid discharges, in which, in most  cases,
there is no orgasm whatever.  Dr. Cullen, however, has continued
to assign the same place and the  same name to the  present species,
and this with still greater inconsistency; since he has struck out of
his definition of gonorrhoea the epithet seminifonnis, and confined it
to a " fluxus humoris ex urethra  prater  naturam."  So  that he has
been obliged to break his own bounds to introduce  this  natural flux 
 120                    NEUROTICA.            [CL. IV.-OR. I.

 into the place he has allotted it.  And hence in his laying down the
 treatment of gonorrhoea in his Practice of Physic, he  takes  no no-
 tice of his gonorrhoea dormientium, as though feeling that it was  al-
 together a different subject.
   We have  already observed that whatever part of the animal frame
 is immediately connected  with the tenour of the  somnolent vision,
 it is often roused, under particular circumstances, from the general
 sleep of torpitude in  which it had participated, and becomes wakeful
 while every other part perseveres in the common repose.  During
 sleep, moreover, our ideas are often more lively and operative than
 during wakefulness, and this on two accounts; first,  because  from
 the uninterrupted activity of the involuntary organs  there is a more
 ready secretion of sensorial, as well as of most other fluids, in a state
 of perfect tranquillity; and  next, because the ideas that  predomi-
 nate at the  time are not broken in upon or weakened by exterior
 impressions  and disturbances.   It  is, on  this account, when the
 faculty of the judgment is stimulated into activity, instead of the ear
 or eye or the motory powers, a man has sometimes  been able to
 solve difficulties in dreaming which  proved too hard for him  when
 vigilant.  And to this effect Dr Spurzheim : " somnambulists," says
 he, " even do things of which they are not capable  in a  state of
 watching; and some dreaming  persons  reason sometimes better
 than they do when awake."*  A singular and  amusing instance of
 this occurred not many years ago to a very excellent and justly ce-
 lebrated friend  of the author's, the Reverend William  Jones of Nay-
 land, Suffolk, who, among other branches  of science, had deeply
 cultivated that of music, to which  indeed he  was passionately  at-
 tached.  He was a man of an irritable temperament,  ardent  mind,
 and most active and brilliant imagination: and was hence prepared
 by nature for energetic and vivid ideas in  his dreams.  On one occa-
 sion during his sleep, he composed a very  beautiful little ode of about
 six stanzas, and set  the same to very agreeable music: the impres-
 sion of which was so firmly  fixed in  his  memory, that on  rising in
 the morning he set down  and copied from his recollection, both the
 music and the poetry.
   It is hence not difficult to conceive that members so irritable as
 the sexual organs, when once the imagination leads energetically to
 the subject of concupiscence, should occasionally participate in the
 vision, and prove their sympathy by the result.
   In some morbid states of  the body, and  especially  when accom-
 panied with  local irritation, produced  by inflammation,  fibrous en-
 tony, the debility of old age,  or a habit of vicious indulgence, a se-
minal flux has sometimes  taken  place without any connexion with
the dream, and  sometimes without either  erection or  turgescence :
but this does not constitute the affection immediately before us ;  in
which the stimulant power lies in the sensory and is propagated
from that organ to those of generation.
* Physiognomical System, p. 175, Hvo. Lond. 181.5 
 CE. V.-SP. III.]       NERVOUS FUNCTION.                  121

   The Roman poet who so  admirably unlocked the  nature  of
 things to his contemporaries, by following the  footsteps of nature
 herself into most of her deepest recesses, directed his attention to
 this subject, among other physiological facts, and has elegantly ex-
 plained it in the above manner; adducing, at the same time, another
 instance of the influence which the ideas of dreaming sometimes ex-
 ercise over the organs connected with them, derived from the eva-
 cuation of the bladder which frequently  takes place in children
 whose  dream is directed  to  this natural  want, and who image to
 themselves the ordinary vessel employed  for  such purpose, as at
 hand for their use.

            Purei saepe, lacum propter, seu dolia curta,
            Somno devinctei, credunt se  extollere vestem ;
            Totius humorem saccatum corporis fundunt;
            Quom Babylonica, magnifico splendore, rigantur.
            Turn, quibus sctatis freta primitus insinuantur,
            Semen ubi ipsa dies membris matura creavit,
            Conveniunt simulacra foris e corpore quoque,
            Nuntia prsclari voltus, pulchrique coloris,
            Qui ciet irritans loca turgida seinine multo,
            Ut, quasi transactis saope omnibus rebus, profundant,
            Flurninis ingenteis fluctus, vestemque cruentent.*

   In the medical treatment of all this species of paroniria we must
 never lose  sight of this principle  that, although in many instances
 their predisponent cause is a peculiar idiosyncrasy or habit, their
 exciting cause is, in all cases, general or local irritation ; and that
 this irritation is of two very  opposite kinds, which it also becomes
 us very particularly to attend to, namely, that of entony or excess of
 power, and that of atony or deficiency.
   It  is to the former that Lucretius alludes, and which is by far the
 most common exciting cause : and  where this exists, our first indi-
 cation is to reduce the superabundant vigour by venesection, pur-
 gatives, laborious  exercise, and a limitation  to  a  plain  and spare
 diet.   While, on the contrary, where  the exciting  cause  is  debili-
 ty, our attention should be directed to a tonic course of medicines,
 and particularly to those tonics which prove sedative  at  the same
 time  that they strengthen the system.   Several of the mineral acids
 are entitled to this character, and  especially the sulphuric: and a
 still greater number  of the vegetable bitters, and  particularly the
 extracts of hop and lettuce.  Dr. Cullen, indeed, as we have alrea-
 dy observed, supposes  a sedative power to exist in all the  bitters,
 though not  equally in all.   How far the  Prussic acid might be em-
 ployed for this purpose I cannot say from personal practice :  but  if
 it really consist, as it is supposed to do, of the sedative principle  of
 the laurocerasus or bitter  almonds, it may possibly prove  a very
serviceable remedy.
   Our next object of attention should be  to  prevent all  undue ac-
VOL. HI.
* De Rex. Nat. iv. 1020.
 16 
 122                     NEUROTICA.            [CL. IV.-OR. 1.

 cumulation of the sensorial principle during sleep, and this may be
 accomplished in two very distinct and opposite ways.  The first is
 the use of a hard mattrass, with so small a covering of clothing that
 the sleep  may be somewhat  less sound than ordinary, and conse-
 quently more easily broken off. For the force of our dreaming ideas
 will always be in proportion to a certain degree of soundness in our
 sleep: I say a certain degree, for if the fatigue  or exhaustion, or
 torpitude, be extreme, the sleep will become profound or lethargic,
 all the faculties  of the mind will participate in it, and, as already
 observed, there will be no ideas or dreaming whatever.
   And hence the  second mode of pre v eft ting an accumulation of sen-
 sorial, and especially of irritable power, will be the employment of
 narcotics  till the  morbid habit is destroyed; for these, when car-
 ried to a sufficient extent, diminish vascular action, and consequently
 take off sense and motion so completely as to  extinguish  the  vital
 principle altogether, and hence not only to suppress all power of
 dreaming, but even life itself.
   I had lately under my care for the last species,  a very modest and
 regular young man, who was a student of  Christ's College, Cam-
 bridge, and was alarmed at the idea of having his constitution un-
 dermined by its continuance.  He was rapidly growing, of slender
 make, and a relaxed habit.  Nitre, which has been so often recom-
 mended as a sedative, in this case did no service :  but under the use
 of a pill composed of one grain of opium and five  of camphor taken
 nightly, and draughts of myrrhe, and infusion of columbo acidulated
 with sulphuric acid, he lost the tendency in a fortnight, after having
 been subject to the discharge  for many weeks.   His bowels were
 kept at the same time constantly stimulated by  the  pill of aloes
 and  myrrh: and  the  cold bath  formed a part   of  his  regimen.
 Pagani and  De Cazelles* have  recommended electricity; but the
 author has never tried its effects,  having uniformly succeeded with-
 out it.
   When either of these species, but particularly the two former,
 are connected with a morfud state of the stomach, the disease must
be  attacked in  this quarter, as it was with great judgment and a
 favourable issue in the  case quoted from Dr. Yeats.
* Jeurn. de Medicine, Tom. lxxiv. 
GE. VI.]               NERVOUS FUNCTION.                 123
                       GENUS VI.

                           MORIA.

                           iFatuftj).

           DEFECT  OR HEBETUDE OF THE UNDERSTANDING.

 Moria is a Greek term from  ft*g«? " stultus, fatuus."  It is here
 limited to its proper signification.   Vogel  employs it, though with
 a different  termination (morosis instead  of moria) in the same or
 very nearly  the  same  sense ;  but  he is  almost the only medical
 writer  that does so.   By Nenter and Sauvages moria  is used to
 denote melancholia complacens (self-complacent melancholy,) while
 by others  it is employed  synonymously  with anoea or idiotism.
 To complete the confusion,  morosis (amentia Morosis) is the name
 given by Sauvages  to mental imbecility (moria irnbecillis,) though,
 as already observed, he had just before used moria in the sense of
 melancholy.  It is  precisely in the signification now offered  that
 the term is employed by Erasmus, in his celebrated treatise entitled
 " Moria:  Encomium^ or " The Praise of Folly," which he dedicated
 to Sir Thomas  More.
  Mora, moror, morosus, morositaf,  are derived from this common
 source ;  and  uniformly  import  " waywardness, tardiness, dullness,
 impediment;"  though the lexicographers, not having hit upon the
 right path, have wandered in different directions without being able
 to satisfy themselves.   In Sauvages  and Sagar morositates are  in fact
 " corporea: mon'ce," defects or hebetudes of the bodily faculties.
  The preceding genera are founded upon a morbid  perversion or
 misrule, a diminished  or excessive excitement of one or more  of the
 powers of the mind operating upon the mind itself or upon the body.
 The  present is founded upon a natural  or permanent dullness, or
 hebetude of one or more of the same powers, producing a deficiency
 in the understanding,  which, however,  may  be  regarded as the
general frame or constitution of the  mind, in the same  manner as
 the body is the general  frame or constitution  of the  organ   which
 form its separate parts.  Moria thus explained, will  be found, as a
genus, to embrace the two following species :—

         1. MORIA  IMBECILLIS.                 IMBECILITY.
         2.  -----  DEMENS.                    IRRATIONAIITY. 
124
NEUROTICA.
[CL. IV.-OR. I.
                         SPECIES  I.

                 MORIA  IMBECILLIS.

                    Rental Xmfcecflfts.

THE DEFECT OR HEBETUDE PARTIAL, OR CONFINED TO PARTICULAR FACULTIES
                     OF THE UNDERSTANDING.

We have already observed that  all the faculties of the mind are as
subject  to  a diseased disturbance  as the  organs  of the  body :
and hence  all of them are liable to be  affected by the present
species.  The  whole of the  varieties, therefore,  under  which
mental imbecility  is capable of  being  contemplated  might form an
extensive list: but it will be sufficient to confine ourselves to the
four following:
as Stupiditas.              Dullness  and indocility of the appre-
  Stupidity.                 hension ;  torpitude and  poverty of
                            the imagination.
£ Amnesia.                Feebleness or failure of the memory.
  Forgetfulness.
y Credulitas.              Weakness  and undue  pliancy of the
  Credulity.                judgment,  with a facility of being
                            duped.
3 Inconstantia.             Instability and irresolution  of the will.
  Fickleness.

  In stupidity there is generally a dullness of several of the faculties
besides the apprehension  and  the imagination; and  sometimes,
perhaps, in all of them : but then  it originates in these, and the rest
are for the most part only secondarily dull, as not being furnished
with a sufficient number of ideas  or in sufficient rapidity for their
use.  Thus the judgment of a heavy or stupid man is often as sound
in itself as  that of a man of capacious comprehension ; and more so,
perhaps, for a reason we have already observed under aiusia facetosa,
or crack-brained  wit, than that of a man of facetious  quickness  of
parts : but  the heavy man requires time and patience to collect his
ideas,  and  compare them with each other; for they are  neither
furnished to him in a free current from his memory  or his imagina-
tion, nor does he readily apprehend or lay hold of them as they are
offered from external objects to his perception, which,  in effect, is
little more than a synonym for  the apprehension, the apprehension
being the perception in a state  of exercise, or exertion.  There is
hence a  material difference in physiology, though, perhaps little in
practice, between ignorance  and  stupidity.   The former is want of
knowledge from want of its ordinary means ; and by the use of such
means may, perhaps, soon be  gotten the  better of: the latter is 
GE. VI.-SP. I.]       NERVOUS  FUNCTION.
125
dullness in the use  of such knowledge as  by ordinary means has
been  acquired and  exists  in the sensory,  though  in  a state of
stagnation or dormancy.  Mr. Locke has made the same distinction,
though he has justly enough observed that, for all practical purposes
the man of stupidity had almost as well be without his knowledge as
with  it.   " He," says this admirable  writer, " who, through this
default in his memory, has not the ideas that are really preserved
there, ready at hand when need and occasion calls for them, were
almost as good be without  them quite,  since they serve him to little
purpose.  The dull man,  who loses the opportunity whilst he is
seeking in his mind  for those ideas that should serve his turn is not
much more  happy  in his knowledge  than  one  that  is  perfectly
ignorant.  It is the business  of the memory to furnish those  ideas
which it has present occasion for, and in the having them ready at
hand on all  occasions, consists that which we call invention, fancy,
and quickness of parts."*
   Stupidity  or dullness of apprehension may be idiopathic ;  but  it
 may  also proceed from want of education,  or education irregularly
conducted; for all the faculties of the mind like the muscles of the
 body, become invigorated  and are rendered more alert by a well-
disciplined  exercise.  And hence stupidity  is a natural result  of
idleness; as it is more particularly of idleness in conjunction  with
an undue use of wine and  fermented liquors, which have a prover-
bial  power  of besotting the understanding.   It is also produced
temporarily or habitually  by various  corporeal diseases; as hemi-
 crania, chronic inflammation or dropsy of  the  head,  gout  in the
 head, and  sometimes repelled cutaneous  eruptions  or habitual
 discharges.
    Stupidity, like  wit, is propagable;  and  hence we frequently see
 it run from one generation to another; and not unfrequently it form3
 a distinctive mark  in the  mental  character of districts or nations :
 in many cases, indeed, where they border closely  on  each other.
 The Dutch have at  least as much solid sense as their neighbours
 the French ; but they are  certainly less quick ; or,  in other words^
 they have a duller fancy and apprehension.   Bceotia  in  respect to
 chorography was merely separated from Attica by Mount Citheron ;
 but in respect to genius the two countries  were as  far apart as the
 poles.  So in the Pacific ocean the natives of Otaheite learn every
 thing with  facility;  the  natives of  New  South  Wales have  no
 aptitude, and learn  nothing.  The residence of a few missionaries
amongst them for a short  term of years, has nearly civilized the
former ; the actual possession of the country for a far longer period,
by a British public and  a British  government, with  a perpetual
 intercourse, and the kindest encouragement, has made little or no
 impression upon the latter.
   A  failure of memory, however, which forms the second species of
 mental  imbecility before  us, is a far  severer  evil  than dullness of
Essay concerning Hum. Unders. B. n. Ch. x. Sect. 3. 
 126                     NEUROTICA.           [CL. IV.-OR. I.

 perception with poverty  of imagination : for as all the sources  ot
 information to which we have been privy cannot be always  imme-
 diately before us to excite the perception, we must necessarily draw
 upon our recollection for those which are not  so, and  whose ideas
 or impressions we stand in need of.  And hence the memory is the
 great store-house  of intelligence; and  in  one sense  at least the
 Platonic doctrine is universally true that « all knowledge is remi-
 niscence."  There are some minds in whom this faculty has been
 peculiarly retentive, as that  of  Newton, who made it answer the
 purpose  of intuition;  and of Pascal, who  is  said never to have
 forgotten, till his health failed him,  any thing he had ever done,
 read, or  thought of.
   Retention of memory, however, is a different property from that
 of quickness.  They may and often do co-exist;  but they are also
 found separate : for there are many persons who can well catch hold
 of an entire  song,  an  entire sermon,  or  a series of  speeches  in
 parliament, and can recite them  almost,  if not altogether, verbatim
 immediately afterwards, but who lose all recollection of them in a
 day or two: while there are others who are obliged to pause over
 the subject submitted to them, or to have  it repeated for several
 times before  they can get it  by heart, yet who when they have
 once fixed it  in the memory,  retain  it as long as they live.  Mr.
 Woodfall, the celebrated reporter of the  parliamentary debates, was
 an instance of the former of these talents: the well-known Jedidiah
 Buxton of the latter.
  Failure of memory takes place in a variety of ways.  It is some-
 times general, and extends to every subject; but it is frequently far
 more manifest  on some subjects than  on others.   Salmuth  men-
tions a case in which the affected person had forgotten to pronounce
 words, but could nevertheless write them*  Mr. J. Hunter was  sud-
denly attacked with a singular affection  of  this kind in December
 1789, when on a visit at the house of a friend in town.   " He did not
 know in  what part of the  house he was, nor even the  name of the
street when  told it, nor where his own house was : he had not a
conception of any thing existing beyond the room he  was in, and
yet was perfectly  conscious of the loss of memory.   He was sensi-
ble of impressions of all kinds from the senses, and therefore looked
 out of the window, although rather dark, to see if he could be made
 sensible of the situation of the house.  The I08S of memory gradually
 went off, and  in less than half an hour his memory was perfectly re-
 covered."!  This might possibly be  connected with  a  gouty habit
 to which Mr. Hunter was subject, though not at this time labouring
 under a paroxysm.  The late bishop  of  Landaff, Dr. Watson, gives
 a singular case of  partial  amnesia in his father, the  result of an
 apoplectic  attack.   " I have heard him ask  twenty times a-day,"
  * Cent. n. Obs. 41.
  + Sir Everard Home's Life prefixed o his Treatise on the Blood, Inflammation)
&c. 4to. 1794. 
GE. VI.-SP. I.]
NERVOUS FUNCTION.
127
says Dr. Watson, " what is the name of the lad that is at college ?
(my elder brother;) and  yet he was  able  to  repeat, without  a
blunder, hundreds of lines out of classic authors."*  And  hence,
there is no reason for discrediting the story of a German statesman,
a Mr. Von B. related in the seventh volume of the Psycological
Magazine, who having called at a gentleman's house, the servants
of which did not know him, was under the necessity of giving in his
name ;  but unfortunately  at that  moment he had forgotten it, and
excited no small laughter by turning round to a friend who accom-
panied him, and saying, with great earnestness,  " pray tell me who
I am, for I cannot recollect."
   From severe suffering of the head in many fevers a great inroad is
frequently made upon the memory, and it is long before the conva-
lescent can rightly put together all the ideas of his past life.   Such
was one of the effects of the plague at Athens, as we learn  from
Thucydides,  tau; it xxt fo,6v  tXxp&xn  •kxpxvtmx xvxo-rxtrxs rm -xetrraf
ofttitis' **t ypynnrxv <r(pxs « at/r«v$, xxt  rov? iitiTwitiovi: " and many, on
recovery,  still experienced such an  extraordinary oblivion of all
things that they knew neither themselves nor their friends."   A few
years ago a  man  with a  brain-fever was taken into St. Thomas's
Hospital,  who as he grew better spoke to his attendants, but in a
language  they  did not understand.   A  Welsh milk-woman, going
by  accident into the ward, heard  him, answered him and conversed
with him.  It was then found that the patient was by birth a Welsh-
man, but  had left his native land in  his youth, forgotten his native
dialect, and used  English for the last thirty  years.  Yet in conse-
quence of this fever he had now  forgotten the English  tongue, and
suddenly recovered the Welsh.
   Boerhaave, however, gives a still  more extraordinary instance of
oblivion in the  case of  a Spanish tragic author who had composed
many excellent pieces, but so completely lost his memory in conse-
quence of an acute fever, that he forgot not  only the languages he
had formerly learnt, but even the alphabet:  and was hence under
the necessity of beginning to read again.  His own poems and com-
positions were  shown to  him, but he  could not be  persuaded that
they were his  production.   Afterwards, however, he  began once
more to compose  verses;  which had so striking a resemblance  to
his former writings that he at length  become  convinced  of his being
the author of them.t
  The  memory may also be prematurely impaired (for in age it is
a natural  defect) by, various other causes.   Idleness or inattention
will do it,  as in the case of stupidity, as will  also an over exertion
of the faculty, injuries of the head, rheumatic, or gouty pains in it,
  * Anecdotes of the Life of Richard Watson, D. D. Bishop of Landaff.
  tPraelect. Acad, in Justit. Med. ex Edit. Hallen. Tom. iv. p. 463.  See also
Cricht.  Of Ment. Derangement, i. 370. 
 128                      NEUROTICA-            [CL. 1V.-OR. I.

 dyspeptic maladies, various  narcotic poisons, prostrating hemorr-
 hages, or want of food, and libidinous indulgence.*
   Dependent upon this last cause Sir Alexander Crichton has given
 a single example of what may be called perverse oblivion in an old
 attorney, nearly seventy years of age, who though married to a lady
 much younger than himself, kept a mistress whom he visited every
 night.   He was suddenly seized  with great prostration of strength,
 giddiness, and forgetfulness ; but the last was of a peculiar kind and
 consisted in the mistaking the name of one thing for  that of another ;
 so that if he wanted bread  he would ask for his boots, and  though
 enraged at the latter  being brought to him, he  would still call out
 for his boots or shoes.  In like manner if he wanted a tumbler to
 drink out of,  it was a thousand to one but he would call for  the or-
 dinary chamber utensil, or, if this were wanted, he would call for a
 tumbler  or a dish.  This gentleman,  however, was cured of the
 complaint by large doses of valerian and other  cardiacs.
   In credulity, constituting the third variety, of the imbecility be-
 fore us, the  faculty of the judgment is the chief seat  of disorder.
 It  is unquestionably more generally to be  found  among ignorant
 people than those whose minds are well stored with the elements of
 knowledge ; but, as we also frequently  perceive  among the  former
 a most obstinate and wilful incredulity, and among the latter extra-
 ordinary proofs of the present failing, it cannot be regarded  as alto-
 gether an effect of a general want of ideas: it is in reality a hebe-
 tude or indolence of the judgment or power of ratiocination, which
induces a man to take things upon trust and allow others to think
 for him,  not for want  of ideas, but for want of comparing one idea
 with another, those of probability with those of improbability, and
 fairly striking the balance ; in consequence of which, under  the in-
 fluence of this mental oscitancy,  he  readily yields himself, body and
 soul, to the opinions of others, and  follows such  opinions blindfold;
 as those who shut their eyes  must be led by those  that see,  or else
fall into the ditch.
   This is voluntary credulity ; yet  many  have been so long accus-
 tomed  to it, that it has all  the effect of a chronic disease, and is as
difficult of cure as  the most obstinate.  There are some men, how-
 ever, whose judgment is more morbidly dull by  nature,  than from
inactivity or a neglected education; or may  possibly have been
 rendered so by intemperance; who are deficient in  natural  skill to
 use the evidence they possess of probabilities ; and being incapable
 of carrying on a train of consequences in their; heads, and weighing
 exactly the  preponderance of contrary proofs and testimonies, are
easily misled, and  rendered the dupes of every plausible sophist,
 and the  playthings of every impostor.  "There  are  some men,"
 says Mr.  Locke,  " of one,  some but  of two syllogisms, and no more;
 and others  that can but advance one  step farther.   These  cannot
* Dissert, da Memoriae Ire stone ex nimis Vener. usu. Alt. 1695. 
 GE. VI.-SP. I.]          NERVOUS FUNCTION.                129

 always discern that side on which the strongest proofs lie ;  cannot
 constantly follow that which in itself is  the more probable opinion."*
   There is another imbecility we have noticed, as strangely inter-
 fering with the  integrity of the understanding; and that is fickle-
 ness, or an instability and  irresolution of  the  will.   The faculty of
 the will requires not only to be  directed aright in infant life, but to
 be fortified and strengthened by  a  course of exercise and  discipline
 as much  as any  faculty whatever.  This we  may say as physiolo-
 gists ; but as moralists we may speak  a bolder language, and main-
 tain that it demands the spur and trammels of  education even more
 than all the other faculties put together, since it is designed  by na-
 ture to be  the governing  power and to exercise an absolute sway
 over the rest, even over the desire itself,  by which,  however,  it is
 moved in all ordinary cases.
   A  child whose inclinations have  never been  reined in, is perpetu-
 ally letting the will and the desire run together, and changing both
 every moment;  and if this disposition be  suffered  to grow  into a
 habit, it will produce the fickleness of which we are  now speaking,
 and form  a character on which there can be no reliance;  whose de-
 termination of to-morrow cannot be known from that of to-day : be-
 cause the will itself, void  of all  firmness or resolution, is the sport
 of every  transient incident, every interposing uneasiness or plea-
 sure : and which, hence, becomes  its own torment still  more than
 the torment of those around it;  since being ever instigated by the
 feelings of the moment, and sacrificing the future to the  present, it
 often purchases a fleeting gratification  and  of subordinate value at
 an expence of permanent and Substantial happiness.
   Upon the remedial process for the mental  infirmities  which ap-
 pertain to  this species, little is  to be  said in a work of medical in-
 struction.   So far as they relate to corporeal causes, and we have
 pointed out various  causes of this kind  that apply to  several of
 them, those causes should be minutely inquired into, and, as far as
 possible, removed or palliated: and whatever will tend to invigorate
 the entire frame, as the metallic tonics,t  regularity  of diet,  sleep
 exercise, and above all cold bathingj must supply the rest.  To the
 arms of mental and moral instruction,  however, the sickly under-
 standing must be  chiefly entrusted; and where these are properly
 applied, the mind may often be rendered sufficiently sound for all the
 ordinary purposes of life, and even some of its elegances, though it
 may never be distinguished for terseness, brilliancy, or  comprehen-
sion.  The leading aim should be to lay hold of the strongest facul-
ty, and to make the direct cultivation of this an indirect cultivation
of the rest.
       * Human Understand.  Book iv. ch. xix.  $ 5.
       t Agricola, commut. in Poppium, Tr. de Argento, p. 136.
       X Dauter, Vom Gebranche des Kalten Wasser?.
VOL. in.                   17 
I3t)                      NEUROTICA.           [CL. IV.-OR,
                        SPECIES  II.

                   MORIA  DEMENS.

               mitUBsntnn.   Xrratfonalt'tg.

DEFECT OR HEBETUDE  OF ALL THE FACULTIES OF THE UNDERSTANDING

Of this species we have three varieties that seem to  require a dis-
tinct notice :
                               Shallow knowledge, vacant coun-
                                 tenance,  light frivolous fancy ;
                                 for the most part  with good na-
                                 ture ; sometimes with obstinacy.
                               Impotence  of  body as  well  as
                                 of mind from premature old
                                 age ; childish desires and  pur-
                                 suits; drawling speech or  gar-
                                 rulous babble, composed of ideas
                                 for the most  part associated by
                                 previous habit.
                               General obliteration of the mental
                                 powers and affections; paucity
                                 or destitution of  ideas;  obtuse
                                 sensibility; vacant countenance;
                                 imperfect  or broken  articula
                                 tion; with occasionally transient
                                 and unmeaning gusts of passion

  The difference between the understanding of some men and that
of others is extreme  : yet it is not every minute  variation  from the
standard of soundness that constitutes a disease whether in mind  or
body • but as soon as, in either case, such variation becomes a mark-
ed or serious evil it is entitled to this name, and falls within the
range of the first of the preceding varieties.
  This which  is what we ordinarily denominate  silliness, is gen-
erally a natural infirmity, and in some families appears to be here-
ditary.  A well directed education, however, may do much, as there
is commonly some faculty that will bear cultivating better than the
rest, and which points to the particular  line to which  the study of
the individual should be especially addressed, and in which he may
appear respectable.   He may  have imitative powers  and make a
good painter or engraver, though he may not have creative powers
and make a good  orator or poet.   He may be fond  of arithmetic,
and fitted  for trade and accounts, though he may not  possess  a taste
for scientific  subtleties,  or be  well calculated  for any one  of the
professions.
x Stultitia.
  Silliness.  Folly.
£ Lerema.
  Dotage.   Superannuation.
y Anoea.
  Idiotism. 
UE. Vl.-SP. II.]
NERVOUS FUNCTION.
131
  Dotage, when a mere result of old age, is hardly to be regarded
as a disease, and i* rarely accompauied by any effervescence of the
passions.  But  it often  appears prematurely, and is especially ac-
celerated by excessive indulgence in corporeal  pleasures;  some-
times by violent mental emotion,  as anger, or by long continued
grief.   Under the two former of these causes, there is often com-
bined with it an incessant garrulity, a very high degree of passion-
ate, but unmeaning effervescence,  and puerile mobility.  M.  Pinel
gives a  striking example of this in a person whom  he had frequently
an opportuity of seeing.  " His motions,"  says he, " his  ideas, bis
broken sentences, his confused and momentary glimpses of mental
feeling appeared to present a  perfect image of chaos.   He came up
to me, looked at me, and  overwhelmed  me with a torrent of  words
without order or connection.  In a moment he  turned to another
person, whom, in rotation, he deafened with his unmeaning babble,
or threatened with an  evanescent look  of anger; but  as incapable
of determined and continued  excitement of the feelings as of a just
connection of ideas, his emotions  were the effect of a momentary
effervescence, which was immediately succeeded by a  calm.   If he
went into a room, he quickly  displaced  or overturned the furniture,
without manifesting any direct intention.  Scarcely could one look
off  before he  would be at a  considerable distance, exercising his
versatile fondness for bustle in some other way.   He was quiet only
when food was  presented to  him.  Even at night he rested but for
a few moments."  A strong desire  of food, however, is by no  means
common  under this species;  it is perhaps  most  frequently met in
 the dotage of old age ; but in premature lerema we often find the ap-
 petite entirely  banished, and a  resistance  to food of all kind  when
 offered.
   Idiotism, the third variety, is often the result, as we have already
 observed, of an original misformation of the cranium,  sometimes in
respect to thickness, more frequently in respect  to shape  ; by both
which  the internal  cavity,  and consequently the capacity of the
brain, is unduly diminished.
  The  internal causes are habitual inebriety, excessive and enervat-
ing pleasures, violent agitation of the passions, whether pleasurable
or painful, as overwhelming joy, startling terror, deep and protrac-
ted grief, or furious anger; tumours within the cavity of the cranium;
injudicious management in ecphronia, and especially an  excessive
use of the lancet.  To  which  some add  suppressed  discharge or
eruptions, as blennorrhoea,* and  itch,t and  the drinking of human
blood.J
  Idiotism, however, is more  frequently congenital, than accidental;
and it is melancholy to think that  it is also sometimes hereditary.
* Ehrmann, Beytrage zur anfklarung des Trippers.
t Wantner, Journ. de Medicine, Tom. lvi. p. 115.
X Sennert, Institut. cum Paralis. Vitel. Ifi67. 4to.
 Zacnt. Ltis.it. Pi ax. Mud. Adm. I. HI. Obt\ 79. 
132
NEUROTICA.
[CL. IV.-OR. 1.
Of those who are idiots from birth  many are sooner or  later afflic-
ted also  with palsy or epilepsy, or both, a clear proof of the exist-
ence of some organic affection of the brain or nerves:  the  former
being sometimes partial, and confined to the face only or extending
down one of the side.   Idiots rarely  attain old age ; they  seldom
exceed  the  term of thirty years;  and when paralysis or epilepsy
are concomitants, they usually die at a much earlier period.
   In idiotism the ideas of sensation  and of reflexion appear to be
equally  inaccurate.  There is a vague, unsteady,  wandering  eye
seldom fixed for any length  of time upon any one object; a stupid
expression of countenance in which no sign of intelligence is pour-
trayed ;   a gaping mouth from which the saliva flows constantly : a
perpetual rolling and tossing of the head ; no memory, no language,
no reason.   The idiot has all the animal instincts, and some of the
passions.  Of the last, joy, fear, and danger, are those with which
he is most frequently affected, but these are of a very limited kind.
His joy is unmeaning mirth : his fear a transient qualm ; his anger
a momentary fit of violence.  The toys of children, and the  gratifi-
cation of hunger and thirst, are his only pleasures:  bodily pain or
fear of  bodily pain his  only distresses.  It  is  said  that idiots have
sometimes shown a strong sexual appetite :  but this is not common,
for they rarely  seem to  attend to any distinction of sex.*
  The treatment where medical assistance  can be of any use, must
chiefly depend  upon the nature of the cause; blistering and internal
stimulants to increase the action of the nervous system, and augment
the habitual torpitude of the abdominal viscera which  are  usually
affected in this  malady,  offer the fairest chance of advantage.  Ac-
cidental commotion of the brain, an occasional cause, has occasion-
ally also proved serviceable, as has likewise a fracture of the crani-
um ; hence too  fevers have relieved the disease ;  and active parox-
ysms of mania  have proved a  complete cure; and I once  knew a
cure effected in a  lad who  fell from the first floor of  a house  into
the street;  the torpitude or obstruction, or whatever was the cause
being hereby removed.
* Crichton, Of Mental Derangement, i. p. 314. 
CLASS  IV.
NEUROTICA.
                          ORDER  II.

                     .ESTHETICA.

             diseases affecting  the ,Scu«satt(m.

 DULNESS, DEPRAVATION, OR ABOLITION OF ONE OR MORE OF  THE ORGANS
                       OF CORPOREAL  SENSE.

 xtirfSTHETicA is derived  from xtviatoftxt " sentio, et, proprie, sensu
 corporis.  The term applies, however, to all the  external senses,
 and, in the language of Galen peculiarly expresses « xtdnrixn iwotfus.
 " the power or faculty of sensation."  It must, also, be admitted that
 it is occasionally applied to mental sensation, as in Isocrates to De-
 monicus ovru mi mum* ywftw cuo-faw  u thus will you  feel  their mind
 or inclination."
   The term has  hence been used in  different significations  by dif-
 ferent medical writers.   It has seldom, indeed, been applied to the
 mind, but has strangely varied between expressing sensation gener-
 ally, and the sense of touch  alone.   In Dr. Young's excellent volume
 on Medical Literature,  it runs for the  most part parallel  with its
 meaning in the present work, and imports diseased action of all the
 corporeal senses, but with this appropriation  of the  term there
 seems to be an incorrectness in applying it, as the same author does
 immediately afterwards, to  defective memory, which he names dyses-
 thesia interna, and ranks in the same list or genus with defect of the
 external senses.  Sauvages, and after  him Sager  and Cullen, have
 applied ctysaesthesiae to a morbid state of the corporeal senses gene-
 rally ;  whence anaesthesias should in  their hands have expressed
 atony or total inactivity of these senses generally.  But while dyses-
 thesia  extends to all the senses, anaesthesia is by  the same  writer*
 limited to the single sense of touch;  with no small perplexity to the
young student. 
134
NEUROTICA.
[CL. IV.-OR. II.
  In the Physiological Proem to  the present class we  have taken
so full a survey of the connexion which exists between  the brain
and the corporeal senses by means of the nerves, that it is not ne-
cessary to  say more upon  the subject at present:  and 1 shall only
therefore further observe in these preliminary remarks  that where
one of  the senses is deficient, and  especially where  naturally defi-
cient,  the  rest have very frequently been  found  in a  more  than
ordinary degree of vigour and acuteness, as though  the sensorial
power were primarily derived from a common source, and the pro-
portions belonging to the organ, whose outlet is invalid, were dis-
tributed among the other organs.*
  The genera, under the  order before us,  are taken in a regular
series from the corporeal  senses  themselves in a state of morbid
action, and are in number six:  of which the first five are derived
from the five external senses,  and  last from a diseased state of par-
ticular branches of the nerves distributed over the frame generally
for  the common and  pleasurable feeling of  health in the different
organs through which they are dispersed.

        I.  PAROPSIS.                        MORBID SIGHT.
        II.  PARACUSIS.                        ------ HEARING.
       III.  PAROSMIS.                        ------ SMELL.
       IV.  PARAGUSIS.                        ------ TASTEj.
        V.  PARAPSIS                         ------TOUCH.
       VI.  NEURALGIA.                       NERVE-ACHE.
                        GENUS  I.

                         PAROPSIS.

                       Jttoriiftr  Stunt.

                 SENSE OF SIGHT VITIATED OR LOST.

Paropsis is literally " diseased or depraved vision" from -xapx, male,
and o^<s, visus ; as paracusis, " diseased or depraved hearing," from
-7fx(x and xkovy)
  The ophthalmic monographists, by making every variety of affec-
tion a distinct disease,  have most unmercifully enlarged the  list
under this genus.f  To say  nothing of Campiani, Taylor has in this

  * Trinckhusius, De Caecis  sapientia ac eruditione, Claris mirisque csecorum
quorundam actionibus.  Gere. 1762.
  Meekrcn, Observ. Med. Chir. cap. xx.
  -t Campiani, Raggionamenti sopra tntti i moli degli eeehi deseritti, &c.  Genoa.
1759. 
GE. I.-SP.  I.J        NERVOUS  FUNCTION.                 135

manner mustered  them  at  two hundred  and forty  three,*  while
Plenck  has contrived to multiply them  to nearly  six hundred.,
Upon a comprehensive view of the subject, it will, 1 think, be found
that this formidable number may be reduced to the thirteen species
following:

     1.  PAROPSIS LUCIFUGA.             NIGHT-SIGHT.
     2.-------NOCTIFUGA.            DAY-SIOHT.
     3.-------LONGINGUA.            LONG-SIGHT.
     4.  ------- PROP1NGUA.            SHOUT-SIGHT.
     5.  ------- LATERALIS.            SKUE-SIGHT.
     6.-------ILLUSORIA.            FALSE-SIGHT.
     7.  ------- CALIGO.                OPAKE CORNEA.
     8.  ---;---- GLAUCOSIS.            HUMORAL  OPACITY.
     9.  ------- CATARRACTA.          CATARACT.
   10.-------SYNIZESIS.             CLOSED PUPIL.
   11.  ------— AMAUROSIS.            DROP SERENE.
   12.  ------- STAPHYLOMA.          PROTUBERANT  EYE.
   13.  ------- STRABISMUS.            SQUINTING.

  Most  of  these fall rather within the province of the  ophthalmic
surgeon than of the physician ; but as their general nature ought to
be known to every practitioner, we shall  proceed to give a glance
at each  of them in their order.
                          SPECIES  I.

                PAROPSIS  LUCIFUGA

                        J£tflfit=<Stoht.

 VISION PAINFULLY ACUTE IN A STRONG LIGHT ; BUT CLEAR A»D  PLEASANT'
          LN  A DEEP SHADE OR THE  DUSK OF THE EVENING.

The specific term  lucifuga is so distinct as  at once  to point  out
the general nature of the  affection while constituting a very pro-
minent symptom.  The author,  however, has found a necessity for
introducing this new name, not more from its own clearness than from
the confusion  which has taken place among  earlier writers in dis-
tinguishing the disease by two directly opposite  terms, nyctalopia
and hemeralopia, according as these terms have been used  in a lite-
ral or a technical and implied sense.  The Greeks called it by the
former name, literally night-sight,  in consequence of the person
  * Catalogue of two hundred  and forty three diseases of the Even.  Edin  Vol.
1749.
  t Doctrina de morbis oculorum. 8ro. Vienn. 2d. Ed. 1783. 
136                      NEUROTICA.           [CL.  IV.-OR. II.

labouring under it being only  able  to  see  at  night, or in a deep
•hade;  while  nyctalopia has been used by most modern writers in
the opposite sense of night-sight-acAe, agreeably to the technical or
implied meaning of opia when employed pathologically, in which
case it always imports  diseased vision, as  though a contraction of
the term paropia or paropsis : whence nyctalopia has necessarily been
made to import day-sight, instead of night-si^ht, or that imperfection
of vision in which the eye can only see in the  day or whenever
there is a strong light.  And hence hemeralopia, the opposite to
nyctalopia, has been used, with the same confusion and contradiction
of signification; by the Greeks importing  day-sight, being  taken
naturally  or literally; by the  moderns  day-sight-ache,  and conse-
quently night-sight, being  taken technically  or by implication;  and
hence Sauvages " Graesis hemeralopia; neoterisis nyctalopia."
   The disease is dependant upon a peculiar irritability of the retina,
produced  by two very different causes: a sudden  exposure to a
stronger light than the eye has been  wont to sustain;  and a defi-
ciency of the black pigment which lines  the choroid tunic.   If the
iris be weak and torpid it is enlarged;  if strong and contractile,  di-
minished.
   From the first cause this disease is common to those who Jive
almost constantly in dark caverns or chambers, as mines, dungeons or
other prisons; or who have recently had  a cataract depressed or ex-
tracted, the growth of which has still more effectually excluded the
light from falling on the retina.  And in all these cases we find it
accompanied with a perpetual nictitation, from the sympathy which
prevails between the  retina and the orbicular muscles of the pal-
pebral.
  Ramazzini asserts that this  complaint  is common to the peasants
of Italy who are employed in agriculture ;  but in whom he is able
to trace no other  peculiarity  than a considerable  enlargement of
the pupil.*  It is not difficult perhaps to assign a reason  for such an
affection among these people,  though Ramazzini is silent upon the
subject.  The sky of Italy is peculiarly bright, its atmosphere  pe-
culiarly clear; and its temperature relaxingly warm.   The peasants
of Italy, therefore, are exposed to the  joint operation of almost
every cause that can produce habitual debility in the iris, and irri-
tability  in the retina.   And we  find these causes acting with renew-
ed power at the time when the disease chiefly  makes its attack,
which we are told is on the return  of spring, or rather at the vernal
equinox, when a double flood  of day breaks on  them.   And such
is the dimness it produces that the peasants lose their  way in the
fields in the glare  of noon; but on  the approach of night, they  are
again able to see distinctly.  It is hence necessary for them to keep
for some  weeks in the shade,  or in comparative  darkness, till  the
eyes recover their proper tone : and the weakness, and consequently
the disease, subsides.   And hence  Ramazzini tells  us  that in  the
* De morbis Artificum, &c. 
G£. I.-SP. I.]
NERVOUS FUNCTION.
137
course of the succeeding month, or, in other words, after they have
taken due care of themselves, the peasants recover the.r sight.
  A deficiency of the black pigment is occasionally found in persons
of a fair complexion and light hair; and as the retina is hereby de-
prived of the natural shade that softens the light in its descent upon
this very sensible  membrane, its morbid irritability is not  to be
wondered at.  Albinoes, who are without the common pigment that
lies between the cuticle and cutis in other persons, are always defi-
cient in this also; and  hence are peculiarly  subject to  his  disease.
In old  persons the same deficiency is sometimes traced, but  without
painful vision : for at this  time  of  life  the optic nerve is  become
more obtuse.  In horses this want  of pigment constitutes  what is
called  a wall-eye.
  The disease is occasionally found as a symptom in ophthalmy, va-
rious  other irritations  of the optic nerve  and hydrops capitis; and
sometimes  terminates in amaurosis.*
  Acuteness of night vision is natural to various animals that prowl
in the dark; as cats,  lynxes, lions, and perhaps, all  the feline genus;
which save their eyes  from the pain produced by broad day-light,
by a closer contraction of their irids than mankind are able to effect;
expanding  them gradually as the night shuts in, till by the extent of
the expansion, they are  able to see much better  than mankind in
the  dark.   Owls, bats,  cockroaches, mothes,  sphinxes and many
other insects have a similar power.                • ,
  Where the disease proceeds from an accidental  irritability of the
retina, sedative applications, as the tincture of bella donna : and in-
ternal  sedatives,  as hyoscyamus and  conium, have  often  proved
serviceable, and the more so when combined with  the bark   In old
age, or an  early deficiency  of the black pigment  that covers the
choroid tunic, medicine has very little  chance of success,  and all
we  can hope for is  to afford  occasional  relief by palliatives, if the
irritation be violent, or accompanied with inflammatory symptoms.
                        SPECIES  II.

               PAROPSIS NOCTIFUGA.

                          23ag=m'flftt

VISION DULL AND CONFUSED IN  THE DARK :  BUT CLEAR AND POWERFUL
                      IN BROAD DAY-LIGHT.

  This species, the nyctalopia of neoteric authors, is said to be en-
               * Piso, De Med. Brasil, Lib. ir.

vol.  m.                  18 
138
NEUROTICA.
[CL. IV.-OR. II.
 demic in Poland, the West-Indies,  Brazils, and intertropical regions
 generally.*  Its cause is precisely the  reverse  of that of the  pre-
 ceding species; and proceeds from too great instead of too small an
 habitual exposure  to light, whence  the   retina becomes torpid,
 and requires a strong stimulus to raise it.  At noon-tide, therefore,
 it is sen-ible to the  impressions of objects;  but does not clearly dis-
 cern them in the shade or towards the close of day.
   Daylight is also said, in a work of allowed  authority,! to be en-
 demic in some parts of France ;  and  particularly in the neighbour-
 hood of Roche Guyon'on the banks of the Seine.   And so general is
 its spread there, that  in one village, we are  told,  it affects one in
 twenty of the inhabitants, and in another, one in ten, every  year.
 It makes its attack in the spring, and  continues  for three  months :
 sometimes, though in  a slighter degree, returning  in  the  autumn :
 and there are individuals who have had annual returns of  the com-
 plaint  for twenty years in succession.   It passes off after having run
 its course, or rather perhaps, after  having been treated with due me-
 dical attention, without any inconvenience,  excepting a weakness in
 a few eyes that renders them impatient  of  wind and  strong  light.
 The soil is here a dazzling chalk,  and the keenness of the first re-
 flected light, after the dreariness  of the winter,  is probably one
 cause  of so general  an  evil.   Perhaps, however, there is no part of
 the world in which  this disease is  found  more commonly,  or  more
decidedly, thao'in Russia : but then it is rarely found except in the
 Russian summer,  when the eye is exposed,  almost without intermis-
sion, to the constant action of light, as the sun dips but little below
the horizon, and there is scarcely any  interval of  darkness.   The
malady, again, mostly  makes its appearance at this  time among the
peasants, who protract their hard labour in  the  fields from a very
 early to a very  late hour; and at the same  exhaust and weaken
 themselves by their daily fatigue.  The  sight is soon restored by
rest, a proper shade, and bathing the  eyes   with an infusion of any
bitter and astringent vegetable.  Dr. Guthrie, in  the  Memoirs of
 the Medical Society of London, from  which this  account  has been
 taken,  gives also an example of the  disease having appeared sud-
 denly  a few springs before in a detachment of Russian soldiers, who
 being ordered to attack a Swedish  post, at the moment of its incur-
 sion had nearly destroyed one another by mistake.  These men had
 been harassed by long  marches, and been exposed night and day to
 the piercing glare of an uninterrupted scene of  snowy mountains,
 both which causes had concurred in producing  this effect.
   Sir Gilbert Blane has found it occasionally occur in scorbutic pa-
 tients; but no such  disease appeared in the Russian soldiery,   rjens
 are well known to  labour uuder this defect naturally; and hence
 they cannot see to pick up small grains in the  dusk of the  evening
* Hantesierck, Recueil d'observations de Medicine, i. ii.
t Mem. de la Societe Royale de Med. 1786. 
<*E. I.-SP. II.]
NERVOUS FUNCTION.
139
 and so employ this time in going to roost:  on which account the
 disease is sometimes called hen-blindness.
   In this species tonics and gentle stimulants offer the best means of
 cure.   The bark may be  freely employed internally, and  blisters
 externally, with the vapour of camphor, ether, or carbonated  am-
 monia ; and occasionally illining the ball of the eye with a few drops
 of the tincture of opium, the citrine ointment, or a  minute  portion
 of prussiate of iron, also in  the form of an ointment.   In most of the
 endemic cases it seems to be an intermittent, as the  preceding  spe-
 cies appears to be occasionally;  and in such  circumstances a  free
 use of the bark is the plan chiefly to be depended upon.
   When the sight is once stimulated by the full light of the day, it
 occasionally becomes peculiarly acute  and  vivid.   Plenck  asserts
 that he has  known some men labouring under this disease, evince so
 high an excitement of vision as to be able to distinguish the  stars at
 noon.
   Dr. Heberden has communicated  a singular  case of this  species
 which it will be best to  give in his own words.*  " A man about
 thirty years old, had in the spring a tertian fever, for which he took
 too small a quantity of bark, so that the returns of it  were weaken-
 ed without being entirely removed.  He therefore   went into  the
 cold bath, and after bathing twice  he  felt no more  of  his fever.
 Three days  after this last fit, being  then employed  on  board of a
 ship in the river, he observed at sun-setting, that all objects began
 to look blue, which blueness gradually thickened into a' cloud;  and
 not long after he became so blind as hardly to  perceive  the light of
 a candle.  The next morning about sunrising his sight was restored
 as perfectly as  ever.  When the next  night  came on he  lost  hii
 sight  again in the same manner; and this continued for twelve day*
 and nights.  He then came ashore  where the  disorder of his eyes
 gradually abated, and  in  three  days was  entirely gone.  A month
 after he went on board another ship, and after  three days' stay in it
 the night-blindness returned as before, and lasted all the time of his
 remaining in the ship, which was nine  nights.  He  then left  the
 ship, and his blindness did not return while he was upon land. Some
 little time afterwards he went into another ship in whiph he conti-
 nued for ten days, during which time the blindness returned only two
 nights, and never afterwards."
   As this distinguished writer has not undertaken to account for this
 singular affection, it may seem, perhaps, presumptuous to  drop a
 hint upon the subject.  Yet it  should  not pass unnoticed that  the
 man was in a state of great nervous debility, and probably irritabili-
 ty as its effect.   He  had formerly been  employed, we are told, in
 lead-works, and had  twice lost the use of his hands.   And not many
 weeks  from the time the above account closes he complained of
loss of  appetite, weakness, shortness of breath, and a cough ; which,
together with other complaints gradually increased  upon him, so
* Medical Transactions, Vol. t, 
 140                    NEUROTICA.            [CL.  1V.-OR. II.

that he died before the end of the year.  I have observed that nyc-
talopia noctifiga U often  an  intermittent affection.   In the present
case it was distinctly of this nature, and evinced a decided quotidian
type.   We are not acquainted with the exciting cause of this inter-
mittent;  but we know that when once a circuit of action has been
established in a weakened and irritable habit, it adheres to the sys-
tem with almost invincible tenacity, and is recalled with the utmost
facility upon a repetition of such a cause.   And hence the uniform
return of the affection on ship-board w here it commenced.
                        SPECIES  III.

               PAROPSIS LONGINQUA.

                         3loug=0tflfit.

       VISION  ONLY ACCURATE WHEN THE OBJECT IS  FAR OFF.

This is the dysopia proximorum of Cullen, the vue  longue of the
French.
  In both the  preceding species the morbid affection seems chiefly
to appertain to the retina;  in  the present species it  belongs chiefly
to the iris, which is habitually dilated, and not easily stimulated  to
a contractile action.   " For  it is well known," observes Dr. Wells,
" to those who are conversant with the  facts  relating to human  vi-
sion, that the eye in its relaxed state  is  fitted for distant objects,
and that  the seeing  of near objects accurately is dependant upon
muscular exertion."
  The species offers us three varieties as follow:

x Vulgaris.                     Iris relaxed, but moveable, cornea
  Common long-sight.            mostly too  flat.
£ Paretica.                     Iris incontractile, pupil unchangea-
  Unalterable  long-sight.          ble,  from partial  paralysis.
y Senectutis.                   Cornea  less   convex;  relaxation
  Long-sight of age.               and  hebetude common to all the
                                 powers of  the eye.

  The first  variety is common  to every period of life,  in which
the iris is affected with an  habitual relaxation ;  and may be suffi-
ciently understood from the  remarks  already offered.
  The second variety constitutes the disease called immutability  of
sight by  Dr.  Young ;* and  is  admirably described by Dr.  Wells  in
the Philosophical Transactions, in an interesting case of  a young
* Phil. Trans, year 1793. 
»E. I.-SP. III.]        NERVOUS FUNCTION.
141
person about thirty-five years of age, whose retina was ns sensible
to the stimulus of lisrht as ever ;  yet who, from a paresis, or perma-
nent dilatation of the pupil, saw  near objects with considerable con-
fuson, but remote objects with  perfect  accuracy.  The  power  of
moving the  upper eye-lH was also lost.   It was an extreme case of
the disease before us. complicated with partial paralysis of the ad-
joining muscles, and  may  be  imitated by applying the  tincture of
bella donna.  It was easily remedied by the use of spectacles  with
convex glasses, by means of which the patient  was  able to  read
without difficulty'in a printed book, whose  letters he  was scarce-
ly able to distinguish from each  other  before  the spectacles were
applied.
   The third variety or that produced  by  old  age, constitutes the
presbytia, and presbyopia of  medical writers,  from rogwSvs, senex;
and here the hebetude and relaxation, while short of  paralysis, ex-
tend usually through the retina,  iris, and, indeed, every part of the
complicated organ of the eye ;  on which  account  the cornea be-
comes less convex in its form and less pellucid in its transparency.
   In the present,  as  in the other varieties  of this affection  of the
eyes, the best remedy  for supplying the deficient convexity of the
cornea, as  well as the deficient irritability of the iris,  is convex
spectacles ;  adapting their power to the precise demand of the eye,
and increasing it as the demand grows  more urgent.
                         SPECIES IV.

               PAROPSIS  PROPINQUA.

                         Snort-m'jjnt

         VISION  ONLY ACCURATE WHEN THE OBJECT IS NEAR.

 This is in most respects an opposite disease to the preceding;  for it
 not only  produces an opposite  effect, but proceeds, in the main,
 from an opposite cause.   In the  former the iris is for the most part
 relaxed and weakly; here it  is sound,  often too much  contracted :
 in the  former the cornea is, in almost all cases, too much flattened,
 in the  present it  is too  convex or polarized.  The best palliative,
 therefore, is spectacles of an opposite character to those recommend-
 ed under the preceding  species; and with  these we  must satisfy
 ourselves till age brings us a natural relief, by taking off the entony
 and depressing the cornea.  Unfortunately, however, this is a relief
 that  does not always continue  for many years; since the excess of
 tone becomes too much  lowered as the age advances, and the  sight
grows  imperfect from this cause.
  Mice are said  to have this kind of vision naturally, and hence one 
142
NEUROTICA.
[CL. IV.-OR. II.
of the  technical names  for  it is myopia or myopiasis, literally
" mouse-sight."
  In the common technical terms for the present and the preceding
ipecies, there is the same kind of confusion in respect to the collo-
quial terms, by which these diseases are  distinguished  as  we have
already shown to exist between the technical and colloquial names
of the first and second species.
  Thus paropsis longinqua,  the long-sight of the common idiom is
the  amblyopia,  or  dyopia  proximorum  of  Sauvages  and Cullen,
literally «- morbid sight of near objects ;" while  p. propinqya,  the
short-sight of the common idiom, is the amblyopia, or dycpia dissi-
torum of the same writers; literally " morbid sight of objects lar off.'
In the  terms  now  offered the  technical and colloquial ideas  run
parallel.
                        SPECIES V.

               PAROPSIS  LATERALIS.

               .Sfectesffllu.   Sight  &sfccto.

   VISION ONLY  ACCURATE WHEN THE  OBJECT IS  PLACED  OBLIQUELY.

In this species the patient can only see in an  oblique direction,  in
consequence of some partial obfuscation of the cornea (usually
perhaps from scratches or slight scars) or of the humours through
which the  light is transmitted,  or from a partial paralysis  of the
retina.  This must not be confounded with strabismus, or squinting,
as it sometimes has been, b«t which proceeds from a different cause,
and is accompanied with different phaenomena.   In skew-sight  or
lateral vision,  the axis of the eye  affected usually coincides with
that of the sound  eye, though it  runs somewhat obliquely to avoid
the  obstruction in the tunic.  In strabismus  the two axes  do not
coincide, and the  judgment is formed from the strongest eye alone.
If, however, in lateral vision, the  obstruction be such as to make
the optical axis of the affected  eye at variance  with that  of the
sound  eye,  squinting must  be   a  necessary  consequence  of the
disease. 
OE. I.-9P. VI.]
NERVOUS FUNCTION.
143
                        SPECIES  VI.

               PAROPSIS  ILLUSORIA.

                        jpatee^Cflfit.

IMAGINARY OBJECTS  FLOATING  BEFORE THE  SIGHT ;  OR  REAL OBJECTI
               APPEARING WITH  IMAGINARY  QUALITIES.

This species, thus defined, clearly includes two varieties as follow:

n Phantasmatum.               Appearances of objects before the
  Ocular spectres.                sight that have no real existence.
C Mutationis.                   Real  objects apparently changed
  Ocular transmutations.          in their natural qualities.

  Both these  varieties offer a  very numerous  family of distinct
illusory perceptions, which require to be noticed in their order.
  Of the ocular spectkes, constituting the  fikst variety, one of the
most frequent forms is that  of dark spots.  These are the muscae
volitantes  of many authors;  and " are sometimes," as Dr. Young
observes, " if  not always occasioned by an opacity of some of the
vessels of the  vitreous  humour, near the retina.  They are seen in
a full  light, and cannot, therefore, as Sauvages has justly remarked
be  caused by  any thing in the anterior part of the eye ;  and they
may often be observed to change their form with the motions of the
eye ;   which they  could not do if they did not  depend  on  some
floating substance.  Their apparent change of position,  when we
attempt to follow them with the eye, is a  necessary consequence of
the motion of the eye itself which contains them."*
  Another form these  ocular spectres exhibit is that of net work •
hence called suffusio reticularis by Sauvages, and visus  reticularis
by  Plenck.  This is sometimes permanent;  sometimes transitory •
and is probably, as conjectured  by Sauvages, produced by a morbid
affection of the arteriolar of the retina.
  A third form is that of sparks ; and hence called  by Sauvages
suffusio scintillans.   It proceeds generally from a blow  or excess of
light.
  The eye is  also troubled  with an imaginary sense  of dazzling
constituting the myrmaryge of the Greek writers.   Its usual  cause'
is supposed  to be  a plethora  of the  minute vessels of  the  eye
  Sometimes from  the  same  cause the  ocular spectres assume an
irripescent appearance ; or exhibit, in splendid  succession, all the
colours of the rain-bow.  This Sauvages calls suffusio  coloris*   It is
occasionally a  regularly intermittent affection, or returns at stated
is, Diss. Phantasmata ante oculos volitantia afiectus oculorum singular!*. 
144
NEUROTICA.
[CL. IV.-OR. II-
 periods,  and particularly in the evenings;  and  occasionally  the
 morbid appearance is confined to a single colour   Dr  Heberden
 has given a curious example of an affection of this kind in a lady of
 advanced age, who took  lodgings on the eastern coast of Kent in a
 house that looked immediately upon the sea, and was of course very
 much exposed to the* glare of the  morning sun   The curtains of
 the bed  in which  she slept, and of the  windows, were  of white
 linen,  which added to the  insensity  of the light.   When she had
 been there about ten days, she observed one evening at the time of
 sun-set that, first the fringes of the clouds appeared red, and soon
 after the same colour was diffused over all the objects  around her,
 and especially if the objects  were white, as a sheet of paper, a pack
 of cards, or a lady's gown.   This lasted the whole night; but in the
 morning  her sight  was again perfect.  The  same  alternation  of
 morbid  and sound sight  continued the whole time the lady  was on
 the coast, which was three  weeks, and for nearly as long after she
 left it; at  which time it ceased suddenly and entirely of its own
 accord.   Excess of light upon a delicate and irritable habit, appears
 to have been the cause of this singular affection.  The retina was
 too strongly excited to throw off the impression easily—and that of
 the red rays of the descending sun,  constituting the last impression
 communicated,  remained after the  sun himself had disappeared.
 The circle of action may  be easily accounted for by an uniform
 return  of the same cause.
  The second variety of false sight or that in which real objects
appear changed in their natural qualities, is by Plenck denominated,
in consequence  of such change, metamorphopsia.
  Sometimes the change  exhibits error of form : and the objects
appear too  large, too small, cut in half, or  distorted.
  Sometimes error of motion : in consequence of which they seem
to be dancing, nodding, or in rapid succession.
  Sometimes error of number : and then they appear double, triple,
or otherwise  increased or  multiplied ;  constituting the diplopia of
Sauvages and many  other writers:
  Sometimes error of colour, in which case one hue is mistaken
for another as  red for green,  or green for yellow,  or every hue
appears alike.  Examples of this imperfection  are not unfrequent.
Mr. Scott has given a singular instance  of it in one of the volumes
of the  Philosophical Transactions,* and Dr. Priestley in another.!
The last  is especially worthy of notice as  in some degree a family
defect; and was communicated to Dr. Priestley by Mr. Huddart of
North America.  Of five brothers and  two sisters, all adults, three
of the former were  affected with it in a  greater or less degree
 while the  remaining two  and the  two sisters  possessed  perfect
vision*.    One of the brothers  could form no  idea whatever of
colours, though he  judged  very  accurately of the form and  other
* Vol. Lxvm. 1778. p. 611.
+ Id. lxvii. 1777. p. 260. 
GE. I.-SP. VI.]        NERVOUS FUNCTION.
145
 qualities of objects ; and hence he thought stockings were sufficiently
 distinguished by the name of stockings, and  could not conceive the
 necessity of calling some red and others blue.   He  could perceive
 cherries on cherry-trees, but only distinguished them, even when
 red-ripe, from the  surrounding leaves by  their size and shape.
 One of the brothers appears  to  have had  a faint sense of a few
 colours, but still a very imperfect notion : and upon the whole they
 seem to have possessed no other distinguishing power than that of
 light and shade, into which they resolved all the colours presented
 to them ; so  that dove  and straw-coloured were regarded as white,
 and green, crimson, and purple, as black, or  dark.   On looking at a
 rain-bow one of  them could distinguish it as consisting  of stripes,
 but nothing more.
   Dr. Nicholl of Ludlow has published a case in the Medico-chirur-
 gical Transactions,* of the same kind, though the imperfection seems
 to  have  been confined to one  or two colours  alone.  The patient
 could easily distinguish the green of the grass  or the leaves of the
 trees, but, like those in Mr. Huddart's statement, he confounded with
 the green the red-fruit  or flowers which happened to be intermixed
 with it.   The  false-sight in  this case  was also  connected  with
 paropis longinqua ; for  the patient saw  objects at a  greater distance
 than  other people,  and  more distinctly in  the dark.   The  irids
 were here, also, grey, with a yellow tinge round the pupil.
   The  causes of these  varieties are not always assignable : many of
 them, however, are the same as have been pointed out under the
 variety of ocular  spectres.  Diplopia, or errors of number,  have
 often been occasioned  by long exposure to severe  cold, sometimes
 by local spasm,  sometimes  by hydrocephalus.!  Baumer  gives  a
 case  produced by a  wrong  position  of the   pupil J  Raghellini
 another caused by  a  double  pupil.§   In Lentin   is a  singularly
 complicated  example  of objects seen triply.||
   Where the disease i> not structural, but dependent upon an entonic
 or a tonic condition of the optic nerve, muscular fibres  or blood-
 vessels,  benefit has  been derived, in the first  instance, from local
 bleeding, blisters, and sedatives;  the sedatives being  employed
 both generally and topically : and in the  last instance by stimulant
 collyriums, and general tonics.
  Many of these varieties of false-sight, and  especially ocular spec-
 tres, are also found as symptoms in several species of dinus, syspasia,
syncope, plethora, cephalitis, and various fevers.
 * Transact, of the Medico-chir. Soc. Vol. ix.
 t Justi, Baldinger, N. Mag. Band. xi. p. 446.
 % Art. Hafn. 1. Art. xxvu.
 t Lettera al S. Coechi sopra TofTesa della vista  in una Donna. Venet. 1748,
^49.
 || Libr. ii. Obs. 20.
 VOL. HI.                    19 
146
NEUROTICA.
[CL. IV.-OR. II.
                        SPECIES VII.

                  PAROPSIS  CALIGO.

                      <©jjafte <£ornear.

DIMNESS OR ABOLITION OF SIGHT FROM OPACITV OF THE CORNEA, OR SPOTS
                       UPON ITS SURFACE

The Latin term calico sufficiently explain the nature of the disease,
by importing " dimness,  darkness, cloudiness, obscurity."   In  old
English this filmy opacity was  denominated a " web  of the  eye:"
whence Shakspeare in King Lear, " This is the  foul fiend Flibber-
tigibbet ; he gives the web, and the pin, squints the eye, and makes
the hare-lip."  The pin is a variety of the synezesis, " closed  or
contracted  pupil," or  of one species \)f amaurosis, and  will  be
noticed  in its proper place.
  The exciting or immediate cause of this disease is rarely disco-
verable, as for the most part it makes its approach imperceptibly ; it
is  often, however, a common  consequence  of old age.  Judging
from the last species, we may place the usual proximate cause in a
torpitude of the  absorbents of the cornea, whence  the  finer and
more attenuate parts of the secerned fluid are alone carried off, and
the denser  and  grosser left behind.  Hence stimulants and tonics,
as blisters, weak solutions of brandy, camphor, alum, and nitrate of
silver,  are often found useful  in the present day; as the saffron-
coloured, or golden acrid juice of the chelidonium majus, or greater
celandine diluted with  water or milk, was formerly.
  The disease is often accompanied with or preceded by congestion
of the  vessels of the head, and consequently  a  stupid  pain  and
heaviness : and in some cases there is reason to apprehend that this
affection of the head is itself the cause, or rather that an obstructed
liver is the primary  cause, from which the overloaded state of the
blood-vessels in  the  head originates.   Leeches  or cupping-glasses
should be here freely applied in the first instance,  as well as brisk
cathartics and mercurial alterants, and afterwards the stimulant plan
just noticed.  It  is,  however,  generally a tedious disease at best:
and the author has at this moment a patient who has laboured under
the whole of the above symptoms for some months, though it is not
long that he has  had the care of her.   She has tried  local bleeding,
purgatives, and at night  an  equal  mixture of Plummer's and  the
mercurial pill; with the  vapour of ether applied to the eyes three
times a-day, and apparently with advantage.
   Baron Stoerck strongly recommended an extract  of the pasque-
flower, pulsatilla nigricans, the anemone Pulsatilla  of Linneus,  for
internal use; and from the success he ascribed to it, the plant found
its way into theEdinburgh Pharmacopoeia.  The anemone pratensis 
GE. I.-SF. VII.]
NERVOUS  FUNCTION.
147
would probably answer as well.   These plants in their recent state
have very little smell;  but their taste is extremely acrid, and when
chewed they erode the tongue and fauces.  Other  German practi-
tioners, however, as Schraucker, Bergius, and Richter,  have  tried
even the  pulsatilla  without success, though they have carried their
doses to a larger extent than Stoerck  ventured  upon.   Small and
frequently repeated doses of tartarized antimony appear,  upon so
many  testimonies, to have been successful in various cases,  that it is
a remedy well worth a trial.  Dr. Rowley used it with success upon
an  extensive  field  of practice*  Gleize employed it  with equal
success alone,t and  Hufeland as satisfactorily in combination with
warm  bathing, and the internal  use  of millepedes:{  lue last ot
which, however, may  be spared without any serious  risk.  The
disease has sometimes disappeared spontaneously  dr without any
known cause.
   In newly born infants, spots on the  cornea are occasionally met
with, which soon vanish spontaneously :§ probably the rays of light
acting as a salutary stimulus upon the occasion.
                       SPECIES VIII.

               PAROPSIS GLAUCOSIS.

                     tumoral  #jracftg.

   dimness or abolition  or sight  from opacitv  of the humours.

 Glaucosis is a Greek term from yXxvxoi, " blueish or greenish-tint-
 ed," from the common colour of the obscurity.   It was also  called
 by the Greeks glaucoma, and by  the  Roman glaucedo.  Glaucosis
 is here preferred to glaucoma, because the final oma imports usual-
 ly, and, for the sake of simplicity and  consistency, ought always to
 import, external protuberance, as in staphyloma, sarcoma, and vari-
 ous others noticed in detail in the  volume of Nosology.
   This species is  probably produced in most instances by*a torpitude
 of action in the absorbents that carry off  the waste  fluid of the
 humours, similar to that described  under the last  species; and is
 sometimes  benefited by  a like stimulant  and tonic plan of treat-
ment.  Sennert calls it indeed a caligo, and distinguishes it  by  its
proceeding from a defect of the aqueous humour—caligo a defectu
humoris aquei;  by which he seems to mean that the  torpitude be-
* On the Principal Diseases of the Eyes,
t Nouvelles Observations, &c.
X Von Blathern. p. 159.
♦ Farr. Med. Commun. II. 30. 
148
NEUROTICA.
[CL. IY.-OR. II.
longs rather to the excretory than the  absorbent  vessels; but^ in
this case, the cornea would appear  depressed or flattened, which
is rarely if ever  a symptom.
   Both this and the preceding species have sometimes ceased spon-
taneously,*  without any apparent cause; and Helwigt gives an in-
stance in which the cessation  was not only spontaneous but sudden.
They have  also been carried  off by fever.



                         SPECIES  IX.

             PAROPSIS  CATARRACTA.

                          Cataract.

DIMNESS  OR  ABOLITION OF  SIGHT FROM OPACITY OF THE CRYSTALLINE
                                LENS.

   The  cataract as it is now  called, was, by old English writers,
named pearl-eye or pearl in  the eve, and is so denominated by
Holland, the faithful translator of Pliny.  Catarracta, as  a Greek
term, is usually derived  from xxrx\\aao-m,  u to disturb, destroy, or
abolish."   K,«T«pp**T« or xurxpuxrvf,  however,  was  employed by
the Greek writers themselves, to signify  a gate, door,  or loop-hole,
and the bar  which fastens it, and becomes the impediment  to its be-
ing opened.   And  it is probably from this  last sense that  the term
cataract was first applied to the disease in question, as  forming a bar
to tKe eyes  which  were  called the  loop-holes or windows  of the
mind  by various philosophers, as we learn  from Lucretius, who thus
closes his opposition to their view :

          Dicere porro oculos nullam rem cernere posse,
          Sed per eos aAlinum ut foribus spectare reclusis
          Difficile est.J—
          To deem the eyes, then, of themselves survey
          Nought in existence, while th' interior mind
          Looks at all nature through them, as alone
          Through windows, is to trifle—

   Whence, perhaps, Shakspeare in the speech of Richmond:—

          To thee I do commend  my wakeful soul
          Ere I let fall the windows of mine eyes.

  The Greeks themselves, however, called this disease indifferent-
* Hagendorn, Observ. Med. Cent. i. Obs. 56. Franc. 1698, 8vo.
  Eph. Nat. Cur. Dec. I. Ant. u. Obs. 166.
1 Obs. 23.
% De Rer. Nat. m. 360. 
CE. I.-SP. IX.]        NERVOUS FUNCTION.                 149

ly hypochvma, apochvsis and hypochysis.  The  earlier Latins suf-
fusio: while catarracta seems first to have been made use of by the
Arabian writers, and was probably introduced into  the  medical no-
menclature by Avicenna.  Yet the more  common name among the
Arabians was gutta obscura, as that for  amaurosis was gutta serena ;
the pupil, in this last species being serene or transparent.
   The Arabians, who had adopted generally the humoral pathology
of Galen, conceived both these  diseases to be the  result of a mor-
bid rheum or defluxion falling on a particular part of the visual orb,
in the one  case producing blindness  with  obscurity,  whence the
name of an obscure rheum or gutta ; and in the other without obscu-
rity, whence the contrary name of  a transparent or serene rheum or
gutta.    But  as  various  other  diseases,  and  particularly  -of the
joints, were also supposed to flow  from a like cause, and were far
more common, the terms gutta, and rheuma were afterwards empha-
tically  applied, and at  length  altogether  limited, to  these last
complaints : whence the terms gout and rheumatism which have  de-
scended  to the present day, as the  author has already had occasion
to observe under arthrodia podagra.  For gutta the Arabian wri-
ters sometimes employed aqua ; and hence, cataract and amaurosis
are described by many of them  under  the names  of aqua obscura,
and aqua serena ; and the former, by way of emphasis, sometimes
under the name  of aqua or  arqua alone.
   The opacity producing a cataract may exist in the lens alone, the
capsule alone, or in both; thus  laying  a foundation for the three
following varieties:
x Lenticularis.                 The  opacity existing  in  the lens
   Lenticular Cataract.             itself and confined to it.
g Capularis.                   The  opacity confined  to the cap-
   Capsular or membranous         sule, or membrane  of the lens.
     Cataract.
y Complicata.                  The  opacity common  to  the lens
   Complicated Cataract.           and its capsule.

   We are told moreover by Ritcher* of  a cataract of the humour
Morgagni, or the interstitial fluid  which lies between  the capsule
and the lens:  whence this has also been  copied by Plenck and Sir
William  Adams into the list of modifications : but rather as a possi-
ble than  an  actual case;  for neither of these  practitioners give  a
single example of  such a variety ever  having occurred to them.
   Cataracts are  of different colours and of different degrees of con-
sistency  from  circumstances influencing  the  morbid  action, with
which  we are but little acquainted.  They are, therefore, black,
white, leaden-hued, ferruginous, green, amber ; as they are also fluid
or milky, soft,  firm, hard, horny, and even bony, for they have been
sometimes found of this last texture.T  They are  not unfrequently

  * Von der Ausziehung des grauen Staars. Gott. 1773. 8vo.
  + Wenzel, Traite de la Cataracte avec des Observations, Paris, 1786. 
 150                    NEUROTICA.             [CL. IV.-OR. H«

 the result of an hereditary taint, adhering to generation after gene-
 ration, and appearing either congenitally, or by a very general pre-
 disposition afterwards.
   From the colour of the cataract no conclusion, in  the  opinion of
 that acute observer Mr. Pott, can be drawn in regard to  its consis-
 tence ;  but he thinks that when the  opake crystalline is perfectly
 dissolved so as to form  a soft cataract, it is somewhat enlarged; and
 that when such dissolution does not take place, and a  hard cataract
 is produced, the crystalline is in some degree  lessened.   The hard
 cataract has also been distinguished by the name of ripe, as the soft
 by that of unripe.   " But if we would think and speak of this mat-
 ter," observes Mr. Pott, " as it really is, we should say that a disso-
 lution or softening of the crystalline lens is by much the most common
 effect;  and that seven times out of nine, when it becomes opake, and
 tends to form a cataract, it is more or less  softened :  the softening
 sometimes extending through the whole range of the  lens and some-
 times through only a part of it;  while, however, the part that re-
 mains undissolved is rarely, if ever  so  firm  as  the centre of the
 sound crystalline."  Mr. Pott, proposes it as a question,  whether cata-
 racts, which have been found  perfectly soft, have  not  in general
 grown opake by slow degrees ? and whether those which have been
 discovered to be firm have not become opake hastily, and been pre-
 ceded by, or accompanied with, severe and deep-seated pain in the
 head, particularly in the back part of it ?*
   We  have already observed, that  cataract is occasionally the re-
 sult of an hereditary taint; in other instances it originates spontane-
 ously or from causes we cannot trace.  It has, however, often fol-
lowed upon convulsions, chronic  head-ache, syphilis, rheumatism,
suppressed perspiration,  and in a few  instances  trychosis  Plica,
 or matted hair.t  It has also  appeared as an effect of inflammation
 produced by a thunder  storm.J
   Like paropsis  Glaucosis or  humoral  opacity,  it  has  sometimes
ceased spontaneously, or without any manifest cause ;§ and Helwig
gives an instance in  which the cessation was not  only spontaneous
but sudden.||  It has also, at times, been carried off by a fever.lf
   There is hence, specious ground for conceiving that some  medi-
 cine might be discovered capable, by some general or specific ac-
 tion, of producing a like change, and  proving a remedy for the dis-
 ease ;  and the more so  as we  find ganglions and  other  accidental
 deformities frequently removed from  the  extreme parts of the sys-

  * Chirurgical Observations relative to the cataract, &c. 8vo. 1775. London.
  t De  la Fontaine, Chirurg. Med.
  X Richter, Chir. Bibl. Band. vi. 158.
  I Haggendorn, Observ. Med. Cent. I. Obs. 50.  Franc. 1698, 8vo.
    Ludolf, Miscell. Berol.  Tom. iv. 258.
    Walker, On the Theory and cure of a Cataract.
  || Observ. Physico-med. 23, Aug. Vind. 1680, 4to.
  T Velschius, Episagm.  20. 
GE. I.-SP. IX.]        NERVOUS FUNCTION.                  151

tem by external or internal applications.  But no  such remedy has
hitherto been descried, or  at least none that can  be  in any degree
relied upon :  for  recourse has been had to mercurial  preparations
both external and internal, as well as almost  every other metallic
salt, aconite, the  pasque-flower, or Pulsatilla, to protracted vomiting,
electricity, and puncturing the tunics of the eyes, but  without any
certain advantage.  This is the more to be lamented, because what-
ever surgical operation may be determined upon as most adviseable,
there is no guarding, on all occasions, against the  mischievous ef-
fects which may  result, I do not mean from the  complication or se-
verity of the operation; for this, under every modification, is sim-
pler and less formidable than the  uninitiated can readily imagine,
but from the tendency which is sometimes met with from idiosyn-
crasy, habit, some  peculiar  acrimony, or other irritable  principle,
to run  rapidly into a state of ulcerative inflammation,  and in a sin-
gle night,  or even a few hours, in spite of the  wisest precautions
that can be adopted, to  endanger  a total and permanent loss of vi-
sion.  I speak  from personal knowledge, and have, in one or two
instances,  seen such an effect follow,  after the operation had been
performed with the utmost dexterity, and with  every promise  of
success; and where a total blindness has taken place in both  eyes,
the operation having been performed on both ; neither of them be-
ing quite opake antecedently, and one of them in nothing more than
an incipient state of the disease, and the patient capable of writing
and reading with  it.   And  hence it is far  better, in  the author's
opinion, to have  a trial made  on one eye only at a  time, and  that
the worst  where both are affected  and  one is still  useful,  than  to
subject both to  the same  risk; for the sympathy between  them is
so considerable, that if an  inflammatory process from  any constitu-
tional or accidental cause should  show itself in  either, the other
would be sure to associate in the morbid action.
   The usual modes of operating for the cure of a cataract are three •
that of couching  or depression : that of extraction : and that of ab-
sorption.   The first was well known to the  practitioners of Greece
and Rome  ; and is  ably described  by Celsus, who advises, in  cases
where the lens cannot be kept down, to cut it into pieces with the
sharp-edged  acus or needle, by which mean it will be the more rea-
dily absorbed.  And from this last remark we have some reason for
believing that even the third of the above methods, that of absorp-
tion, was also known at the same time ; as it is  probable,  indeed,
that the second, or the operation by extraction, was  likewise; since
we find Pliny recommending the process of simple  removal or de-
pression in preference to  that of  extraction  or drawing  it forth;
" squammam in  oculis emovendam  potius quam extrahendam,"*
which Holland has thus honestly, though paraphrastically translated
" a cataract or pearl in the eye is  to be couched rather, and driven
down by the  needle, than quite to  be plucked forth."
* Nat. Hist. Lib. xxix. Cap. 1. 
152
NEUROTICA.
[CL.  IV.-OR- H
   In the East, however, both these plans appear to have been pur-
 sued through a much longer period.  Both are noticed by the Ara-
 bian writers in general,  and especially by  Avicenna and Rhazes;
 and both seem to have  been practised from time immemorial in In-
 dia, and, according to the account of the cabirajas, with wonderful
 success.  Dr. Scott was informed by one of the travelling opera-
 tors, who, however, spoke without a register, that in the operation
 of depression this success was in proportion of a hundred who were
 benefited to five who obtained no advantage whatever.
   The operation of extraction seems to have derived no small im-
 provement from the method of Sir William Adams, who,  after de-
 taching the cataract, first  passes it through the opening of the pupil
 into the interior chamber by means of his needle, and then extracts
 it by an opening on the outer side of the cornea, instead of by one
 in its inferior part.
  The simplest and least  irritating of these operations, however, is
 that by absorption; but it should be known to the operator that
 while the solvent power of the aqueous  humour  is wonderfully ac-
 tive, that of the vitreous is weak and inconsiderable : and hence the
 absorbent plan,  as practised by Sir William  Adams, and to which
 he is much attached,  consists in dividing the cataract, after its se-
 paration, into small fragments, and passing them with  the needle,
by which they are thus  divided, through the pupil into the anterior
chamber, which constitutes the seat of the aqueous humour.  The
fragments thus deposited are usually dissolved in a few weeks; and
where the cataract is fluid they have often been dissolved and ab-
sorbed in a few  seconds;  and sometimes even before the needle
has been withdrawn.
                        SPECIES X.

                PAROPSIS  SYJNIZESIS.

                       ®losrtr mm.

BIMNESS OR ABOLITION OF SIGHT FROM CONTRACTION  OR OBLITERATION
                        OF THE PUPIL.

The term svnizesis is derived from «■«»<£*>, " consido, coeo, coalesco ;"
and was used among the Greek grammarians before it obtained  an
introduction  into the medical vocabulary, to signify the coalescence
of two or more syllables into one.  This species exhibits two va-
rieties :

« Simplex.                   Simple  closure  of the pupil.
  Simple closed pupil. 
ge. i.-sp. x.]        Nervous function.                   153

£ Complicata.                  Closure  of the pupil complicated
  Complicated closed pupil.      with cataract, or opake cornea.

  The pupil becomes closed or obliterated from a gradual contrac-
tion and  at length coalition of the muscular fibres of  the iris;  from
inflammation of surrounding membranes ;  or from protrusion of the
iris.  In  all these cases it is a simple obliteration of the tupil.  It
is complicateo when the obliteration is combined with an  opacity of
the cornea, or with a cataract.
  The natural form of the  human pupil  is circular, this  being the
natural form of the fine fringe of the iris  by which it is surrounded.
But in a very few instances the fringe or  rays of the iris has evinced
a different figure, and the  pupil, in consequence, has been found
oblong, or heart-shaped.*   The first has  occurred most frequently :
and according to Albinus has sometimes  preceded loss of vision.!
Block gives an instance in which the disease was congenital and he-
reditary.;);
  If the  iris contract irregularly sometimes only a few of its fibres
spread across the pupil  while others are retracted:  and  hence we
have  examples  of double  or more than  double pupils,  though of
smaller dimensions than  the natural circle.  Solinus gives an instance
of two pupils  hereby produced,§ and Janin  of  not  less than five.||
Dr. Plenck who very unnecessarily  multiplies diseases, confines the
term  synizesis to a total  contraction of the pupil; and makes its par-
tial contraction a distinct affection, which he calls mydsis: and the
second or complicated variety, another distinct affection  which  he
denominates synechia.  But this is to perplex rather than to simplify
the subject.
  Medicines in this disease are of little  avail.  In the first variety
the external application  of the tincture of bella  donna has occasion-
ally effected a cure by destroying the contractile action;  and dilute
solutions of brandy, camphor, or  sulphate of zinc, by their tonic or
stimulant power.   The  complicated  variety belongs manifestly to
the art of surgery, and its removal  must  be sought for in books  on
that subject.

           * Eph. Nat. Cur. Dec. in. Ann. vii. vm. Obs. 21.
           t Anat. Acad. Lib. vi. cap. 3.
           X Medinische Bermerkungen, p. 1.
           i Vide Marcel. Donat. Lib. vi. cap. ii. p. 619.
          || Memoires, &c.
VOL.  HI.
26 
 15-1                      neurotica.            [cl. iv.-or. ii.


                         SPECIES  XI.

               PAROPSIS  AMAUROSIS.

                        33roj>  Serene.

DIMNESS OR ABOLITION  OF SIGHT WITH AN UNALTERABLE PUPIL, USUALLY
  BLACK AND DILATED; BUT WITHOUT A.N V OTHER  APPARENT DEFECT.

This is the gutta  serena of the Arabic writers, whence the  term
" Drop Serene," of our own tongue ;  terms we have already ex-
plained under paropsis catarracta.  Milton is well known to allude
to this  affection in  his beautiful address  to light, a>  he does also to
the cataract by him called suffusion, as the Latins call it suffusio: but
it is singular that,  in the course  of this  allusion, he seems doubtful
as to which of the two diseases he ougrht to ascribe his own blind-
                    Thee I revisit safe
           And feel thy sovereign, vital lamp ; but thou
           Revisit'st not these eyes, that roll in vain
           To find thy piercing ray, and find no dawn.
           9b think a drop SERF.:**: has quench'd their orbs,
           Or dim suffusion veil'd.*

   The term amaurosis is derived from the Greek xpxvooc., '; obscu-
 rus, caliginosus, opacus."  The most  common cause is a paralysis
 of the retina, usually in conjunction with a paralysis  and  dilatation
 of the iris. Occasionally, however, the iris is rigidly contracted ; its
 debility being accompanied with great irritability ; and hence, offer-
 ing two varieties ;  to which a third may be added, from thedisease*
 assuming, at  times, an intermittent type.

 x  Atonica.                  With permanent  atony, and dilatation
   Atonic amaurosis.           of the  pupil.
 S  Spasmodica.               With a  permanent contraction of the
   Spasmodic amaurosis.        pupil.
y  Intermittens.              With periodical cessations and returns.
   Intermittent amaurosis.

   It would be easy to admit other varieties if we were to attend to
all that has been written on the subject, and adopt all the opinions
that have been delivered; for we are told of cases in which the pu-
pil has  not been permanently immoveable, but  has  contracted on
exposure to an intense light ;t and of others in which the  pupil in-

  * Par. Lost, m. 21.
  t Caldani ad  Haller. v. Richter, Nov. Comm. Soc. Goett. Tom. iv.  p. 77.
   Hey, Medic. Observ. and Inquir. Vol. 5. p. 1. 
GE. I.-SP. XI.]
NERVOUS FUNCTION.
155
stead of being black has evinced a pale or  nebulous  appearance.*
In the first of these exception* the disease has not acquired comple-
tion: and the other is allowed for occasionally in the definition.  It
will often be found nothing more than an incip;ent cataract.
  Plenck makes a distinct disease of an unalterable  pupil  with or
without injury of the vision under the name of mydriasis.  When ac-
companied with injured vision it is evidently a variety of amaurosis;
and it is  questionable whether an unalterable  pupil  is ever to  be
traced without defective vision.
  Under the one or other of these varieties amaurosis is also found,
occasionally, as a symptom  or  sequel in  hysteria, syspasia,  and
lues.
   It is probablv to the spasmodic variety of this species, that Shaks-
peare chefly alludes by the term pin  or  pin-eye, the pupil being
sometime* contracted to nearly the diameter of a pin's-head;  though
the synizesis is equally entitled to the name.  I have quoted  one ex-
ample already un.W P. Caligo, which he calls web-eye :  another is
contained in the following couplet:

                ------------Wish all eyes
                Blind with the  fin and web.

   The existence of an amaurosis is known by the  specific symp-
toms of the pupil  being peculiarly black and dilated, and the want
of contractibihtv in the iris on exposure to a strong light.   Its com-
mencement is often accompanied with  pain  in  the head, which di-
minishes a* the disease increases. Yet  it occasionally steals on with-
out  pain; and if it be confined to  one eye  only, it will sometimes
exist for months or perhaps years, without a person's being sensible
of it;  as, in such  cases, it is only traced by the patient's accidental-
ly closing his sound eye alone and then finding himself in darkness,
or by some other incident.
   The black cataract has sometimes been confounded with it, or
mistaken for it, of which we have just noticed an instance in Milton,
as has also that modification of the  capsular cataract, in which the
posterior lamina of the capsule is alone opake.
   The occasional cause is, therefore, for the most part incapable of
being followed up. Richter contends that it is often dependent upon
a dyspeptic state of the digestive organs; and it has often occurred
suddenly upon a plethoric state of the  vessels, apoplexy, cephalaea,
a blow on the head, or some  other injury  of the sensorium.  It is
also well known to be  temporarily produced by the juice of the so-
lanum or atropa Bella donna ; and in one or two instances  perma-
nently from  an accidental immission into the eye of the poison of a
serpent or spider.t   It has likewise been induced by  a flash of light-
ning, by insolation or  undue  exposure  to the rays of the sun, by a

  * Richter, Nov. Com. Soc. Goett. Tom. iv. p. 77. Gooet, Cases, Ed. II. p. 52.
  t Bosnian, Beschreibung von Guinea, p. 369.
  Bojle, Tract, de Concord. Medic. Specific. 
156
NEUROTICA.
[CL. IV.-OR. II.
suppressed catarrh, suppressed haemorrhages, or  venesection when
rendered habitual,* suppressed exanthems, and eruptions of various
kinds, especially porrigo, herpes, and scabies, by some sudden strain
or other violence;  or by some overwhelming passion of the mind
as wrath or terror.!  It has also appeared as a sequel or metastasis
upon fevers;  and  succeeded  to  the use of poisonous  cosmetics.
There are a few cases in which it has proved hereditary.J
  The  prognostics are generally unfavourable,  except  where the
disease  exists  as a symptomatic affection.  Where we can decidedly
trace its existence to plethora whether entonic or atonic,  or  to
some violent injury to the head, bleeding and purgatives are clearly
indicated, but  have frequently failed : for in  the  exquisitely tender
organ of the  eye,  palsy is often  induced before these  evacuations
can  relieve the oppression.  In the  spasmodic variety active eme-
tics frequently repeated, and resolutely persevered in at each time
till  the system becomes  weakened, as in  the  treatment  for the
epidemic  opthalmy, have certainly been at  times found successful.
Blisters and sternutatories also demand  attention : the  first  should
be applied to  the  lemples; the second  is best formed of  turbeth
mineral with  about ten times its  proportion of mild snuff, or any
other light powder.   The vapour  of ammonia, ether, or camphor,
mixed with  hot water, has sometimes also afforded benefit.
  Where it has followed on repelled eruptions, it has been occasion-
ally  found to yield  to setons  and blisters, or a restoration  of the
suppressed efflorescence :  and, as in other diseases, what has some-
times proved  the sources  of its production,  has been found its best
remedy, so that the cause has become the  cure   Thus it  has  at
times yielded  to the violence of a fever, to that of a sudden blow on
the head, to a strong light, to a paroxysm  of convulsions.   Elec-
tricity,  and  especially voltaisra have probably been serviceable in
some instances; at least the assertions to  this effect are very
numerous, though in various cases these have sometimes been alto-
gether unsuccessful; nor is the magnet without its recommendations,
having been applied  to the upper part of the spine, while minute
bags filled  with iron  filings were  placed on the eyes ;§ and  in an
imperfect case of the complaint Weher conceives he derived  benefit.
The chief dependencies  besides have  been on camphor,  cajeput,
musk, mercury, iron, bark,  arnica, and externally  the Pulsatilla
nigra.   Of the arnica or German leopard's bane,  Pellier, as well as
Collier, speaks warmly.  The latter recommends it in all nervous
atonies, whether general or local.  He employed  the flowers of the
  * Heister, Wahmehm. B. ii. p. 441. Bresl. Samml. 1726. i. 503.
  t Herculanus, Coram, in Rhazis Lib. ix. Richter L. c. p. 81.  Schaarschmid,
Med. und Chir. Nachrickten in. n. 18.
  X Redlin, Curat. Med. Millenar. n. 822.  Oehme de amaurosi, p. 20.
  ♦  Wurkung  des Kiinstbichen Magnets, &c. p. 24, 25.   Hell. v. Nootnagel, 1. c,
» 22. Eph. Nat. Cur. Dec.  n. Ann. v. Obs. 247. 
GE. I.-SP.  XI.]
NERVOUS FUNCTION.
157
plant in decoction* in the proportion of about half an ounce to a
pint of the strained liquid, which may be taken in a day or a day and
a-half.  Richter, Schmiicker and other German writers declare it
to be of no avail.   The pulsatilla  is certainly better entitled to
attention.   " I  would  recommend it,"  says Dr.  Cullen  with his
usual liberality, " to  the  attention of my countrymen,  and particu-
larly to a repetition of trials in that disease so frequently otherwise
incurable, the  amaurosis.  The  negative experiments of Bergius
and  others are  not sufficient to discourage all trials, considering that
the disease may depend upon different causes, some of which may
yield to remedies  though others  do not."f   When distilled with
water it gives forth a terebinthinate substance resembling camphor,
which necessarily  possesses  a  stimulant, and  hence  a medicinal
power.   Whence the euphrasia  officinalis, or eye-bright, obtained
the  character  it once  possessed  as  a specific in this disease, it is
difficult to say.   By Hildanus and Lientaud, however, it was chiefly
confined, even in its zenith  of popularity, to the  amaurosis  of old
age.  Its chief sensible quality is that of being a mild astringent.
Rue, which rivalled it at  one time, and by Milton is put  upon a level
with it, has far better pretensions when used externally in the form
of a potent infusion; for it  unites the properties of  volatile pun-
gency and bitterness  : both which, as concentrated  in strong chamo-
mile tea, I have occasionally found  highly serviceable in an inci-
pient state of this disease produced by weakness.
   The  narcotics, if  they have ever been serviceable in any way,
can  only have  been so in the spasmodic variety.   Of these aconite
has  been chiefly popular in Germany : it  has been strongly recom-
mended  by many writers of reputation,  and has  sometimes been
given by gradual augmentation to the amount of a drachm daily.J
Chevillard combined the  use of antimonials with blisters : but cold
applied  externally,  and  cold bathing as  recommended by Warner,
will often be as much entitled to  our attention, as any other process.
   Dr. Powell relates a case  of sudden loss  of vision,  preceded by
an acute cephalaea, in  which an  emetic was found, during the act
of vomiting, abruptly to restore  sight to the right eye  (for both
were affected) with  a  sensation as if a flash of lightning had taken
place, but the  vision  was soon again lost.  More than a twelve-
month afterwards the patient tried emetics again ;  when, after the
use  of the second, the pupils of the eyes recovered the power of
dilating and  contracting on exposure to  light, and preserved it till
death, but the power of vision was not restored.  During the whole
of this case of blindness, the  sense of hearing was peculiarly acute.§
  * Prodigious  enlargement and dropsy of the  eye.  Dr. Layard Phil. Trans.
1757-8. Vol. 50. p. 747.
  t Mat. Med. Vol. II. Part ii. Ch. v. p. 216.
  X Beobachtungen und UntersuclHing?n, Sic. Band. ii. Nurmb. 1767
  J Trans. Med. Vol. v. p. 226. 
158                    NEUROTICA.           [CL. III.-OR. II.


                       SPECIES  XII.

             PAROPSIS  STAPHYLOMA.

                    ^rotufcrrant Sgr.

ENLARGEMENT OF THE BALL OF THE EYE ; PROTUBERANCE OF THE CORNEA ,
                   SIGHT DIM OR ABOLISHED.

The term staphyloma is derived from ptxQvM, " uva," a grape, from
the resemblance  of the tumour to the pulpy and semi-transparent
appearance of this fruit.  Richter seems first  to have pointed out
the real nature of this disease ; which from the difference of its cause
and prominent symptoms, may be considered as  affording three
varieties :
k Simplex.                      From increased secretion of the
  Simple protuberant eye.          aqueous  or other  humour :
                                  pupil transparent.
5 Purulentum.                   From flow of pus from an abscess
  Purulent protuberant eye.         in  one  of the  membranes :
                                  pupil cloudy.
y Complicatum.                  Complicated  with  a rupture of
  Complicate protuberant eye.      the  iris, and  its protrusion
                                  upon the cornea constituting
                                  a  grape-like tumour :  sight
                                  abolished.

  Plenck, who makes staphyloma a gen'i-, and, as we have already
observed,  multiplies the diseases of the eyes almost  without end,
has several other subdivisions  which  are easily reducible into  some
one of those ; as he has also several other genera which do not
essentially  differ from the present, as exophthalmia,  ophthalmop-
tosis,  and  ptosisiridis.   All these proceed from  similar  causes,
exhibit a like appearance, and, when manageable, are to be treated
by the same means.
  The staphyloma, therefore, embraces all morbid collections of
fluids  within  the cavity of the eye, producing an enlargement of
the eye-ball, and, in most instances, a protrusion  of the transparent
cornea from  its  being  the  weakest part of the eye ; sometimes,
indeed, a partial  protrusion into the sclerotica or opake part of the
eye.
  The first variety has occasionally been called hydrophthalmia,
or dropsy of the  eye, as being formed by an increased  secretion of
the aqueous humour, or a torpitude  of the absorbents that should
carry  off the fluid when secreted in its healthy proportion.   Where
it is from the first accompanied with a slight pain,  we have reason
to infer  augmented action, and, consequently,  the first  of these 
GE. I.-SP.  XII.]
NERVOUS FUNCTION.
159
 causes;  where there is no pain, which is  usually the case, the
 second.
   In the second and  third varieties the pain is frequently severe
 and shoots backward into the head, attended  with constant restless-
 ness, heat, and other febrile symptoms, and at times with a sense of
 tension and fiery sparks, which frequently continue, not only till the
^ight  is lost, but till the  eye bursts of itself, or its contents are
 discharged by an opening.
   The causes are for the  most part internal, as inflammation and
 abscess, which break down the  membranous septa by which one
 part of the ball is so curiously divided from the rest, and throw the
 whole into confusion, with an increase of effused fluid.  They are
 sometimes, however, dependent on external violence ; and in a few
 instances are  resolvable into severe strains  from vomiting,* the
 hooping-cough,t or  vehement  muscular action.^
   In the first variety,  and where the cause consists in an atony of
 the absorbents of the membranes, it may sometimes admit of a cure
 by external stimulants, and particularly by illining the opake cornea
 with a minute drop of butter of antimony on the tip of a small pen-
 cil brush, as first recommended by Janin, and afterwards by Richter.
 It rarely happens, however, that the use of the eye can be preserv-
 ed,  and  hence  says Mr. Bell,§ our chief objects in general are to
 abate  the violence of the pain, which is  often very  severe, and to
 remove  that deformity  which an enlargement of the  eye is always
 sure to produce.  The last intention belongs to the art of surgery.
 For the  first,  bloodletting,  blisters, cooling  applications to the eye
 and opiates, are principally to be depended upon in the  commence-
 ment of the disorder.  But if these and similar means do not prove
 effectual;  if suppurat'on take  place, and the pain still continue se-
 vere,  nothing  will  more certainly  afford relief  than taking away
 the  painful distention of the eye by making au incision into the ball,
 and thus evacuating the  contents: as has  been recommended indeed
 ever since  the time  of Ceisus.   It is sometimes necessary, as in
 dropsies of other membranes, to repeat the puncture, as the effused
 fluid is apt to re-accumulate.   Some practitioners have  repeated
 the operation to the fifth time, and effected a radical cure  at last.
  A singular instance of this disease, produced apparently by  mus-
cular exertion  and accompanied with the mode of treatment adopt-
ed, is given by Dr. Layar.l, in one of the volumes of the  Philoso-
phical   rransactions.jl   The patient was a  lad  thirteen  years of
age, engaged at the  time in beating dung about a pasture.   He felt
all at once a violent pain in his eye,  which increased, and was ac-
* Act. Nat. Cur. Vol. n. Obs. 194.
  Saint Yves. Noveau Traiu des Maladies des yeux. Paris 1722.
t Layarcct, Phil. Trans. Vol. i. 1758.
X Procliaaka, Mohrenhoim Wciherischen Beytrager, B. ii.
« Surgery, Vol. ill. p. 319.
|| Tract, de ductibus ocwlorum aquosis p. 120. Vol. t. 1758. 
160
NEUROTICA.
[CL. IV.-OR. tf.
companied with inflammation,  and a swelling of the entire ball,
which in a few months protruded so considerably that the  whole
eye was out of its orbit, and hung down over the cheek to the up-
per lip.  The coats  were greatly discoloured, all the vessels tur-
gid, the sight totally  lost, and the humours appeared like fluctuating
pus.   An incision was made, the accumulated fluids were discharg-
ed, a great portion of the eye extirpated,  and the remaining part
reduced within the orbit;  the  wound  soon  assumed a healthy ap-
pearance.  But the patient having caught cold before it was healed,
a second inflammation ensued, a new and very large  cyst was form-
ed, filled with a transparent fluid, and constituting a very protube-
rant dropsy.  This on being punctured, discharged a large tea-cup
full of the accumulated liquid.   The cyst,  consisting apparently of
a part of the sclerotic tunic which had been left,  collapsed, and the
next day was easily removed : when the wound healed without fur-
ther inconvenience or disfigurement than that of appearing to have
the eye closed.
                       SPECIES  XIII.

              PAROPSIS  STRABISMUS.

                         SqutntiUQ.

      optic axes of the eyes  not coinciding on an object.

This disease, in colloquial language now called squinting, was for-
merly denominated goggle-eye, whence the word goggles is still ap-
plied to the glasses which are used by persons  affected with the
complaint.   The French call these glasses masques it louchelte; lite-
rally squinting-guards.  The technical term  strabismus, is  derived
from the Greek 0T{«C««, " tortus oculis," or -' sight-twisted."
  The optic axis is an imaginary line passing from the centre of the
vitreous humour, lens, and globe of the eye to the object of vision.
In perfect vision the optic  axis of the one eye is in unison with that
of the other; and, consequently, they converge or coincide at the
same point; and the object which would otherwise appear  double,
as being seen by each  eye, is contemplated  as single.   In order to
this coincidence, the muscles  of each eye must  constantly  assume
the same direction,  their position and  configuration be precisely
alike, and  the  sight be of an  equal power and focu« :  a deviation
from each of which postulates  must necessarily  produce squinting,
or an inaccordant action of one eye with the  other.  From common
and early habit we acquire an equal  command over the muscles of
both,  and are able to give them any direction,  or power of direc-
tion, and to fix them upon any object we please.  And such is the
/ 
GE. I.-SP.  XIII.]         NERVOUS  FUNCTION.               161
 force of habit that they at length involuntarily associate in the same
 action,  and it is difficult  for  us  to give  to the one  eye a different
 direction from that of the other; or, in other words, to make  their
 optic axes diverge  instead of converge.  In persons born blind no
 benefit  can be derived from  this unity  of action, and hence it is
 never attempted ; and the muscles being never  subjected to disci-
 pline, the  eye-balls roll at random,  and  wandfer in every direction.
 In consequence of which one of the  most  difficult  tasks to be ac-
 quired by such persons after obtaining sight, is that of keeping their
 eyes fixed, and giving the same  bearing or convergent line to each.
 And hence, again, they see things  double at first, and in a  state of
 great confusion.
    When one eye is naturally  stronger, or of a more favourable fo-
 cus, or  more frequently employed than the other, as among watch-
 makers and jewellers, the latter, from comparative neglect, relapses
 into an  undisciplined state, and less readily obeys the control of the
 will.  Its muscles do not assume the same direction as those of the
 eye employed; and  if they do, in the two former cases, the object
 still appears double ; and hence,  the neglected, or weaker eye, wan-
 ders and stares at one or at various objects,  while the eye relied
 upon is  fixed upon  some other.  And it is this divergence of the
 optic axes, this inaccordance of direction,  or looking at different
 objects at the same time, that constitutes the present disease.
   It is obvious, therefore, that strabismus may have three varieties:

 x Habitualis.                 From a  vitiated habit; or the custom
   Habitual squinting.           of using one eye,  and neglecting
                                the other.
 <S Atonicus.                  From debility of  the affected eye,
   Atonic squinting.             whence the  sound eye possesses a
                                different focus and power of vision;
                                and is alone  trusted to: in conse-
                                quence of which the weak  or neg-
                                lected eye insensibly wanders as
                                already stated.
 y Organicus.                 From  the eye being differently con-
   Organic squinting.            structed in form  or position.

   The first of these varieties constitutes the  nystagmus  of Dr.
 Plenck,  and its cause is sufficiently obvious.  In the second the sound
 eye is alone trusted to, because it is  the only eye on which any de-
 pendence can be placed;  and hence  tjie weak eye, neglected by the
 will, wanders insensibly,  as in the preceding order we have seen
 that  any one of the mental  faculties  will wander in  like  manner
 under the same want of discipline.   In  the third variety the diffe-
 rence of form or position, respects the situation or figure of the one
 eye  compared with the other,  or of the particular parts of the one
 eye  compared with those of the other:  in consequence of which
the one is favoured and the other thrown into disuse.
  In  this last variety a complete cure is hardly to be  expected.
     vol. in.              21 
162
NEUROTICA.           [CL. IV.—OR.  II
In the second it is attended with considerable difficulty ;  and m the
first is rather to be accomplished by what, in mania, we have called
moral treatment than by medicine.  A constant and  resolute  exer-
tion on the p.rt of the patient to obtain a command  over the weak
or irregular eye is of absolute necessity,  while, the  neglected  eye
itself, if weak, should be strengthened by tonics  and gentle stimu-
lants.  Goggles, though, often  recommended, are seldom service-
able, and especially to children; for although the  sight must hereby
be restrained in each eye to a common  line, the  child will still use
the sound eye alone, and leave the irregular eye unemployed.   It
is a better plan to affix  some object  near the orbit  of the affected
eye at such a distance that it may constantly catch and draw ott the
pupil from the inner angle to the outer.  But the method that I
have myself found by far the most effectual,  is to blindfold the sound
eye with  a blink for a  considerable  part of every  day; and thus
force the affected eye into use,  and  a subserviency to the will.  I
recommend this simple plan most strongly,  and especially in the
case of children; and may venture to predict that it will be sure to
succeed in the first variety of the disease,  that of habit, and fre-
quently in both the  others.
                     GENUS   II.

                      PARACUSIS.

                     Jftortftr fUrartng.

              SENSE OF HEARING VITIATED OR LOST.

Paracusis is a term  of Hippocrates derived from irxtxxtvu " perpe-
ram, depravate,  vitiose audio."  The  mechanism of the ear is as
complicated as that  of the eye, and as admirably adapted, in all its
parts, to the perfection of the sense which constitutes  its function.
Its lobes, its entrances, its  openings, its  various drums, its minute
and  multiplied  foramina, its delicate  bones, all contribute to one
common  effect.   Even the surrounding bones, and still more  than
this, the teeth, are in no small degree auxiliary to the same object:
as the experiments  of M. Perolle, given in the fifth volume of the
Turin Transactions, have abundantly established : as they have, al-
so, that bone in general is a far better conductor of sound than air,
alkohol, or water
   We may hence learn one very important use of the  four minute
bones deposited  in  the  posterior chamber of the tympanum, the
loss of any one of which  impairs the hearing, and, in  some instan-
ces,  has  produced  total  deafness  : of which  we  have  a  striking
proof in the case of a lad, described in the Philosophical Transac-
tions, who had parted with the incus on  one side,  and  both the in-
cus and malleus on the other, by means of an ulcerated sore throat 
NERVOUS  FUNCTION.
163
GE.  II.]

that opened a passage from the fauces into each ear, and  through
which the bones were discharged.  The tympanum, on the boy's
recovery, seems not to have lost its vibratory power, for  he was
sensible of violent or sudden  sounds, but altogether insensible  to
conversation, and- apparently as deaf in the ear that had only part-
ed with the incus as in that which had parted  with both bones.*
  From the complicated organism of the ear it follows  necessarily
that, like the eve, it must be subject to a great variety of diseases;
while many of the diseases of the  one sense  must  bear a striking
analogy to those of the  other.  Thus painful and  obtuse  hearing
and  deafness,  may be  well compared with painful and obtuse vi-
sion and blindness.   As the eye is at times affected  with  illusory
objects  so is the ear with illusory sounds;  and as, when the optic
axes do not harmonize, as in strabismus, the  same   object  may be
seen double, so may the same sound be heard  double when  the ac-
tion of the one ear is ioaccordant with that of the other.
  And  hence it is not at all to be  wondered at that a peculiar  de-
gree of sympathy should exist between these senses, and the state
of the one be frequently affected by that of the other.  Bartholine
gives a case in which deafness and blindness  alternated with each
other,t  and  we  shall presently have  to  observe that a temporary
affection of the eyes  may sometimes be  produced  by particular
noises.
  As the  organ  of  the  ear, however, is less  exposed than that ol
the eye, we are far less acquainted with the immediate seat of its
diseases, and  even  with the exact bearing  which  every  particu-
lar part sustains  in the general phenomenon of hearing.  It was  at
one  time supposed that the nicest power of discriminating  sounds,
or in other words, that accuracy of distinguishing which constitutes
what is called a musical ear, is seated in  the  cochlea;  birds, how-
ever, whose perception is exquisite have no cochlea.  It has since
been conceived by Sir Everard Home that it is the  membrana.tym-
pani in  which this fine feeling Is peculiarly lodged,^ and that it de-
pends upon the muscularity of this membrane: yet the same feeling
has remained, and in a high  degree, in  persons  whose membra-
na tympani has been ruptured.
  Paracusis as a genus includes the following species :
1.
2.
3.
4.
5.
6.
PARACUSIS  ACRIS.
--------OBTUSA.
————  PERVERSA.
--------DUPLICATA.
—  .   ■ -  ILLUSORIA.
--SURDITAS.
ACUTE HEARING.
HARDNESS OF HEARING
PERVERSE HEARING.
DOUBLE HEARING.
IMAGINARY SOUNDS.
DEAFNESS.
* Vol Li. No. 50. 1761.
t Epist.  Cent. iv. No.  40.
X Phil. Trans. Year J800. 
164                     NEUROTICA.           [CL. IV.-OR. IL


                        SPECIES I.

                 PARACUSIS  ACRIS. .

                     Petite Rearing.

 HEARING PAINFULLY ACUTE  AND INTOLERANT OF THE LOWEST SOUNDS.

This occurs occasionally as an idiopathic affection in nervous  and
highly irritable idiosyncrasies, and bears a striking analogy  to that
acritude of sight which  we have noticed under  paropsis lucifuga
acris.
  It depends  upon a  morbid excitement, sometimes of the  whole
of the auditory organs, but more generally of some particular part,
as the  tympanum,  or the  labyrinth, and particularly the cochlea,
or some of the internal canals.  In many instances it seems confined
to the branches of the nerve ; and Bonet gives  an instance of it
from the very singular cause of a triple  auditory nerve formed on
either side *  It is  found frequently as a  symptom  of ear-ache,
head-ache, epilepsy, otitis, cephalitis, and fevers of various kinds.
  The sensation is sometimes so keen as to render intolerable the
whisperings of a mere current of air in a room, or the respiration
of persons present, while  noises before  unperceived become high-
ly distressing.
  I have at this  moment before me a most impressive  description
of this effect, in a letter from a  young lady of about twenty-eight
years of age, of an irritable habit, great genius, and a highly cultir
vated mind,  who about a twelve-month ago  was attacked  with a
cephalitis which proved severe and alarming.  The br;iin has here-
by  been weakened,  but the mental  powers  are  rendered more
acute;  and  the  external  senses, especially those  of  hearing  and
seeing, strangely sympathize with each other.  " You think me,"
says she, in this letter, " unfit for study,  but study I must, whether I
am#t for it or not,  otherwise my mind preys upon itself,  and no
power can prevent my thinking, which is almost as bad  as reading.
Last night 1  was kept awake  for some hours by so powerful an ex-
citement  of  the  brain  that I really thought it would have taken
away my senses.  The  pain is very acute, but I do not mind  that
so much as the distraction which accompanies it.   It usually comes
on  with a most painfully quick hearing. I feel as  if the tympanum
was stretched so tight as to make the least  sound  appear almost as
loud as thunder; and a loud noise is just  as if I  received  a blow
quite to the  centre of the brain.  This really is  not imagination
but actual sensation. Moreover a noise affects  my eyes so much
that I am obliged to darken my room when at any time I am under
* Sepulchr. Lib. r. Sft, xix. add. Obs. 7. 
GE. II.-SP I.]         NERVOUS  FUNCTION.
165
the necessity of hearing any thing like a noise : a loud sound affects
my eyes, and a strong light  my ears.  They  seem to act reciprocally.
My head is certainly not so bad,  nor any thing  like it, as it was at
Clifton, but still the sudden  attacks I have from  over-exertion of
the mental  powers,* or upon any other excitement, make  me  al-
ways fearful I shall lose my senses."
   Injections of warm water,  or a few drops  of almond oil dropped
into the ear will  occasionally succeed in affording relief, by relax-
ing the spastic tone of the vessels.  But cold water, and  cold appli-
cations about the  ear, and  even pounded ice where  there is no ten-
dency to a periodic rheumatism,  by directly inducing torpitude,
will, at times, have a better effect:  laudanum may also be introduc-
ed into the ear and a blister be applied  to its immediate  vicinity.




                         SPECIES  II.

                 PARACUSIS OBTUSA.

                   i^artmcss of f^eartnfl.

HEARING DULL AND CONFUSED ; AND DEMANDING  A CLEAR AND MODULAT-
                       ED ARTICULATION.

 This  may  proceed from organic  defect; from  local  debility,  in
 which case it is called nervous  deafness ; or from  some accidental
 obstruction in the external tube or passage, as  that of mucus, wax,
 sordes, or any other extrinsic body : or in the internal or Eustachian
 tube from mucus, inflammation or ulceration and its consequences.
 It is also found occasionally  as a symptom or sequel in  various fe-
 vers, in hemiplegia, apoplexy, otitis, lues, and polypous caruncles
 or concretions in the passage of the ear: and has followed on  drinJd
ing cold water during great heat and perspiration  of the body, m
which several examples  are given  in the  Ephemerides of Natural
Curiosities.   Among the  cases of  organic defect one of the least
common  is  atresia, or imperforation :  yet  Albucasis*  gives us an
instance of this, as does Bartholinet and Henckel.J  And among the
more  singular obstructions of an accidental kind may be mentioned
insects and the grubs of insects  or worms.  Bartholine mentions a
leech which was once found to have burrowed in the ear: and Wal-
 ker a small stone which  had unaccountably become lodged  there
and was discharged by a fit of sneezing.§
* Vide Marcell. Donat. Lib. vi. Cap. ii. p. 619.
t Hist. Anat. Cent. vi. n. 36.
X N. Anmcrk. I.
J Obser. Medico-Chirurg. xx. 8vo. 1718, 
 166                     NEUROTICA.            [CL. 1V.-OR. H.

  The cure must depend upon the nature of the cause.  All foreign
 bodies must be carefully removed or destroyed, and  the  cavity of
 the ear be washed by means of a syringe. Accumulations of wax may
 be softened  by oil of almonds and alkohol which will dissolve what-
 ever resinous part it possesses, and a like inunction will be  found the
 best means of destroying insects.  Atonic or nervous deafness will of-
 ten bid defiance to o-ir utmost exertions : but it will  sometimes yield
 to local stimulants and tonics ; of the former are alkohol,  ether, cam-
 phorated spirits, and the tinctures of the gum-resins, as myrrh, amber,
 kino,  balsam of Tolu, and blisters  about  the  ear.   Of the  latter
 cold water,  and solutions of alum, white  vitriol or other metalic
 salts.
  Where hardness  of hearing is habitual  and cannot be  radically
 cured, we can only endeavour to diminish the evil  by advising a
 hearing trumpet, which is, in fact,  an instrument formed  upon the
 principle of the outw:trd  ear itself, and the object of which is to
 collect a  large body  of sonorous tremors and send them to the tym-
 panum in a concentrated state, by means of a convergent  tube, or,
 in other words, to increase as much as possible the vibratory power
 of the sound.  Now  sound  is well known to  be propagated in
 straight  lines, and  hence  persons  partially deaf will always hear
 most  distinctly when  directly opposite  the speaker.    For the
 same reason  the trumpet itself should be formed as nearly as possible
in a straight line ; though we are sometimes, for the sake of conve-
 nience, obliged to deviate  from this direction, and to bend the tube
 into the segment of a circle  by which some degree of power is al-
 ways  lost.  The metal of which  the tube is made should be that
 which is found most sonorous, or, in other words, which most com-
 pletely reflects, instead of absorbing, the sound ; and while the fun-
 nel or larger aperture is  as  wide as possible, the extreme  end of
 the pipe cannot be too small.
                        SPECIES  III.

              PARACUSIS PERVERSA.

                    Perbcm f^carfttg.

THE  EAR ONLY  SENSIBLE  TO  ART'CULATE  SOUNDS  WHEN EXCITED  BT
        OTHER AND  LOUDER SOUNDS  INTERMIXED WITH  THEM.

This is a very extraordinary hebetude of the  organ,  though it has
occasionally been met with in most countries : where it exists, the
ear, as in other cases of imperfect hearing, requires  to be roused,
in order to discriminate the  articulate sounds addressed to it, but
finds the best excitement to  consist in a  great and vehement noise 
GE. II.-SP. III.]
NERVOUS FUNCTION.
167
of almost any kind.*   It consists, according to Sauvages, who seems
to judge rightly concerning it, in a torpitude or paresis of some parts
of the external organs which, in consequence of this additional sti-
mulus, convey the  proper sounds addressed to them  beyond  the
membrane of the tympanum, in the same manner as the drowsy or
those who are sluggish in waking, do not open  their  eyes, or ad-
mit the light to the retina unless a strong glare  first stimulate  the
exterior  tunics.  It seems, however, sometimes to depend upon an
obstruction of the Eustachian tubes.
  Under  the influence of this species it sometimes happens that
particular sounds or noises  prove  a better stimulus than others
though equally loud or even  louder: as the music of a pipe,  of a
drum, or of several bells ringing at the same time.   Holder relates
the case of a man who  never  heard but  when he  was  beating a
drum ;t and  Sauvages a similar case of a woman who, on this  ac-
count, always kept a drum in the house, which was constantly play-
 ed upon while she  was conversing with her husband.  The latter
<rives another case of a person who  was always deaf except when
 travelling in a carriage, during which time, from the rattling of the
 wheels, he was perfectly capable of hearing  and engaging in con-
 versation.   And Stahl gives an  instance of like  benefit derived
from the shrill tones of a pipe.J
   In ordinary cases of practice if we can  once hit upon a stimulus
 that  succeeds in giving temporary  tone to a debilitated  organ, we
 can often avail ourselves of it to  produce a permanent benefit,  and
 sometimes a complete  restoration, by raising or lowering its power,
 continuing its power for a longer or shorter term of time, or modi-
 fying it in some other  way, so as to adapt it to the  particular exi-
 gency.   And it is hence  probable that if any of these sonorous sti-
 muli were to be employed medicinally, and with a due  respect to
 length of time, and acuteness of tone, they might, in some instances,
 be  made the medium of obtaining a perfect  success. Dr. Birch,
 indeed,  gives  an  instance of such  success  in a person  who  only
 heard during the ringing of bells ; and who, by a permanent use of
 this  stimulus, recovered his hearing altogether.§   Voltaism  may
 here also be employed in many cases with a considerable proAse
 of advantage ;  and especially in connection  with the ordinaryTou-
 tine of general and local tonics  and stimulants,  as cold, and  cold-
 bathing, pungent masticatories, and injections, bark, valerian, alone
 or with ammonia, and a free use  of the siliquose and  coniferous
 plants as a part of the  common diet.

              * Feiliz  in Richter Chir. Bibl. Band. ix. p. 555.
              t Phil. Trans. 1668. No. 26.
              X Colleg. Casual. N. 7«.
              k Hist. Vol. iv. 
168
NEUROTICA.
[CL. IV -OR. H.
                        SPECIES IV.

              PARACUSIS DUPLICATA.

                     Bouble Hearitifi.

THE ACTION OF THE ONE EAR INACCORDANT WITH THAT  OF THE OTHER J
     SOUNDS HEARD DOUBLY, AND IN DIFFERENT TONES OR KEYS.

This pravity of hearing depends upon an inaccordance of the audi-
tory nerve on the one side with that on the other: so that the same
sound produces, on each side, a very different effect, and is conse-
quently heard, not homotonously, or in like  tones, but heterotonously,
or in separate and unlike.  And hence this species of morbid hear-
ing, as I have already observed, has a considerable parallelism with
that of strabismus or squinting, in which the optic axis of the one
eye is not accordant with that of the other, whence the  same ob-
ject is seen double, and often in a different position.   Sauvages has
given two or three very curious examples of this affection.  A mu-
sician while  blowing his flute heard two distinct sounds at every
note.   The  sounds were in different keys, and consequently not in
harmony; and  as they were  heard  simultaneously, the one could
not be an echo of the other.  On another  occasion he was consult-
ed by a person who for several mnnths had been troubled with a
hearing of two distinct voices whenever he was  spoken to; the one
at least an octave higher than the other, but not in  unison with it;
and hence producing a harsh and insupportable discordancy.
  This affection  is mostly temporary, and as proceeding altogether
from a  morbid condition of the auditory nerve, has been cured by
blisters and  other local stimulants.  From  not being attended  to,
however, in  due  time, it has  sometimes assumed a chronic charac
ter, when it is removed with great difficulty : and in a few instan-
ces it  has been  connected with a constitutional irritability of the
nervous system;  in which  case a plan of general tonics must co-
*p£rate with local applications.
                        SPECIES V.

               PAROPSIS  ILLUSORIA.

                   Kmaflinavfi Souutrs.

      INTERNAL SENSE OF  SOUNDS WITHOUT EXTERNAL CAUSES.

This is in most instances strictly a nervous  affection, and bears a 
<*E. II.-SP. V.]         NERVOUS FUNCTION.                169

striking analogy to paropsis illusoria, or that illusory or  false sight,
in which unreal objects of various forms,  colours, and  other sensi-
ble qualities appear before the  eyes.  The morbid state is often
confined to the auditory nerves, or some of the branches alone ; yet
it is not unfrequently  the  result of a peculiar  irritability that ex-
tends through the whole ol the nervous system.  And  occasionally
it proceeds from an obstruction of one or both the Eustachian tubes.
The  sounds  hereby produced differ  greatly in  different persons,
and sometimes in the very same  person at different periods: but it
is sufficient to contemplate them under the three following varie-
ties:
a Syrigmus.               A sharp,  shrill, successive sound.
   Ringing, or tinkling.
8 Susurrus.                An  acute, continuous, hissing sound.
   Whizzing.
y Bombus.                 A dull, heavy, intermitting sound.
   Beating.
   Heister recommends, in cases arising  from  a debility  of  the
local nerves, to fumigate the ears with the vapour of a hot vinous
infusion of rosemary and  lavender; and, where a spasmodic affec-
tion of the inner membrane may be  supposed  to follow upon such
debility,  he advises a simultaneous  use of diaphoretics internally.
If it proceed from  an  obstruction of the Eustachian tubes in conse-
quence of spasm or inflammation, the fumes of tobacco drawn into
 the mouth, and forcibly pressed against  these  tubes by closing the
 lips and nostrils, and  then urgently sniffing the vapours upward to
 the palate, have often proved serviceable by taking off the irrita-
 bility on  which the spasmodic or inflammatory action is dependent.
 Stimulating the external ear by blisters, or aromatic injections has
 sometimes availed  though not often.  Chronic cases are extremely
 difficult of cure; though 1 had lately an  elderly lady for a patient,
 who after having at different times suffered from  each of these mo-
 difications of illusory  sounds for several  years, and tried every re-
 medy that could be suggested in vain, at length lost the distresjjpg
 sensation by degrees,  and  without the assistance of any  medicine.
                        SPECIES VI.

               PARACUSIS  SURDITAS.

                          Drafncss.

       TOTAL INABILITY OF HEARING OR DISTINGUISHING SOUNDS.

In the preceding  species the  sense of hearing is in various ways
  vol. m.                     22 
[70
NEUROTICA.
[CL. IV.-OR. II.
depraved  or impaired ;  in the present it is  altogether abolished ;
and may proceed  from causes which offer three distinct varieties
of affection:
x Organica.                  From organic defect or impediment.
  Organic deafness.
£ Atonica.                   From local debility or relaxation.
  Atonic deafness.
y Paralytica.                 From local palsy.
  Paralytic deafness.
  The  organic  defect or impediment may  exist in the  outer or
inner entrance or  in the  cavity of the ear.   The outer entrance
has in a few instances been  imperforate ;*  but far more generally
illined and blocked up with  indurated  wax, or  some other  sub-
stance.  The inner  entrance  or Eustachian tube has been some-
times also found  imperforate on both  sides but more frequent-
ly obliterated by ulceration,! or closed by the mucous secretion of
a catarrh, or the pressure of the tonsils in whatever way morbidly
enlarged.   If the defect  or  impediment exist in  the  cavity of the
ear its precise nature can seldom be known  during the life of the
patient, and if known would  rarely admit of a remedy.
  Atonic deafness, or that dependent on local debility or relaxation,
may be superinduced by a chronic cold, abruptly plunging the head
into cold water in  a heated state, a long exposure to loud and  deaf-
ening noises, or the sudden and unexpected  burst of some vehement
sound upon the earsj as that of a cannon, or a thunder-clap§ where
the constitution is  in a state  of great nervous  irritability : in which
state moreover it has in a few instances been produced by a violent
fright.||   It has also proceeded from an atony of the  excretories of
the outer ear,  in consequence of  which  there  has  been neither
wax nor  moisture of any kind.   And it has  followed as a sequel
upon  various fevers, and inflammations, especially cephalitis and
otitis, rheumatic hemicrania, and other nervous head-aches, repel-
led%out, and repelled cutaneous eruptions.
  Paralytic deafness  may  be regarded in many cases as  nothing
more  than an extreme  of atonic deafness'T and almost  all the causes
producing the one, when operating with greater violence or upon
a feebler frame, may also produce the other.  It has  not only been
induced suddenly by loud sounds, and violent  frights, but by a vehe-
ment fit of sneezing, and, from sympathy,  by the use of powerful
sternutatories.1T
  Deafness has often been transmitted hereditarily; of which nume-
* Cels. De Medicin. Lib. vh. c. 8.  Buchner, Miscell. Phys-med. p. 318.  1727
t Haller. Elem. Phys. Tom. v. p. 286.
X Schulzc, Diss, de Auditfis difficultate. Sect. 23.
} Borelli, Observ.  Cent. iv. Par. 1656.
|| Eph. Nat. Cur.  Cent. ix. Obs. 6.
T Ephem. Nat. Cur. Dec. it. Ann. ix. Obs. 26 
GE. II.-SP. VI.]       NERVOUS FUNCTION.                  171

rous and unequivocal instances  are to be found in Hoffman,* Mor-
gagni,t and other writers of established reputation.
   The most usual causes of total deafness are  beyond the power of
the medical art to relieve; ;tnd hence the disease runs very gene-
rally through the whole period of life.  Where the cause is an im-
perforation  of either of the  passages, an opening has been often
effected with success.   Many other impediments, as of indurated
wax, or infarction from  inflammation, are in  general  removeable
still more  easily;  and some obstructions have been suddenly carried
off by a fall or other violent concussion of the  head.
   In deafness from atonic  relaxation almost all the stimulant and
tonic methods  pointed out under the preceding species have been
tried in turn, occasionally with palliative success, sometimes  alto-
gether in  vain.   The fumes  of  tobacco sniffed up the  Eustachian
tubes from the mouth, in the manner  described under the last spe-
cies were  recommended by Morgagni,J and many other writers  of
earlier times, and have  occasionally  been found beneficial in our
own day,  the spasm or other obstruction of the fine  tubes  ceasing
of a sudden, and  with the  sensation  of a smart  snap  that  almost
startles  the patient.   And as sight has sometimes  been restored  in
amaurosis  by a violent fever, or a flash of lightning, so has deafness
from atony approaching to paralysis been recovered by a like fever
or a thunder clap ;§ ordinary causes being thus transferred into ex-
traordinary modes of cure.
   Among the stimulants most useful, where the deafness is depend-
ent upon debility of the membrane of the tympanum, or the nerve
of hearing, have  been the  aura of voltaic electricity, applied two
or three times a-day for half an hour or longer each time, and  per-
severed in for many weeks; a series of blisters continued for a  long
period,  and a diluted solution of nitrate of silver.   Yet a chronic
ulcer forming in the ear, and discharging plentifully  has often  pro-
ved more  effectual than any of these.
   Mr. Gordon in  the Edinburgh Medical Commentaries, relates a
case of total deafness produced suddenly on a soldier in good health,
by plunging overhead into  the sea : which, after  a long routine  of
medicines  had  been  tried in vain for three months, yielded to^the
use  of mercury as soon as the mouth began to  be affected.   A gen-
tle salivation supervened, his hearing was gradually  restored,  and
in six weeks from its commencement he returned to his duty perfect-
ly eured.||   The  excitement of the  salivary glands seems, in  this
case, to have extended by sympathy  to the Eustachian tubes, or
whatever other parts of the organ of hearing were diseased.
* Consult, et Respons. Cent. i. cas. 40.
t De Sed. et caus. Morb. Epist. xlviii. Art. 48.
X Epist. Anat. vn. Art. 14.
  Eph. Nat. Cur. Dec. i. Ann. vi. Ob?. 110.
$ Bresl. Saraml. 1718. p. 1541.
II Edin. Med. Com. Vnl. in. p. 80. 
 172                     NEUROTICA.          [CL. IV.-OR. W

  When  the Eustachian  tubes are imperforate or irrecoverably
closed, which may commonly be determined by an absence of that
sense of swelling in the ears which otherwise takes place on blow-
ing the nose violently, Mr. now Sir Astley, Cooper has ingeniously
proposed a substitute  for  the canal by making a small perforation
through the membrane of the tympanum; and as this does not de-
stroy  the  elasticity of the  membrane, it has occasionally been at-
tended with success.
                     GENUS  III.


                        PAROSMIS.

                      aWorfctUf Smell.

                SENSE OF S/*ELL VITIATED OR  LOST.

This is the parosmia and anosmiJ* OI"manv writers; from *«g«, male,.
and oga, olfacio, analogous with paracusis paropsis : anosmia, how-
ever, will not include one of its specjes, and the present termina-
tion is preferred on account  of its analogy with that of the parallel
terms.
 "Under this genus may be arranged the three following species:

        1. PAROSMIS ACR1S.             ACUTE SMELL.
        2.-------OBTUSA.            OBTUSE SjMELL.
        3.-------EXPERS.             WANT OF 2MELL.
                         SPECIES 1.

                   PAROSMIS  ACRIS.

                       &crOr  Sbtntll

   ?MELL PAINFULLY ACUTE OR SENSIBLE TO OI >OURS NOT  GENERALLY
                          PERCEIVED.

Generally speaking the sense  of smell in all  animals is in propor-
u?n J° tlie extent of the Schneiderian or olfac tory  membrane with
which the  nostrils are lined, and over  which tin "■ branches of the ol-
factory nerves divaricate and ramify.  And  henc e this membrane is
much more extensive in quadrupeds and birds, wh ich chiefly trust to 
GE. III.-SP. I.]
NERVOUS FUNCTION.
173
jhe sense of smell in selecting their food, than in man; for it ascends
considerably higher, and is, for the most part, possessed of numerous
folds or duplicatures.  It is hereby the hound distinguishes the pe-
culiar scent thrown forth from the body of the hare, and the domes-
tic dog recognises and  identifies his  master from all other indivi-
duals.
   Yet the nerves of smell are not only spread in great abundance
over the  olfactory membrane of all animals, possessing such an or-
gan, but  they are  distributed so near the  surface as to  be almost
naked;  and hence in every class they are easily and hourly excited
into action, being covered with little more than a layer of bland,
insipid  mucus, thin at its first separation, but gradually  hardening
by the  access of air into  viscid  crusts, and which is expressly se-
creted for the purpose of defending them.   From this nearly naked
state it is that they are stimulated by aromatics,  however  finely
and impalpably divided : whence the violent sneezings that take place
in many persons in an atmosphere in which only a few particles of
sternutatories or other acrid  olfacients are floating: and hence also
the rapidity  with which  a  sympathetic  action  is excited in the
neighbouring parts  or in the system at large, and the refreshment
which is felt on scenting the  pungent vapour of carbonate of ammo-
nia, or vinegar, or the grateful perfume of violets or lavender, in
nervous head-aches or fainting  fits.   The  fetid  odours  are well
known to affect the nostrils quite as poignantly as the pleasant; and
to produce quite as extensive a sympathy;  and hence  the nausea,
and even intestinal looseness  which often  follows on inhaling putrid
and other offensive effluvia.
   Under peculiar circumstances, however, the ordinary apparatus
for smell possesses an activity,  and sometimes even an intolerable
keenness, which by no means belongs to it  in its natural state.  M.
Virey,  who has written a very learned treatise upon the subject of
odours, asserts  that the olfactory sense exists  among savages in a
far higher degree of activity than among civilized nations, whose
faculty of smell is blunted by an habitual exposure to strong odours,
or an intricate combination of odours,  and by the use of high-flavour-
ed  foods.   And he might  have  added that this sense,  like  every
other,  is capable of cultivation and of acquiring  delicacy of discri-
mination by use ; that savages, many of whom make an approach to
the life of quadrupeds, employ it, and trust  to in a similar manner;
and that this is, perhaps, the chief cause of the difference he has
pointed out.   It is in like manner relied  upon by persons who are
deprived  of  one or  two of the other  external  senses, as those of
sight or hearing,  or both : not merely in consequence of more fre-
quent employment,  but from the operation of the  law  we  have
already pointed  out, that where one of the external senses is des-
troyed or constitutionally wanting, the rest, in most  cases, are en-
dowed with an extraordinary degree of energy, as though the share
of sensorial power, naturally belonging to the defective organ,  were
distributed among the rest and modified to their respective  uses. 
174
NEUROTICA.
[cL. 1V.-OR. II.
One of the most interesting examples that I am acquainted with of
this transfer of sensorial  power is to be found in the history, first
given to the public by Mr. Dugald Stuart, of James Mitchell, a boy
born both blind and deaf;  and who, having no other senses by which
to discover  and keep up a connexion with an external world than
those of smell,  touch, and  taste, chiefly depended for information on
the first, employing it on  all occasions, like a domestic dog, in dis-
tinguishing  persons and  things.  By this sense  he identified his
friends and relatives; and conceived a sudden attachment or dislike
to strangers, according to  the nature of the effluvium that  escaped
from  their skin.   He appeared, says  Mr. Wardrop, who has also
published an account of him,  to know his  relations and intimate
friends  by smelling them very slightly, and he at once detected
strangers.  It was difficult, however,  to ascertain at what distance he
could distinguish people by this sense ; but from what 1 could observe
he appeared to be able to do so at a considerable distance from the
object.   This was particularly  striking, when a person entered the
room, as he seemed to be aware of this before  he could  derive in-
formation from any sense  than  that of smell.  When a stranger ap-
proached  him  he  eagerly began to  touch some part of the body,
commonly taking  hold of his arm, wbich-he held near his nose; and
after  two or three strong  inspirations through  the nostrils  he ap-
peared  to  form a  decided  opinion  concerning him.   If it were
favourable he showed a disposition to become  more intimate, ex-
amined more minutely his dress, and expressed, by his countenance,
more  or less satisfaction.   But if it  happened to be unfavourable,
he suddenly went off to a  distance with  expressions of carelessness
or disgust.*
  The Journal des  Scavans for 1667, gives a curious  history of a
monk who pretended to be able to ascertain, by the difference of
odour alone,  the sex and age of a person, whether he were mar-
ried or single, and the manner  of life to which he  was accustomed.
This, as far as the  fact  extended, may possibly have been  the re-
sult of observations grafted upon  a stronger natural sense than be-
longs  to mankind  in general;  and is scarcely to  be ranked in the
list of diseased  actions.  But among  persons of  a highly nervous or
irritable idiosyncrasy, I have  met with numerous instances of an
acuteness of smell  almost  intolerable  and distracting to those who
laboured under it; which  has fairly  constituted an idiopathic affec-
tion ;  and sometimes nearly realized the description of the  poet,
in making its possessors ready at every moment to
                   Die of a rose in aromatic pain.
  Mr.' Pope seems to have written  this line as a  play of fancy at
she time, but the writings of various collectors of medical curiosi-
ties abundantly show that  he has here described nothing  more than
  * History of James Mitchell, a boy born blind and deaf, &c.  By James Ward-
rop.  F. R. R. Ed. 4to 1813. 
GE. III.-SP. I.]
NERVOUS FUNCTION.
175
an occasional and sober fact.  Thus M. Orfila gives us an account
of a celebrated painter of Paris of the name of Vincent,  who can-
not remain in  any room where there are  roses  without  being
in a short time attacked  with violent cephalaea succeeded by faint-
ing.*   And M.  Marrigues informs us that he once knew a surgeon
who could not smell at a rose without a sense of suffocation, which
subsided as soon as the  rose was removed from  him;  as he also
knew a lady who lost her voice  whenever an  odoriferous nosegay
was applied to  her  nostrils.!
   We have observed that a keen stimulation of the olfactory nerves
is often  productive of a very powerful sympathetic  action in other
organs.  There are few persons who, on inhaling the fine particles
of black hellebore  and colocynth, while in the  act of being pound-
ed, would not feel their effect on the intestines by a copious  diarr-
hoea ;  but where the acuteness of smell  exists  which constitutes
the present disease, whether limited to particular odours, or extend-
ing to all odours equally, the sympathetic action is sometimes of a
very singular description.   M. Valtain gives the history of an offi-
cer who was thrown into convulsions and lost his senses by having
in his  room a basket of pinks of which, nevertheless, he  was very
fond.    The  flowers were  removed, and  the  windows opened,
and in the course of half an hour the convulsions ceased, and the
patient  recovered  his  speech.   Yet for  twelve years  afterwards
he was never able to inhale the smell of pinks  without fainting.^
 And M.  Orfila  relates the case of a lady  of  forty-six years of age
 of a hale constitution, who could never be present  where a decoc-
 tion of linseed was preparing without being troubled in the course
 of a few minutes  afterwards with a general swelling of the face,
 followed by fainting and a loss of the intellectual faculties:  which
 symptoms continued for four and twenty hours.§
   The predisponent cause of the species before us is a nervous  or
 irritable habit.  The occasional causes are local irritation from a
 slight  cold, in which the contact of the air alone, as inhaled, often
 produces sneezing; or excoriation of the mucous membrane of the
 nostrils from the use of sternutatories in  those  not accustomed to
 them.   It is often the result of idiosyncrasy ; and perhaps at times,
as  in  paracusis acris,  of  a  superfluous distribution of olfactory
nerves.  As a symptom it is often found in  opthalmia and rheuma-
 tic hemicrania.
   Where the disease is connected with the habit, the nervous ex-
citement should be diminished by refrigerants  and tonics, as the
 shower-bath, bark,  acids, neutral, and several of the metallic salts.
 And where it is chiefly local, we  may often produce a transfer  of
 action by blisters in the vicinity of the organ:  or relax the Schnei-
derian membrane,  and  moisten its surface by the vapour of warm
* Sur les Poisons, Tom. n. CI. v. { 972.
t Journ de Physique, year 1780.
X Hygiene Chirurgicale, p. 26.
h Sur les Poisons loc. citat. 
176
NEUROTICA.
[CL. IV.-OR. II.
water.  The sniffing up cold water will also prove  serviceable in
many instances, by inducing  torpitude at first, and additional  tone
afterwards.  Dr. Darwin advises errhines for the first of these pur-
poses, that of exhausting the  excitability and blunting the sense.
                        SPECIES II.

                 PAROSMIS  OBTUSA.

                      <S)l3tttsc Smell.

          SMELL DULL, AND IMPERFECTLY DISCRIMINATIVE.

This is often a natural defect, but more frequently a  consequence
of an habitual use of sternutatories, which exhaust,  weaken, and
torpify the nerves of smell,  as  long exposure to  a  strong light
weakens and impairs the vision, and sometimes destroys it altogether.
To those  unaccustomed to sternutatories,  the mildest snuffs will
produce such an excitement as is marked  by a  long succession of
sneezing,  which is nothing more than  an effort  of the  remedial
power of  nature to throw  off the offending material;  while those
who have habituated themselves to  snuff for years, can hardly he
excited to sneeze by the most violent ptarmics.
  The evil is here so small that a  remedy is seldom sought for in
idiopathic cases : and in sympathetic affections, as when it proceeds
from catarrhs or fevers, it  usually,  though not always, ceases with
the cessation of the primary disease.  It is found also as a symptom
in hysteria, syncope, and several species of cephalaea, during which
the nostrils  are  capable of inhaling very  pungent, aromatic, and
volatile errhines, with no other effect than that of a  pleasing and
refreshing excitement.
  Where the sense of smell is naturally weak, or continues so after
catarrhs or other acute diseases, many of our cephalic snuffs may be
reasonably prescribed, and will often succeed in removing the hebe-
tude.   The best are those formed of the natural order, verticillatae,
as rosemary, lavendar, and marjoram; if a  little more stimulus be
wanted, these may be intermixed with a proportion of  the teucrium
Marum ; to which, if necessary, a small quantity of asarum may also
be added: but pungent errhines will be sure to increase instead of
diminishing the defect. 
GE. III.-SP. Ill ]
NERVOUS FUNCTION.
177
                         SPECIES III.

                  PAROSMIS  EXPERS.

                      ESTant of Smrll.

       TOTAL INABILITY OF SMELLING OR DISTINGUISHING ODOURS.

 This  species is in many instances a sequel of the  preceding; for
 whatever causes operate in producing the former,  when carried to
 an extreme or continued for a long period, may also lay a founda-
 tion for the latter.  But as it often occurs by itself, and without any
 such introduction, it is entitled to be treated of separately.  It offers
 us the two following varieties :

 x Organica.                     From natural defect, or  acciden-
   Organic want of smell.           tal lesion, injurious to the struc-
                                   ture of the organ.
 C Paralytica.                     From local palsy.
   Paralytic want of smell.

   The first variety occurs from a connate destitution of olfactory-
 nerves,  or  other  structural defect;  or from external injuries of
 various  kinds :  and is  often found as  a sequel  in ozaenas, fistula
 lachrymalis, syphilis, small-pox, and porphyra.  The second is pro-
 duced by neglected and  long continued  coryzas, and a persevering
 indulgence in highly acrid sternutatories.
   The author once knew  a very beautiful and elegant young lady
 who had from birth so total a want of smell, as not only to  be inca-
 pable of perceiving any difference in the  odours of different perfumes
 or flowers, but of sweet and corrupt  meats; and  who could inhale
 very  powerful errhines  without sneezing.  Though this affection
 seemed to have been connate,  and  dependent upon a natural desti-
 tution  of the nerves of smell, the  Schneiderian  membrane had
 something of the  thickening  which is ordinarily produced by
 catarrhs, and the lady always spoke as though under the influence of
 a slight cold.
   When this  affection is a sequel  of  local irritation  as  from a
coryza or catarrh,  warm stimulating vapours, as of vinegar or frank-
incense,  are  often useful.   If  produced by syphilis the fumes of
cinnabar may be inhaled by the nostrils; or a sternutatory may be
used composed of turbeth mineral and ten times the quantity of any
mild and light powder, as orris-root.
  vol.  in.                  23 
 178                     NEUROTICA.           [CL. IV.-OR. II.



                      GENUS   IV.

                      PARAGEUSIS.

                       jHodinr Eastt,

                sense  of taste  vitiated or  lost.

Parageusis is  derived  from iraex, male, and yuu,  gustwn prabeo,
whence «w*g«yjtw, and  consequently ma^xytvrts.  The author  has
preferred with Vogel, the present termination to parageusia, as
analogous to the names of the preceding genera of the order before
us.
  In the senses of taste  and smell there  is a considerable association,
partly  perhaps resulting from the proximity of their organs and
partly from an affinity in the modification of the sentient fluids with
which they are supplied.  The young lady I have just noticed who
was  destitute, or nearly  so, of the sense of smell,  was  equally
destitute of that of taste, and could not  distinguish by this criterion
between beef, veal,  and pork,  and consequently in respect to  all
these had no preference.
  The chief organ  of  taste is the tongue,  but this is not the only
organ, nor is it absolutely necessary for an existence of the sense.
The Philosophical Transactions give us examples of persons who
possessed a perfect taste after the tongoe had been wholly destroyed ;
and professor Blumenbach  in his Comparative Anatomy, affords us
a similar example in an  adult whom he visited, and who was born
without a tongue.   Consonant  with which many insects appear to
have a faculty of taste,  though  they have  no organ of a tongue:
and among these the gustatory  function is supposed by professor
Knoch to  be performed by the  posterior  pair of palpi or feelers.
While,  on the other hand, there are  many  animals  possessing a
tongue who do not use  it as an organ of taste.  All  birds possess a
tongue, for even the  pelican, which has been said to be tongueless,
has a rudiment of this member:  yet there are but few birds, com-
paratively, that taste or are able to taste with this organ.  Parrots,
predacious, and swimming  birds  are an exception to this remark;
for they possess a soft thick tongue covered with papillae and mois-
tened with a salivary fluid, and select that which is the most agree-
able.   Yet in by far the greater proportion of birds we do not find
the tongue appropriated to this purpose.   In many of them, indeed,
it is stiff, horny, and destitute of nerves.  The tongue of the toucan,
though  sometimes several inches in length,  is scarcely two lines
broad at its root: it  has throughout the appearance of whale-bone
and its margins are fibrous.  The tongues of the  woodpecker and
cock of the woods are equally hard and horny:  in themselves they 
GE. IV.]
NERVOUS FUNCTION.
179
are short, and in a quiescent state, lie backward in the mouth, and
are covered with a sort of sheath issuing from the os hyoides or the
oesophagus:  but they possess a mechanism which renders them
extremely extensile, and capable of being thrust forward to a consi-
derable distance.  That  of the wood-pecker is  sharp-pointed  with
barbed sides,  and is darted  with great rapidity out of the mouth to
an extent of some inches; by  which means it  follows up  such
insects as the animal is in pursuit of,  through all their  crannies in
•the bark  of trees; sticks them through with its apex,  and in this
state  drags them out for food.  The chameleon  has a tongue of a
somewhat similar kind, which, in like manner, answers the purpose
not of taste, but of preying for food.   It is contained in a sheath at
the lower part of the  mouth, and has its extremity covered with a
glutinous secretion.   It admits of being projected to the  length of
six inches ; and is used in this manner by the animal in catching its
spoil, and especially in catching flies.   It is darted from the mouth
with  wonderful celerity and precision ; and the viscous secretion on
its extremity entangles minute animalcules, which constitute another
portion of its food.
   The tongue, when it forms an organ of taste, as in man,  is
studded, and especially on  its upper surface and  lateral edges, with
innumerable nervous papillae issuing from a peculiar membrane that
lies beneath, and has a near resemblance to the  skin in other parts,
but is softer and more spongy.   Its external tunic or cuticle  is an
exquisitely fine epithelium, which is moistened,  not by an oily fluid,
like  that of the surface of the  body, but a peculiar mucus which
proceeds from the foramen caecum of Meibomius, and the rest of the
glandular expansion of Morgagni.
   We have here,  therefore, a more  exquisite sense  of touch than
on the general skin, whose papillae are not only smaller but dry.
   There can be no question, also, that the sentient fluid with which
they  are supplied  is  differently modified, from that  of  the  skin;
and hence the provinces of the two  senses, though they occasion-
ally approach  each other,  are still kept distinct;  and the tongue
becomes a discerner of certain qualities, which the skin cannot discri-
minate : as sour, sweet,  rough, bitter, salt, and aromatic.
   Thus  much we  know,  but we  do not  know the  cause of that
different effect, or, in  other words, of that variety of tastes which
different substances produce upon papilla? of the tongue, and which
constitute their respective flavours.   It was supposed by the Epi-
cureans, and the doctrine has descended to the present  day, that all
this depends upon the geometrical figure of the sapid corpuscles;
and particularly so with  respect to saline  bodies, which is cubic in
sea-salt, prismatic in nitre, and equally diversified in vitriol,  sugar
and other crystals.  It is sufficient, however, to annul this explana-
tion to observe, that many crystals of very different forms are alike
insipid ; while  others of the same, or nearly the  same shape, possess
very  different flavours; as also that the flavour  in  any of them
continues the same even where  we are able to change the figure ; 
180                     NEUROTICA.            [CL. IV.-OR. II.

as fof example, by rendering common nitre cubical.   The cause of
flavours, therefore, appears to reside in  the  elementary principles
of substances that lie beyond the reach of our senses.
  But the variable condition of the peculiar covering of the papillae
ef the tongue, together with the condition of the adjoining organs,
which concur in the purpose of the  tongue,  as also the changeable
nature of the saliva, and of the substances lodged in the stomach, all
concur  in  influencing the  taste  and  giving a  character to the
flavour.   And hence the same flavours do  not affect  persons of all
ages nor of all temperaments ;  nor even  the  same  person  at all
times.   In general whatever contains less salt than the saliva does,
seems insipid.  The spirituous  parts of plants are received, in all
probability, either into the papillae themselves, or into the absorb-
ing villi of the tongue ; and hence the rapid  refreshment and reno-
vation  of strength, not easy to be accounted for  otherwise,  which
these stimulating  materials produce even when they are not taken
into the stomach.
  It is from the diversity of flavours by which nature  has  distin-
guished different substances, that animals are  taught instinctively
what is  proper for their food : for speaking generally, no aliment is
unhealthy that  is of an agreeable taste; nor is  any  thing ill tasted
that is fit for  the food of man.   We here  take no notice of excess by
which the most healthy foods may be rendered  prejudicial,  nor of
mineral preparations which are  not furnished  by nature but pre-
pared by art.   And hence the wisdom of Providence  incites man to
select the nutriment that is best fitted for his subsistence equally by
the pain of hunger, and the pleasure of tasting.   Man, however, is
often guided by instruction and example as well as by his own in-
stinct :  but animals which are destitute of such collateral aids, and
have to  depend upon their instinct alone, distinguish  flavours, as we
have already observed they do smells,  with a far  nicer accuracy
than mankind; and, admonished  by this  correct and curious test,
abstain  more cautiously than man  himself  from eating what  would
be injurious.   And hence  herbivorous animals whose vegetable food
grows often intermixed with a great diversity of noxious plants, are
furnished with much longer papillae, and  a  more  delicate structure
of the tongue than mankind, as they are  endowed also with a more
accurate sense  of smell;  both which, indeed, they jointly rely upon
for the same  purpose.
  The sense of taste,  therefore,  which  possesses so close an ana-
logy to  that of smell,  is  subject to  a similar train of specific dis-
eases, and consequently the genus parageusis  must contain the three
following species:

1. PARAGEUSIS ACUTA.                ACUTE TASTE.
2. ---------  OBTUSA.                OBTUSE  TASTE.
3.      '     F.XPERS.                WANT OF TASTE; 
                    NERVOUS FUNCTION               *<   181
                                     V

                        SPECIES I.

                PARAGEUSIS ACUTA.

                        ^cttte arastc.

TASTE PAINFULLY ACUTE  OR SENSIBLE TO SAVOURS NOT GENERALLY PER-
                            CEIVED.

The sense of taste, like that of sight, smell, or hearing, is capable
of acquiring a higher degree of accuracy by use :  and hence those
who are in the Jiabit of tasting wines by this organ perceive a va-
riety of flavours or modifications of flavour, which another  person
not versed in such trials, is  insensible  of.  We also  perceive that
the nerves of taste, like those of every  other sense, become ex-
hausted, and  cpnsequently  torpid, by  much  labour  and fatigue.
And hence the nicest discriminater after  having tried a variety of
wines, spirits, or other pungent savours in quick succession, is far
less capable of judging concerning them, and has at last little more
than a confused perception of gustatory excitement.
   Morbid acuteness of taste, however, varies essentially from accu-
racy of taste:  for under particular  states of irritation, pungent sa-
vours of whatever kind give equal pain to the tongue which at the
same time is altogether incapable  of distinguishing between  them.
   This painful acuteness may proceed from two  causes:  a  morbid
or excessive secretion  of sentient fluid,  or a deficient secretion of
the peculiar  mucus that lubricates the lingual papillae,  in conse-
quence of which the latter are exposed, in a naked state to whatever
stimuli are introduced into the mouth.  The former is sometimes
found, though for the most part only temporarily, in highly nervous
and irritable constitutions, and especially during a state of pregnan-
cy : the latter in an acrimonious  condition of the stomach  accom-
panied with great thirst and a parched tongue.'" "Both these  causes,
however, very frequently co-exist: as in ulcerated sore throats, or
other excoriations of the mouth, in which the papillae are in a state
of the keenest excitement, while the tongue is sore  either from a
defective secretion of  mucus, or from its being carried off by amor-
bid and augmented action of the absorbents as fast as it is formed.
   In this state of diseased action, moreover, it not unfrequently hap-
pens that the  mucus itself is secreted in a morbid and acrimonious
condition; and the palate, instead of being soft and smooth, becomes
 harsh and rugous or furrowed, exquisitely irritable, and intolerant
 of the  slightest touch  or  the mildest savours.  I have sometimes
 met with this  distressing affection,  apparently as  an  idiopathic ail-
 ment, or at least unconnected with any manifest disease of  the sto-
mach or any other organ; and seemingly induced by a rheumatic
pain fron  carious teeth.   It is,  however, far more frequently a
symptom of acrimonious dyspepsy, porphyra, and chronic syphilis.
«;e,
IV.-SP. I.] 
182
NEUROTICA.
[CL. 1V.-OR. II.
   In treating this affection we should, in the first instance, direct
our attention to the state of the stomach, and clear it of whatever
sordes may probably be  lodged  there.  This  may sometimes be
done by aperients: but.when  we are sure of an«crimonious defe-
dation in this organ it will be the shortest way to commence with
an emetic.
   The local symptoms may, in the mean while,  be relieved in  two
ways.  First by changing the nature of the morbid action, or exhaust-
ing the accumulated sentient power by acid  or  astringent gargles,
or a free use  of the coldest water alone :  for which purpose  also
sage-leaves and acrid bitters have  often  been  employed with ad-
vantage.   And next the naked and irritable tongue may be sheathed
with mucilages  of various kinds, and  thus a substitute be obtained
for its natural defence.   And in many cases both these classea of me-
dicines may be  conveniently united.
  When  the  affection is a symptom of some other disease,  as in
the case  of syphilis and scurvy, it can only be cured by  curing the
primary malady.  Carious teeth, if such exist, should be  extracted;
and if the palate be rugous or spongy, scarification should  be em
ployed copiously and repeatedly.
                        SPECIES II.

                PARAGEUSIS  OBTUSA.

                       ©tituse arastr.

           TASTE DULL, AND IMPERFECTLY DISCRIMINATIVE.

This  species  rarely calls for medical  attention.  It occurs some-
times idiopathically, and seems to be dependent on a defective sup-
ply of nerves, or nervous  secretion subservient to the  organ of
taste.   I have seen it  under this form in various instances : and, as
already observed, have found  it connected in a few cases with ob-
tuseness of smell.  The patient  has not been altogether without
taste or smell, but both have been extremely  weak  and incapable
of discrimination.   In  the  case alluded to  under the last species,
the individual could distinguish the smell of a rose from :hat of gar-
lic, and the flavour of port wine from that of mountain or madeira;
but she could not discriminate between the odour  of a rose and that
of a lilly, nor between the  taste  of beef, veal, or pork,  and conse-
quently gave  no preference to either of these dishes.
  As a symptom this affection occurs in almost all the diseases that
are accompanied with hebetude of smell, as catarrh, hysteria, and
several species of cephala?a. 
GE. IV.-SP. III.]      NERVOUS FUNCTION.
183
                        SPECIES III.

               PARAGEUSIS EXPERS.

                      ffi^aut of ftaste

       TOTAL INABILITY OF TASTING OR DISTINGUISHING SAVOURS.

As an utter want of smell is sometimes  a natural or congenital ef-
fect, so in a few instancesis an utter want of taste, and unquestiona-
bly from the same cause, an absolute destitution of nerves or ner-
vous power subservient to the gustatory organ.  This default is  al-
together immedicable:  as is also for the most part the  same when
a result of palsy general or local: though  here stimulant gargles or
masticatories, as mustard-seeds, horse-radish, pyrethrum, and  cam-
phor, have sometimes succeeded in restoring action to the torpid
nerves.  When, however, it occurs,  as it sometimes  does from a
long use of tobacco, whether by smoking or chewing, or of other acrid
narcotics, these stimulants will be of no use.
  In fevers, various exanthems, and inflammations, this species ex-
ists temporarily, partly perhaps from a diminished or morbid secre-
tion  of sensorial fluid, but chiefly from  a conversion  of the mucus
of the  tongue  into  a dry,  hard, or tough and viscid  sheath ; the
lingual absorbents drinking up  only the  finer parts of  the mucus,
and leaving the coarser to agglutinate upon the surface of the  or-
gan    And where  there is  much  increased heat and action, the
epithelium or cuticle of the tongue itself  becomes often peculiarly
thickened and coriaceous or leathery.  Acids, in the  form of gar-
gles, are the pleasantest means of  removing this  morbid substance,
but  they will often  succeed best if rendered viscid  and converted
into a soap by mixing with them a little almond-oil, which may at the
same time be sweetened with honey.
                      GENUS V.

                        PARAPSIS.

                      ^ttorfritt  ftoucft.

       SENSE OF TOUCH OR GENERAL FEELING VITIATED OR LOST.

Parapsis is derived from the Greek terms, -xa.fx, and anjoutu, " per-
peram tango." The  common  technical name  for the genus  is
dysaesthesia, but not  quite correctly; since  this word, as we have 
 184                    NEUROTICA.            [CL, 1V.-OR. II.

already had occasion to observe, is also employed to express morbid
external sensation of any kind, whether of touch, taste,  smell, sight
or hearing: while by Dr. Young it is equally applied to  one at least
of the faculties of the mind, as in dysaesthesia interna, which he
characterizes as "a want of memory, or confusion of intellect."
  This genus embraces three species as follow:

1. PARAPSIS ACRIS.               ACUTE  SENSE OF  TOUCH  OR GENERAL
                                 FEELING.
2. ------- EXPERS.              INSENSIBILITY OF  TOUCH  OR GENERAL
                                 FEELING.
3.-------ILLUSORIA.            ILLUSORY SENSE OF TOUCH OR GENERAL
                                 FEELING.
        SPECIES  I.

 PARAPSIS  ACRIS.

&cute  Sense of  JTouch.
THE  SENSE OF  TOUCH PAINFULLY  ACUTE OR  SENSIBLE  TO IMPRESSIONS
                   NOT GENERALLY PERCEIVED.


This  species of morbid  sensibility shows  itself under almost in-
numerable modifications : but the four following are the chief:
x Teneritudo.
£ Pruritus.
y Ardor.
3 Algor.
Soreness.
Itching.
Heat.
Coldness.
  In the first variety or that of soreness there is a feeling of painful
uneasiness or  tenderness, local or general on being touched with a
degree of pressure that is usually unaccompanied with any trouble-
some sensation.   This is often an idiopathic affection ; but more
generally a  symptom or sequel of fevers in their accession or first
stage, inflammations,  or external or internal violence, as strains.
bruises, and spasms.
  It is not always easy  to account for this feeling, and jferhaps the
cause is, in every instance, more complicated than  w<* might at first
be induced to suppose.   It occurs where  there is  detention of the
vessels, where there is contraction of them, and  where   there is
neither.  Wherever it  exists, however, it is a concomitant of de-
bility, and may,  in many instances, be regarded as the simple pain
of debility, the uneasiness of an organ thrown off  from its balance
of health.   The general health of the body depends in a very con-
siderable degree upon the harmonious co-operation of its respective 
GE. V.-SP. I.]
NERVOUS FUNCTION.
18f)
organs ;  insomuch, indeed, that this harmony of action, as we had
occasion to observe in the Physiological Proem prefixed to the pre-
sent class, was supposed by a distinguished school of ancient philoso-
phers,  and is still supposed  by many physiologists of the present
day, to constitute the principle of life itself.   Regarded as an uni-
versal  principle the  hypothesis is unfounded, though in many re-
spects beautiful ahd plausible.*  Yet notwithstanding that the life of
the animal frame does not altogether  depend upon  an harmonious
co-operation of the whole of the organs that enter  into  its make,
much of  the comfort of life has such  a dependence :  and we trace
the same  principle in the minutest and comparatively most trivial
parts of the animal functions as manifestly as in the largest and most
complicated organs.   Where every portion of a member, however
subordinate in itself, as a toe or a finger, works well or healthily,
there is a feeling of ease and comfort,  but wherever it works ill or
with difficulty,  there is a sense of disquiet,  and, under particular
circumstances, of tenderness or soreness.  A change in the diameter
of a vessel whether  by dilatation or  contraction, provided  it be
moderate  and gradual, is  accompanied with no  uneasy sensation
whatever;  but if either be  violent or  sudden, a feeling of soreness
is a certain result, of which we have daily examples in strains and
spasms.   There may perhaps be no great difficulty in accounting for
this: but the more common cause of tenderness is of a different kind,
and a cause which often operates when neither of these are present
though  it is often combined with them.
   In order that every part of an organ may play upon every other
part with a feeling of ease and comfort,  it is well known that through-
out the entire system, not  only every  surface, but every, even  the
minutest, interstice in the tunics of the minutest vessels, is supplied
by a soft  and  lubricous fluid,  which is poured forth by  secernents
of exquisite subtilty, and having executed  its purpose and  become
waste matter, is  carried off by equally subtile absorbents, and suc-
ceeded  by a fresh secretion of the same fluid.
   Now in all cases of  external or internal  violence these, are  the
vessels  that first  give way and are rendered  incapable of fulfilling
their function.   '1 he secernents that supply this  lubricous fluid be-
come weakened, and pour  fourth a smaller  quantity of it than is
sufficient  fop  a free and easy play of one  part of an organ upon
another part, and  hence there is a tenderness or soreness from  the
friction of sides or surfaces against each other, and their coming into
naked  contact.  But as the corresponding  absorbents are  equally
weakened, they cannot carry off the whole of the fluid that is actual-
ly secreted, how7  much soever diminished in  quantity  : and  hence,
while  they imbibe the subtler and more attenuate  particles, they
leave the grosser behind; which not only become so many sources
of impediment,  but,  from forming part of  a mobile and lubricous
effusion, are transformed into so many harsh and stationary goad?.
               * Vol. in. {». 30.
vol.  ni.                   '21 
186
NEUROTICA.
[CL. IV.-OR. If.
And hence  another cause of that soreness  which  accompanies all
cases of violence, as well internal as external, and particularly upon
external  pressure.  The  effect of such pressure,  as forcing upon
each other naked and  highly sensible surfaces, may be easily con-
ceived ; hot there can be little doubt that the chief sense of soreness,
in the case of external  pressure, proceeds, from thus forcing against
each other the naked  and  unlubricated sides of the vasa vasorum,
which, in this manner deprived of their usual inunction, are incapa-
ble without uneasiness, of yielding even to the ordinary impetus of
a vis a tergo, or the touch of the common fluid they convey.
  It appears probable that some such  morbid change in the natural
powers of these excretories and absorbents takes place occasionally
without any strain or violence whatever, and from causes we cannot
follow  up; for we sometimes  meet with  a like sense of soreness
without any forcible injury; but that these are the vessels which
primarily and most readily give way under the operation of violence
is clear from their being frequently, even from  slight accidents,
altogether deprived of tone and rendered completely torpid ; so that,
while the absorbents carry off no part of whatever fluid is effused,
the excretories open without resistance, and from  mere  relaxation
to the  impetus behind, and admit fluids of almost every kind, as
coagulable lymph, yellow serum, and occasionally  even red blood:
whence the extensive  swelling that  sometimes takes place almost
immediately upon a strain or bruise, and the diversified hues it ex-
hibits ; the diversity of hues, however, appears chiefly as the swell-
ing subsides; for as the subtlest, which are the most limpid, parti-
cles are first carried off by themselves, as soon as the  absorbents
begin to resume  a healthy action, the grosser, which are the colour-
ed particles, as the yellow and the  red or purple, are left nearly
alone,  and consequently in a more concentrated state, and acquire
an elaborate subdivision before they  can be fitted for removal.
  From all which we  may easily trace the principle that renders
warmth, gentle friction, and such stimulants as spirits, balsams, and
essential oils, of general advantage wherever the kind of tenderness
we are now describing occurs, and is  unconnected with inflamma-
tion.
   The sense of  itching, which  may be defined a  painful titillation
local or general, relieved by rubbing, is commonly a result of some
mechanical or morbid irritant applied externally or internally to the
part affected ; though sometimes, unquestionably, dependent upon a
morbid sensibility of the nerves of feeling  themselves.  If the sum-
mit of the nerves or  their extreme points be alone touched, the
effect is tickling or titillation, as in the vellication of the skin by
a feather; if it descend a little below the summit it is accompanied
with a vibratory feel  which we call tingling, as when the beard of
barley-corns creeps unobserved by us up the arms ; and  if it reach
still deeper, it is combined with a sense of piercing, which we call
pricking,  as when  the  keen hairs of several species of dolichos or
cowhage  are handled or blown upon the skin  by a light breeze. 
tiE. V.-SP. I.]
NERVOUS FUNCTION.
187
  In many cases  all these modifications of itching are the  effect of
some  acrimonious  secretion on the surface of the body,  or of an
acrimonious change in the common matter of perspiration in con-
sequence  of its  lodging in the cutaneous  follicles  longer than it
should do.  The  papulous efflorescences we shall have to treat of
under the third order of the sixth class will afford abundant exam-
ples of both these causes of itching, as they will also of an  intolera-
ble itching, apparently produced by, or closely  connected with, a
morbid sensibility  of the cutaneous nerves themselves.   For the
present we can do nothing more than refer generally to various
species of exormia, as lichen and prurigo ; and of ecpyesis,  as impe-
tigo and scabies.   It is, moreover,  highly probable that that disor-
der called fidgets is sometimes  chiefly dependent on a morbid sen-
sibility of the summits or extreme ends of the cutaneous nerves.
  This affection  is also found  as a very  troublesome symptom in
pernio and  other cutaneous inflammations,  as likewise in  urticaria
and other rashes.
  The sensations of heat and cold may be explained at the same
time.  An easy and pleasureable warmth depends, in a state of health,
upon a moderate temperature of the atmosphere, which cannot be
very  accurately  laid down, because,  from habit or constitution, or
some other circumstance, different persons enjoy very different tem-
peratures.  Now it is the well known  property of heat and cold to
disturb the  temperature, whatever it may be, that affords  ease and
comfort to the nerves of feeling; and to produce disquiet as they
either raise or depress it.   And this both of them do in two distinct
ways.  Heat is a strong irritant, and even if it made no change in
the bulk of a living organ, or the juxtaposition of its particles, like
all other irritants it would still excite a troublesome feeling, amount-
ing  at length to  acute pain, if raised  to a considerable  range
beyond the ordinary scale.  But it does, in  every instance, excite a
change in the bulk of living organs and the juxta-position of their
particles; for it enlarges the former in every direction, and only does
this by separating the particles from each other; in which forcible
and sudden divellication we have a second source  of the troublesome
and acute sensation which so constantly accompanies a temperature
when carried very considerably above the point of health.
  Heat, as an idiopathic affection,  occurs chiefly in plethoric and
irritable habits.   In the former it is relieved by blood-letting, and
evacuants of neutral salts: in the  latter by mild diaphoretics, and
afterwards cold bathing and other tonics.
  As  a symptom it is found, also, in the second stage of fever, in in-
flammation, and entonic empathema.
  Cold is also a strong irritant, though it acts by the opposite means
of heat.   When  the  atmospheric  temperature is too high  it is a
pleasant and reviving agent, inasmuch as it both reduces the heated
medium, and restores the particles of the affected  organ from a state
of disquieting tenseness to their usual  scale of approximation.  If
the cold  be pushed  farther it may  go a little beyond this and still 
188
NEUROTICA.
[CL. 1V.-OR. H.
 be pleasant and healthful; for the organ or the general system may
 be in a state of morbid relaxation, and, consequently, in their actual
 scale of approach, the  living particles may be too far  remote for
 the purposes of high elasticity and vigour.  And it is in such a con-
 dition as this that cold  chiefly shows its stimulant  power, and is so
 generally resorted to as a tonic.   But if the agency of cold be car-
 ried farther than this, it produces uneasiness to the nerves of feel-
 ing by a process precisely the  reverse of that we  have  just shown
 to be pursued by heat, and consequently in a two-fold manner.  First
 by lowering the warmth of  the organ, or of the  system, below its
 scale of ease and comfort, and next by  *orcing the living  particles
 into too close and crowded a state, and not  allowing them sufficient
 room for play.
   Cold, as an idiopathic affection, is chiefly local, and most common
 to the head and  feet.  It is  temporarily relieved by  warmth and
 stimulants, and particularly  by  the  friction of a warm hand; and,
 where it can  be used, the exercise of walking.   It is permanently
 relieved by the warmer tonics, as sea-bathing and aromatic bitters.
   Considerable mischief has often been produced by a sudden ex-
 posure of the feet to severe  cold and  especially  in delicate and ir-
 ritable  habits, unused to  such  applications:  as  colic,  cephalaea,
 catarrh, fevers of various kinds, and,  in a  podagral diathesis, gout.
 But the application  of  severe  and sudden cold to  the head or sto-
 mach by drinking ice or cold water, and  especially when  the indi-
 vidual is heated and perspiring, has been followed  with more alarm-
 ing effects,  and even with death itself.   Mauricean relates an in-
 stance of death produced during baptism, by applying to the head
 the water of the baptismal font.* But this must be a rare occurrence ;
 while the fatal effects of  drinking ice or iced water in a state  of
 heat are innumerable.
  It is observed by Dr. Fordyce,t and the observation is quoted and
 called curious by Dr. Darwin,  " that those people  who have  been
 confined some time in a very warm atmosphere, as of 120 or 130
 degrees of heat, do not feel cold, nor are subject to paleness of their
skins, on coming  into a  temperature of 30 or 40 degrees; which
would produce great paleness and painful  sensation of coldness in
those  who  had  been for  some time confined  in  an atmosphere of
only 86 or 90 degrees."   The cause is not difficult of explanation.
The sensorial power is exhausted,  and the nerves of feeling render-
ed torpid by a long exposure  to a heat of 120 or a 130 degrees, and
the turgid capillaries, whose  dilatation produces the general blush,
lose their power of constriction or collapse ; while in a heat  of 86
 or 90 degrees neither of such effects takes place.
  Cold, as a symptom, is found in the first stage of fever, in syncope,
hysteric syspasia, nausea, and atonic empathema; in all  which the
affection is general.
* Tom. ii. p. 348.
t On Simple Fever, p. 168. 
UE. V.-SP. II.]         NERVOUS FUNCTION.                189


                        SPECIES II.

                 PARAPSIS  EXPERS.

        Knseitiuutlttg of  2Foucn, (General jprelfng.

THE ORGAN OF TOUCH TOTALLY IMPERCIFIENT  OF OBJECTS APPLIED  TO IT.

Under this species, by some writers denominated  amblyaphia, we
may mention the two following varieties:

» Simplex.                       Confined locally or generally to
   Numbness.                      the organ of touch : sometimes
                                  accompanied with uneasiness.
C Complicata.                   Complicated with insensibility in
   Complicated insensibility.        several of,  or all,  the  other
                                  senses.

   Occasional and local numbness  is common  to most persons.  A
tight bandage, or accidental pressure of one limb upon another, by
obstructing the  flow or activity of  the nervous fluid will  often pro-
duce this, when the limb is commonly and emphatically asserted to
be asleep.  A very slight motion, however, takes it off, when the
irregular flux of the sensorial power, on its first return, produces a
sense of pricking, as though a ball of needles was in the limb and
pushing in every direction.  Where such numbnesses, however, occur
without pressure or any manifest cause, they well deserve watching
and resisting by tonics or stimulants local or general; for they clear-
ly show a tendency to  paresis if not to paralysis.
   But there are some persons who possess by nature a numbness or
privation of the sense of feeling in particular organs or parts  of the
surface, which appears to  depend  on  a  natural destitution of the
nerves of touch wherever such insensibility  is to  be found.  And
hence they are able, in such parts of the body, to prick or cut them-
selves, or to run pins to any depth below  the skin  without pain.  I
have seen several striking examples of this peculiar affection.  Some-
times the  numbness has been limited to a single limb, but common
to the whole of it, as the hand, for example, which at the same time
has possessed a full power of motion.   Sometimes the insensibility
has been universal, or  extended over the whole surface.   Lamarck
relates a case in which this want of feeling was confined to the arm;
but at the same time was so complete, that the man who laboured
under it had no pain during the progress of a phlegmon ;  and  on an-
other occasion in which he broke his arm, felt nothing more  than a
crash, and merely thought he had broken the spade he was at work
with.  Dr. Yelloly has  described another interesting case in the
third volume of the Medico-Chirurgical Transactions.   The patient
aged 58, had  been  first affected in Jamaica about three  years be- 
 190                     NEUROTICA.            [CL. IV.-OR. 11.

 fore, and the affection had become permanent.   " The hands," says
 Dr. Yelloly,  " up to the  wrists, and the feet half-way up the  legs,
 are perfectly insensible to any species of injury, as cutting, pinch-
ing, scratching or burning.  The insensibility, however, does not
suddenly terminate ;  but exists to a certain degree  nearly up to the
 elbow, and for some  distance above  the knee.  He accidentally put
 one of his feet, some time ago,  into boiling water, but was no other-
wise aware  of the high  temperature, than  by finding  the  whole
surface a complete blister on removing it.  The extremities are in-
sensible to electrical sparks taken in every variety  of mode."
  As  an example of  the second modification or insensibility in the
organ of touch, complicated with insensibility in several other senses,
we may mention the  following which Sauvages has copied from the
Academy  Collections:  " The  patient, a delicate young  man, was
suddenly in the morning deprived equally of speech and of the sense
of touch, without any assignable cause or premonition.   Punctured
and pricked in different parts of his body, in his head, neck, back,
shoulders, breast, arms, abdomen,  he felt nothing whatever, and
even laughed at  the  singularity of the phaenomenon; as, with the
exception of numbness, and cutaneous insensibility, he laboured
under no kind of disease.   The complaint continued two days, and
seems to have yielded to venesection."
  Insensibility of touch, either simple or complicated, is also felt as
a symptom in apoplexy, palsy, catalepsy, epilepsy, syspasia, and
syncope.
  Where  the numbness is complete and constitutional, it lies be-
yond the reach of medicine :  where  it is  recent and less extreme, it
will often yield to friction alone, or with camphorated oil or spirits,
heat,  especially  that of the warm bath; ether, volatile alkali and
water, and the voltaic stream, or small shocks of electricity.
                        SPECIES  III.

               PARAPSIS  ILLUSORIA.

                Xllttsors Sense of  SFoucn.

IMAGINARY SENSE OF TOUCH,  OR GENERAL FEELING IN  ORGANS THAT HAVE
                          NO EXISTENCE.

This is  the  pseudaesthesia of Ploucquet; and is  frequently found
among persons that have suffered amputation;  who for a long time,
after the loss of the separated limb, have still a sense of its forming
apart of the body, and suffer in idea the same kind of pain or other
inconvenience they endured before its removal. 
GE. V.-SP III.]        NERVOUS  FUNCTION.                 I"1

  It proceeds from that close sympathy which peculiarly prevails
between the extremities of the  living fibre in all organs whatever,
and which, as we have already had  occasion to show, extends also
between the terminating links of various  chains of action that run
into organs at a considerable distance from each other.  Of the first
we have an example in the constrictive pain produced in the glands
penis when the neck of the bladder is irritated by the lodgement of
a calculus upon it.  So  if the fauces or upper end of the oesophagus
be tickled by a feather, the stomach at the lower end, will be exci-
ted to nausea  and sickness: and if the stomach itself feel suddenly
faint and enfeebled, the  rectum will at the same time give way, and
involuntarily discharge  its  contents.   Of the second kind of sympa-
thy  or that which shows itself between remote organs engaged in a
common chain of action, we have a striking instance in the swelling
of the mammae on the irritation of the uterus in pregnancy ; and we
had occasion to point out another equally  striking^ when treating,
under the last class, of  several species of marasmus, in which  the
chylific and assimilating organs, constituting the two extremities of
the great chain of the nutritive function, maintain, on  various occa-
sions, a wonderful harmony both of energy and weakness*
  And hence, in  a diseased limb, the pain which originates  in the
part affected is often extended, or even transferred, by sympathy to
its tendinous  extremities, where the morbid impression remains in
many instances long after the diseased portion of it has been remov-
ed.  Nor is this  protraction of the  impression to be wondered at,
for we  are  perpetually witnessing  cases, in  which, when a mor-
bid impression has oace been established, it continues to manifest
itself in the  same manner.  Thus,  when  dust has been blown into
the  eye, a sensation of pricking is just as  much felt in the conjunc-
tiva for some hours after the dust has been washed out,  as  when
it was actually goading the tender  tunic:  and in like manner when
an  ague has been once  generated in the  animal frame by an expo-
sure  to  marsh miasm,  the patient  will be still  subject  for many
weeks,  or perhaps months, to the same return of febrile paroxysm,
how widely soever he  may  remove from the tainted region,  and
thus free himself from the  cause of the disease.
  In the case  before us the illusory  feeling becomes fainter by  de-
grees, and as the  affected fibres return to a healthy condition.  And
if in the mean time it be very troublesome, it may generally he re-
lieved by a moderate use of narcotics.
  A like imaginary sensation is  occasionally  felt,  as a symp:om  b
hypochondrias, and various other mental affections; in whici  ide«
of pain and distress are mistaken for realities, and produce m severe
a suffering.
* Vol. n. p. 476. et alibi. 
                          NEUROTICA.           [CL. IV.-OR. II.



                     GENUSVI.

                       NEURALGIA.

                         J£erfcc=ache

ACUTE SENSIBILITY AND LANCTNATING PAIN IN THE COURSE OF ONE OR MORI?
  BRANCHES OF NERVES IN AN ORGAN ;  MOSTLY WITH AN IRREGULAR MO-
  TION OF THE  ADJOINING  MUSCLES ;  RECURRENT IN SHORT  PAROXYSMS
  WITH INDETERMINATE INTERVALS, OR REMISSIONS.

The term neu algia from nv^ov  " nervus" and  xXy»? " dolor" has
been for  many years employed with great accuracy to express a di-
vision of diseases which  will probably  hereafter be found to be pe-
culiarly numerous, and, in some modification or other, to appertain
to most of the organs of the animal frame.
  I am not aware, however, that more  than one species or modifica-
tion of this disease was ever described  by any writer till the appear-
ance of the  volume of Nosology which forms the text-book of the
present work, in the beginning of February 1817, at which time Dr.
Meglin of Strasburg, had just published, though  unknown to the
present writer, his treatise on the common form under which it ap-
pears, and had named it neuralgie faciale.*  To this, in the Nosology
named neuralgia faciei, I ventured to  add  a second subdivision or
species derived  from a  case I  had for some years an  opportuni-
ty of contemplating, and which, from its seat, was denominated neu-
ralgia Kpedis.  Professor Chaussier,  probably without having had a
sight of  the Nosology, published  at Paris, a few months after its
appearance,  a still fuller account of the disease,  under the  same
general head and the same two subdivisions, the subdivisions being
neuralgia facialis, and n.  plantaris, a notice of which first occurred
to the present writer in the Gazette de Sante for August  1817.
   Since  the publication  of the Nosology I have been consulted on
 i very striking disease of the same  kind, occurring, with a few lo-
cal peculiarities of feature, in the female breast, and we are hence
put into  possession of another species, making the entire number
thref that have  now exhibited themselves under precise and deter-
 minate characters.  These species, therefore, are as follow :

     1- NEURALGIA FACIEI.         NERVE-ACHE OF THE FACE.
     ~------------PEDIS.       NERVE-ACHE OF THE FOOT.
     3.-----------MAMMil.      NERVE-ACHE OF THE BREAtT.

    The  Corporeal  senses which have hitherto passed  within the
  range of ov^ observations, as the seat6  of different genera of diseases
  * Rccberches e Observationes sur la Neuralgie faciale. ou le Tic douloureux de   •>
la face.
192 
GE. VI.-SP. I.]        NERVOUS FUNCTION.                 193

are external,  and serve  to convey impressions peculiar  to them-
selves.  It is, however, sufficiently known to every one that there
is not an organ in the body but is possessed of nerves productive of
a very different kind of sensibility from  any of these, less distinct,
perhaps, and elaborate, but the index of its  weal or wear, its com-
fort or  disquiet:  and which  may be  sufficiently expressed  by the
name of general feeling.  It is possible, indeed, that this general feel-
ing may,  in some degree, be differently modified in every organ;
but as the distinctions, whatever  they may*.be, are not nice enough
to trace out and arrange, as they  are in the local senses, it is suffi-
cient for all the purposes  of pathology to regard this feeling as com-
mon to  all the sentient organs, and consequently as one and the same.
We have  already taken some notice  of it in  the proem to the pre-
sent class,* and have observed  that it has been  described by some
physiologists under the name of caenesthesis, and by the Germans is
denominated gemeingef iihl, or general feeling.   Dr. Hubner  pub-
lished an inaugural dissertation on this subject in 1794, in which he
enumerates its properties  at some length.!  I  have never seen this
treatise, but Sir Alexander Crichton,  who has, describes it as a very
ingenious production.
  It is these nerves of general sensibility that seem to constitute the
seat of disease in  the three species we are now about to enter upon,
and consequently indicate that the present is their proper place in
a system of physiological nosology.
                          SPECIES I.

                 NEURALGIA  FACIEI.

                  3£etrfce=aehe of the iFaee.

"LANCINATING PAINS SHOOTING FROM THE REGION OF THE MOUTH TO THE OR-
   BIT, OFTEN TO THE EAR, AND OVER THE CHEEK, PALATE, TEETH, AND
   FAUCES J  WITH CONVULSIVE TWITCHINGS OF THE ADJOINING MUSCLES.

This is the trismus maxillaris, or t. dolorificus of M. de Sauvages, for
it is not necessary to  make a distinction between them as  Sauvages
himself has done ; by Dr. Fothergill it is denominated dolor crucians
faciei.  As the French give the name of tic to trismus or locked-
jaw, they  distinguish this first species of neuralgia, affecting the
nerves about the jaw, by the name of tic douloureux, by which term
the disease is, perhaps, chiefly known even in our own country in
  * Ante, p. 18.
  t Cojnmentatio de Cienesthesi Dissert. Inaug. Medica.—Auctore. C. F. Hubner,
1794.
  vol. trr.                  25 
194
NEUROTICA.
[CL. 1V.-OR. li-
       the present  day.  1 shall  have occasion to observe, more at  large
       under the genus trismus that the word tic is commonly supposed to
       be an onomatopy or a sound expressive of the action it imports ;  de-
       rived, according to  some,  from the pungent stroke with which  the
       pain makes its assault, resembling the bite of an insect;  but, accord-
       ing to Sauvages and Soleysel, from the sound made by horses that
       are perpetually biting the  manger when labouring under this pecu-
       liar affection.  We do not, however, appear to be acquainted with
       the real origin of the term.
         From the symptoms by which this complaint is distinguished it is
       not difficult  to  decide concerning both its  seat  and nature.  The
       character of the pain is very  peculiar, and its course corresponds
       exactly  with that of the nerves.  The second branch  of the fifth
       pair is,  perhaps, more  frequently affected than  either the first or
       the third.  But the portio dura of the seventh  pair, which is dis-
       tributed  more  extensively upon the face,  under the name of pes
       anserina, is more frequently the seat of affection than any of the
'       branches of the  fifth pair seem to be; which is  a matter of no
       small regret  as it is  difficult for any operation to  reach this quarter
       effectually, although it is a difficulty which  we shall presently find
       has in one instance, at  leastT  been encountered  and  surmounted.
       When, however, the disease is  seated in the seventh pair of nerves
       we can be at no loss to decide concerning it, in consequence of the
       course and divarications of the pain whieh commences with great
       acuteness in  the fore-part of the cheek towards the mouth and alae
       of the nose, sometimes spreading as high as  the forehead, and rami-
       fying in  the  direction of the ears.   At other times the forehead,
       temple and inner angle of the eye on the side affected, and even the
       ball of the eye  itself, form the chief lines of pungent agony, while
       from irritation of the lachrymal gland the eye weeps involuntarily.
       In this case  we may reasonably suspect the  disease to be seated in
       some part of the superior maxillary nerve, constituting the second
       branch of the fifth pair.  And it is hence obvious that the radiation
       of the pain must vary according to the nerves or nervous twigs that
       are affected.
         The disease  has  been  occasionally mistaken for rheumatism,
       hemicrania and tooth-ache: j'et the brevity of the paroxysm, the
       lancinating pungency of  the  pang, the absence of all intumescence
       or inflammation, the comparative shallowness,  instead  of depth, of
       its seat,  and  its invariable  divarication in the course  of the facial
       nerves or their offsets, will always be sufficient to distinguish it from
       every other kind of pain.
         Of its exciting causes we know but little.  It seems sometimes to
       have  been produced  by cold,  and sometimes  by mental  agitation  in
       persons of an irritable temperament.  But it has  been found in the
       robust as well as in the delicate, in the middle-aged as well as in the
       old.
         Andre  appears  to  have been the  earliest  writer  who remarked
      this painful affection  with accuracy, and he  succeeded in removing 
GE. VI.-SP.  I.]
NERVOUS  FUNCTION.
19D
it permanently by applying a caustic to the infra-orbitary, or max-
illary branch of nerves in one case io which a previous division of
the nerve by the scalpel, as practised by Marechal,  had produced
only a temporary cure.  Andre, who resided at Versailles, published
his account in 1756, whimsically enough intervening it in a treatise
on diseases of the urethra.  A few unsatisfactory experiments  and
operations were given to the public in the course of the next fifteen
years, chiefly by  French practitioners,  from  which little  of real
value  is deducible;  in 1776, Dr. Fothergill, in the fifth volume o
Medical Observations and Inquiries, communicated a very full  and
elaborate description and history of the disease : since which time
M. Thouret, and Pujol have each published a valuable paper on the
same subject in the  Memoirs of the Society of Medicine of  Pans,
containing various cases collected and described with great  minute-
ness ;  and  we  have already adverted  to the  more  recent  publica-
tions of Dr.  Meglin  and professor Chaussier.
   It has of late been suspected that in some cases of this disease, at
least,  the  seat  of irritation might be at the origin instead of at
the extremity of the nerve ; an idea that has arisen from the power-
ful sympathetic action manifested by the eye and the stomach form-
ing the boundaries of the chain, upon which subject wc shall have
to speak at large when treating of the genus  entasia in the ensuing
order.  " The nerves,"  remarks Dr.  Parr, " that  supply the  eye
externally,  and the slight  connexion of the intercostal with the
brain, are nearly from the same spot in the cerebrum, and it did not
seem improbable, in the case alluded to, that the disease may have
really been at the origin of the nerve, although felt as usual at its
 extremity.''  Dr. Parr was, in consequence, induced to try arsenic,
 and in one instance, he tells us with a decidedly good effect.   It is
 also said to have been since found serviceable in a few other cases. In
 Mr. Thomas's hands, however, we shall presently perceive  that it
 completely failed.  Mercury is also reported to have occasionally
 proved successful, and especially when carried to the extent of sali-
 vation ; though in numerous instances it has been tried even to this
 last effect without any benefit whatever.
   When about thirty years ago animal magnetism was a fashionable
 study in France, it was had recourse to for this disease among others,
 and had its day of favour as a popular remedy.  Of late, however,
 neurakia has been  attempted to be cured in  France by an  external
 u«e of acetic  ether;  while in Germany Dr. Meglin has employed
 pills  composed of the extract of henbane, and sublimed oxide of zinc,
 and according to his own statement with great success: but farther
 trial  is desirable upon this subject.
   In  effect neither narcotics, nor tonics, nor  any other class of med-
 icines that has hitherto been  employed, can be depended  upon for
•x radical cure, though some of them seem occasionally to afford  tem-
 porary benefit.  '• My father," says Dr. Perceval of Dublin, " in his
 manuscript comment on the present authors Nosology, was subject
 to veuraWiz faciei for several year;, and used a variety of medicines 
 196                     NEUROTICA.           [CL. IV.-OR. II.

without relief.  He was worse  in  close damp weather, and much
worse when his mind  was occupied.  At length he had an issue in-
serted  in the nucha, kept his bowels free with James's analeptic
pills, and exchanged a town residence for  the  country.  In this si-
tuation he soon threw off  the disease, from which he was free for
a considerable time before his death."  Change of scene, a transfer
of morbid action, and a recruited cheerfulness  of spirits are valua-
ble auxiliaries in the present as in every  other nervous  affection:
but I much question whether these alone have ever operated a cure.
A spontaneous cure is the  work of time alone; and time, though
often a long and tedious period  is  requisite, will generally accom-
plish it, and probably did so in the case before us.   The fact is that
the nervous system in every part, and every ramification, becomes
gradually torpefied by excess of action; and as the eyes grow blind
and the nostrils inolfacient by strong stimulants applied  to them, so
the nervous twigs  of  every kind,  after a  long series of irritation
from the present disease, become exhausted of power and obtuse in
feeling.
  In the mean while the only artificial cure is  to be found in  a di-
vision of the affected branches, provided they can be followed home.
Dr. Haighton  completely succeeded some  years ago in a case in
which he divided the suborbital branch of the fifth pair;  and Mr.
Cruikshank and Mr. Thomas more  recently in a case of considera-
ble complication, and where the affection was evidently not confin-
ed to the different  branches of any  single nerve.  This last case is
given by Dr. Darwin, whom the patient had intermediately consult-
ed, in the second part of his Zoonomia, and is one of the most inte-
resting  sections of the work.  The  patient,  a Mr. Bosworth by
name, was between thirty and forty years of  age.  When he  first
applied to Dr. Darwin he  complained of much  pain about the left
cheek-bone.  Dr. Darwin suspected the antrum maxillare might be
diseased; and, as the second of the grinding teeth had been lately
extracted, directed a perforation into the  antrum, which was. done,
and the wound kept open for  two or three days without advantage.
Afterwards by friction about the head and neck with mercurial un-
guent, he was for a few days  copiously salivated, and had another
tooth extracted by  his own desire,  as also  an incision made in such
direction as to divide the artery near the centre of the ear next the
cheek, which gave also a chance of dividing a  branch of the affect-
ed nerve ; but without success.  Internally opiates were administer-
ed in large quantity when  the pain was exceedingly violent: bark
being used freely in the intervals, but without  effect.
  The pain spread in various directions from a point in the left
cheek a little before the ear, sometimes to  the  nose, and forepart of
the lower jaw, aud sometimes to the orbit of the eye on  the samr-
side; the under part of the tongue  being at times also affected.  It
returned on some days many  times in an hour, and continued seve-
ral minutes; during which period, it is well  worth observing, as
showing the connection between an irregular sensitive and an irtci 
 GE. VI.-SP. I.]        NERVOUS FUNCTION.                 197

 gular irritative power in  the same  muscles, the patient, says  Dr.
 Darwin, seemed to stretch  and exert his  arms, and  appeared to
 have a tendency to epileptic actions, so that his life was rendered
 miserable to himself to support, and  to his friends to witness.  The
 complaint  gradually  grew worse, and Mr. Bosworth  removed to
 London for the purpose of again putting himself under Mr. Cruik-
 shank's care, and of submitting to any operation he should  recom-
 mend.  The pain was now  intolerably acute, and  almost unremit-
 ting ;  and opiates afforded him little  or no  relief though taken to
 the quantity of  six teaspoonsful of laudanum at  a time.  The ope-
 ration of dividing  the diseased nerve was therefore determined
 upon.
   " As the pain," says Mr.  Thomas in his letter to  Dr. Darwin,
 after its completion, " was felt more acute in  the left  ala of the
 nose, and the upper lip of the same side, we were induced to di-
 vide the second branch of the fifth pair of nerves as it passes out at
 the infra-orbital foramen.  He was  instantly relieved in the nose
 and lip; but towards night the pain  from the eye to the crown of
 the head became more acute than ever.  Two days after we were
 obliged to  cut through the first branch passing out at the supra-or-
 bital foramen: this afforded him the  like relief  with the first.  On
 the same day  the pain attacked, with great  violence, the lower lip
 on the left side, and the chin ;  this circumstance induced  the neces-
 sity of dividing the third branch, passing out at the foramen men-
 tale. During the whole period, from  the first division of the  nerves,
 he had frequent attacks of pain on the side of  the tongue; these,
 however, disappeared on division of the last nerve.
   " The patient was  evidently bettered by each  operation ; still the
 pain was very severe, passing from the ear under the zygoma to-
 wards the nose and mouth, and upwards round the orbit.  This route
 proved pretty clearly that the portio dura of the auditory nerve
 was also affected, at least  the uppermost branch  of the pes anseri-
 na.  Before I proceeded,  (continues Mr. Thomas,) to divide this—
 (Mr. Cruiksbank had  operated  hitherto)—I  was willing  to try the
 effect of arsenic internally, and he took it in sufficient quantity to
 excite nausea  and vertigo, but without perceiving any good effect.
 I could now trust only to the knife to alleviate  his misery,  as the
 pain round  the orbit was become most violent;  and therefore inter-
 cepted the  nerve by an incision across the side of the nose, and also
 made some smaller incisions about  the ala nasi.   To divide  the
great branch lying below the zygomatic process, I found it necessary
 to pass the  scalpel through the  masseter muscle till it came  in con-
 tact with the jaw-bone, and then to cut upwards ; this relieved him
 as usual.  Then the lower branch  was affected, and also divided ;
 then the middle  branch running under the parotid gland.   In cutting
this the gland was consequently divided into two equal parts, and heal-
ed tolerably well after a copious discharge of saliva for several days.
  "I hoped and  expected  that this last operation would  have termi-
nated his sufferings, and my difficulties; but  the  pain still affected 
198
NEUROTICA.
[CL. 1V.-OR. II.
 the lower lip and side of the nose, and upon coughing, or swallow-
 ing, his misery was dreadful.  This pain  could  only arise from
 branches from the second of  the fifth pair passing into the cheek,
 and lying between the pterygoideus internus muscle and the upper
 part of the  lower'jaw.  The situation of this nerve rendered  the
 operation hazardous, but after some attempts it was accomplished."
 This  finished the series of  operations and restored the afflicted pa-
 tient to perfect health.
   I have dwelt the longer on this interesting case because it seems
 to show, first, that there is  no certain cure  but  in the use  of the
 knife; secondly, that a delay in performing the operation only af-
 fords time for the disease to spread from  one branch of the affected
 nerve to another, and even to different branches of nerves in a state
 of contiguity: and  thirdly, that  the disease  betrays the  spasmodic
 character of the diathesis when  minutely watched, even in cases in
 which this character is most obscure.  Dr. Darwin objects properly
 enough  to  arranging this  disease as a trismus,  " since no  fixed
 spasm," says he, " like the  locked  jaw exists in this malady."   He
 adds, indeed, that in  the few cases he has witnessed, there has  not
been any convulsion of the muscles of the  face; but  in Mr. Bos-
 worth's  case he has expressly noticed the morbid stretching of  the
 arms, and the tendency to epileptic actions.
                        SPECIES II.

                  NEURALGIA  PEDIS.

                  Berfoe-aefie  of the iFoot.

RACKING AND LANCINATING PAINS RANGING ABOUT  THE HEEL J AND TRE-
  MULOUSLY SHOOTING IN IRREGULAR DIRECTIONS  TOWARDS  THE ANCLE
  AND  BONES OF THE TARSUS.

This is the neuralgia plantaris  of professor Chaussier: who men-
tions a very decided case of it, to  which Dr. Marino, a physician of
Piedmont, had  been long subject.  It  commenced, he tells us,  in
early life ; was  relieved by the mineral waters of Vivadio ; and still
more by  the pressure of a tight bandage.  With advancing years it
became less severe, the cause of which we have already explained
in the preceding species, but never ceased altogether.  It alternat-
ed with  other  nervous affections, and  was  at  length complicated
with convulsive asthma.
  In calling, as I believe for the first time, the attention of the me-.
dical profession to  this  species, by introducing it into the volume of
Nosology before  the presentation  of  M.  Chaussier's book  to the
world, I had my eye directed to a very  marked case which had then 
GE. VI.-SP. II.]
NERVOUS  FUNCTION.
199
lately occurred to me in a clergyman of this  metropolis, about for-
ty-five years of age, but otherwise  in firm health and cheerful spi-
rits.  He had for many years been  a victim to it.  The paroxysms
were short, and of uncertain recurrence, but  so acute as nearly  to
make him faint, and at length  compelled him to relinquish the du-
ties of the pulpit, for which from his zeal and eloquence he was ad-
mirably  qualified, but where  he had  frequently been obliged  to
break off with great abruptness from the unexpected incursion of a
fresh paroxysm.   The pain usually extended up the calf of the leg
towards the knee, and ramified towards the toes in an opposite  di-
rection, and  was  usually compared by himself to  that of scalding
verjuice poured over a naked  wound.  The tibial  branches of the
popliteal nerve,  and particularly the  plantar twigs, seem in this
species to have been the part  chiefly affected, though  it is proba-
ble that some of the offsets from the peroneal  branch associate  in
some instance in the morbid action.
   Every therapeutic process that the art of medicine in the  hands
of the most experienced physicians of this metropolis  could devise,
was in this  case tried  in a long  and  tedious succession in vain.
Sometimes external and sometimes internal preparations, or a tight
ligature, appeared to afford a temporary alleviation, and to protract
the intervals : but never any thing more.  It was in consequence
proposed by a  surgeon of  great  eminence  to  amputate the leg,
which was at one time on the  point of being submitted to, though
protested against by the  present author, on two accounts.  First,
the uncertainty  whether the morbid condition of the  nerve might
not be seated chiefly m the origin instead of in the extremity of the
nerve; in which case, amputation could be of no avail; and second-
ly, the chance that in process  of time  the keen sensibility of the
affected branches would be worn out and  obtunded by the violence
of the action.   Such was the undecided and miserable  condition  of
this patient at the time of noticing his case on the publication of the
authors  volume  of Nosology.  Since  this  period,  the  prediction
that the disease  would gradually wear itself out, has  been complet-
ed : the paroxysms are now slight  and tolerable, and the intervals
much  longer;   and the patient  has  for nearly  a  twelvemonth
been  able to resume the  duties  of his profession  without any
interruption. 
200                      NEUROTICA.           [CL. IV.-OR. II.


                        SPECIES III.

                NEURALGIA   MAMMjE.

                 3ierfoe=aene of  tfte Jlreast.

SHARP,  LANCINATING PAINS  DIVARICATING FROM A  FIXED  POINT IN THE
   BREAST ;  AND  SHOOTING  EQUALLV  DOWN THE  COURSE OF THE  RIBS
   AND OF THE ARM TO THE ELBOW :  THE BREAST RETAINING ITS NA-
   TURAL SIZE,  COMPLEXION AND  SOFTNESS.

It is about two  years ago that I was requested  by an  eminent sur-
geon  of this metropolis in dispensary practice, to examine a young
woman, then eighteen years of age,  who,  for more than two years
had been subject to a painful  disorder of the breast  that seemed
equally to defy all parallel and all mode of treatment.  On examin-
ing into the  nature of the  symptoms, 1 found them as described in
the preceding definition.   The  organ was full-formed, soft, and
globular, without the slightest degree of inflammation, or hardness.
When the paroxysm of pain was not present it would bear pressure
without inconvenience,  but during the pain the whole  breast was
acutely sensible.   The paroxysms returned at first five or six times in
the course of the day, and were short and transient: but as the dis-
ease became more fixed, it became  also more severe and extensive:
for the agonizing fits at length recurred as often as once an hour,
and sometimes more frequently: and from being comparatively con-
centrated, the lancinating shoots darted both downward in the course
of the circumjacent  ribs,  and upwards to the axilla, whence  they
afterwards  descended to the  elbow, below which I do not know
that they proceeded at any time.  These fits were at length so fre-
quent and vehement as to embitter  her whole life, and incapacitate
her from pursuing any employment,  for it  frequently happened
that, if she attempted needle-work,  her fingers abruptly dropped
the needle a few minutes after taking hold of it, from a mixture of
pungent pain and tremulous twitching.   The twitching or snatches
in the shoulder,  for it at length reached to this height, were at one
time so considerable as to give the  patient an idea, to use her  own
words, that something was alive there ;  while though the lancinat-
ing pain did not descend below the  elbow, a considerable degree of
trepidation reached occasionally to  her fingers' ends.   Her general
health was in the  mean time  unaffected,  and she  was  regular in
menstruation.
  I had no hesitation in  regarding  this a non-descript species of
neuralgia; and as little in  communicating my fears that no plan of
medicine we could lay down would be more than palliative, even if
it should prove  thus far beneficial, and that we must  trust to  time
alone  for a cure, and that obtuseness of sensibility which I have 
CK. VI.-SP. III.]        NERVOUS FUNCTION.               201

already noticed as a common consequence of high nervous irritation,
continued till the organ becomes exhausted and torpefied.
  Every remedial process was, nevertheless, tried in succession for
the purpose of obtaining relief, if not full success.  Bleeding, local
and  general, frequently and profusely repeated ;  purgatives  of all
kinds; tonics and antispasmodics of all kinH« ; the hot and  cold bath;
electricity and galvanism in every form ; rubefacients,  blisters, se-
tons, issues,  and whatever  else could be suggested,  were  enlisted
into service in succession.  But every thing was equally  without
avail: nor do I know that even a temporary relief was obtained by
any  of these.  Narcotics of all  kinds proved impotent: drowsiness,
indeed, and a comatose stupor were hereby in various instances ob-
tained, but the  interval of wakefulness was as much as ever tor-
mented  with  the  same racking paroxysms.  From  the powerful
influence of nux vomica in many cases of nervous affection,  to some
of which we shall have occasion to  advert hereafter, I  had  some
hope of producing a slight  impression on the nerves affected: but
the hope proved illusory : she took it in infusion as far as to  about
eight  grains at a dose three or four times a-day,  till her head was
intolerably confused and every other part become numb,  but the
paroxysms were intractable.
  The poor sufferer,  whose  relations  were incapable of affording
the resources of private practice, tried one dispensary after another,
and at length one of the largest hospitals of this metropolis,  with-
out the smallest benefit, and from each was discharged as incurable.
About six months ago, however, being nearly four years from the
commencement of the disease at home,  and  having  utterly relin-
quished all medical means with the exception of a seton  under the
breast, which was not dried up, she began to think herself rather
better, and has continued to improve  ever since, till a week ago,
when  her mother came to inform me she was worse again.  This
intelligence greatly surprized me,  till I learned that the seton was
now  quite healed.  It has since  been opened and there is a hope of
her again improving.
VOL, in.
?f. 
CLASS IV.
NEUROTICA.
                        ORDER III.


                      CINETICA.


            Bim&ms affecttns the JHuscles.

IRREGULAR ACTION  OF THE MUSCLES OR MUSCULAR  FIBRES ;  COMMONLY"
                      DENOMINATED SPASMS.

Having, in the Physiological Proem to the present class, glanced as
far as our space would allow, at the disputed question concerning the
nature  of muscular irritability, and its affinity with sensorial or ner-
vous influence, it is now only necessary at present to take a very brief
view of the general character and mode of action of muscles as they
appear to the naked eye in a massy form, or in other words as com-
posed of an almost infinite variety of minute fibres.
  A muscle  thrown  into action, increases in absolute  weight, in
density, and in power  of resistance.   It is also  said to increase in
absolute bulk: but the  experiments upon this subject are contradic-
tory ; the middle  or belly of the muscle, indeed, is at this time evi-
dently enlarged, but then its length appears to be proportionally di-
minished.  Muscles constitute the cords, as bones do the levers of
the living frame ; and in most cases the muscles grow tendinous as
the  bones do cartilaginous towards  their extremities; by which
means the fleshy and the osseous parts of the organs of motion be-
come  assimilated and  fitted for that  insertion of the one  structure
into the other upon which their mutual action depends;, the extent
 and nature of the motion being determined by the nature  of the
 articulation,  which  is varied with  the nicest  skill to  answer the
 purpose intended.   Whether, however, the substance of tendons
 consists of the same  fibres as the belly of a muscle but  only in a
 state of closer approximation and possessed of finer vessels which
 i& not admit the  introduction of red blood, or whether they form a 
CL. IV.-OR. III.]
NERVOUS FUNCTION.
103
distinct system of fibres, merely attached to those of the mucles, is
at present undecided.   It is certain that tendons  possess nothing  of
the peculiar structure of muscles,  and seem to be more nearly allied
to the simple solid.
   It appears singular, at first sight, that  the  tendinous fibres which
thus seem to be compacted into a  firmer and  more substantial cord
than those of the muscles, should be sometimes broken by muscular
exertion, while the muscular fibres remain uninjured; yet  this un-
questionably depends upon their greater rigidity,  and, consequently,
inability of yielding to  the force by which they  are opposed. And
hence it is that the bones themselves are sometimes  broken in the
same manner as by a violent jerk, or a sudden and spasmodic con-
traction, of which we  shall presently  meet with examples, espe-
cially in the patella, the  ribs,  and the   arm.  The muscles them-
selves, however, are occasionally  ruptured by a  like irregular vio-
lence and excess of  power, as the recti abdominis in tetanus, and
the gastrocnemii in cramps.
   Muscular action then consists in  a mutual attraction and concen-
tration of the constituent fibres of muscles, in a manner peculiar  to
living matter, for we cannot imitate it by any combination or action
of mechanical fibres.   It is not, however, a contraction in every di-
mension, since in this case the  muscular volume would be diminish-
ed ;  but in length only,  attended  with  a proportional  increase  of
bulk, so as to preserve  the absolute volume unchanged, or nearly
so.
   It is easy to  conceive, from these few remarks, that the force ex-
erted by muscular contraction  may be  enormous; but by the me-
chanical physicians it was calculated in  the most extravagant man-
ner  from  premises  in  many instances  wholly chimerical.   Thus
Borelli estimated the force with which the heart contracts,  in or-
der to carry forward the circulation of the blood, to be equal to not
less than 180,000 lbs. at each contraction; while  Pitcairn, applying
the same speculation to the function of digestion, conceived that this
process is accomplished by a muscular exertion divided equally be-
tween  the  stomach  and the  auxiliary muscles  that surround   it,
amounting in the stomach alone to the force  of  117,088  lbs. for
which " had he assigned five ounces," says  Professor Munro, " he
would  have been nearer the truth."*   Yet we do not want these
visionary calculations to prove  the wonderful power possessed  by
muscular fibres; the facts we have already adverted to, and  others
we shall have to notice in the course of the present order, are suf-
ficient to establish their astonishing energy,  without having re-
course to unfounded hypotheses, or exaggerated statements.
  In general, says Dr.  Parr, in a very  excellent  article  upon this
subject,! it appears that the force  with  which a  muscle contracts  is
in proportion to the number of its fleshy fibres, and the  extent  of
* Monro, Comp. Anat. Pref. p. viii.
t Med. Diet, in verb. Musculus. 
204
NEUROTICA.
[CL. IV.-OR. II r.
the surface to which these fibres  are attached ; but its  degree of
contraction  or the extent of its motion  is in  proportion  to  their
length.   The limits of contraction differ in the long and in the cir-
cular muscles; for the former do not contract more than one  third
of their length, but the  circular fibres of the stomach, which in
their utmost dilatation may be expanded to a  foot in circumference,
may, after  much fasting  be reduced to  the circle  of an inch.  It
must, however, be added  that in circular muscles no fibres pass
completely round; bundles of fibres are collected and end  at  diffe-
rent points, while some begin where others end.  Each may, there-
fore, admit of only a  limited contraction,  while the dilatation just
mentioned  may be the sum of the whole.
  The action of muscles  is never intermitted, and  only diminished
in the sleeping state; though where the  sleep  is profound and le-
thargic the diminution amounts to almost  a cessation, except in the
voluntary organs.   When muscles are not exercised, the sensorial
or irritable fluid moves forward with an easy flow;  or in the words
of Haller " the vis insita  is very slightly  exerted;"  but we can still
trace its  influence by  the position which  the limbs assume  and dis-
cover the relative strength of the antagonising muscles.   Thus we
find  the flexors stronger than the extensors; for,  during sleep, the
head falls forward, and the body, legs, arms, and fingers are slightly
bent.  The cause of this additional strength is easily explained;  for
the flexors have stronger and more numerous fibres; their insertion
is farther from the centre of their motions, and under a larger angle
must increase when  flexion  has begun.   This superiority of the
flexors bends the fetus in the  womb into  a round ball.  The  same
Superiority of power  continues, though in a less degree, after birth,
and  hence  frequent pandiculations are required to give activity and
energy to the extensors,  which they again lose  in advanced age.
On awaking  from a sound sleep the same yawnings and stretchings
occur from the same cause : and Bethel fancifully  refers the crow-
ing of the cock and the fluttering of his wings to a  similar purpose.
It is always useful in  diseases to examine the position  of the  limbs
during sleep, particularly the  sleep of children.   If  they  deviate
from the ordinary degree of flexure to a more straight position, there
is generally some irregularity in the state of tone, and of course in
the vital influx.
   The muscles of the body may be divided into two grand  classes,
voluntary or animal, and involuntary or  automatic.   In  the former
we meet with some that are peculiarly remarkable for strength and
continuity  of contraction, as the greater  part of the round  muscles;
and  others as remarkable for mobility and vacillation ;  among which
we may place most  of  the long muscles.  These properties are
strikingly  exemplified in a state of disease, and call  for particular
attention;  the muscles characterised by  mobility presenting exam-
ples of atonic or agitatory spasm; while those that are conspicuous
for  continuity  of action  are chiefly subject to  rigid  or  entastic
spasm. 
i L. IV.-OR. III.]
NERVOUS FUNCTION.
205
  Continuity of exertion, however, is generally less evident in the
voluntary than in the involuntary muscles, of which  last some or-
gans, as the heart, continue their efforts through life without inter-
mission; though  all of them relax or remit occasionally or period-
ically.   For this greater permanency and  regularity of action they
are indebted to the peculiar provision which has been made for their
supply of nervous power; for while the voluntary  muscles are fur-
nished in a direct line from the sensorium, whence  indeed the close
connection they hold with it, the  control  the  will exercises over
them, and their catenation with the prevailing emotion of the mo-
ment : the involuntary muscles are dependent chiefly on  the inter-
mediate or ganglionic system described in the Proem to the present
class, and are more remotely connected with the  sensorium: they
are in consequence far less influenced by  the variable impulses  of
the mental faculties,  and are placed beyond  the  jurisdiction of the
will.  And hence the tenour of their action is more equable, more
permanent, more uninterrupted, and less subject to fatigue or wea-
riness.
   But as these organs are by no means free from the power of in-
jury, or diseased action,  they are also subject at times, in common
with the voluntary  organs, to those abnormal motions which are or-
dinarily denominated spasms :  and it is not a little curious to observe
the uniform tendency which different spasmodic affections manifest
towards  some organs or  function  rather  than  towards  others.
Thus the vital  function, in which the heart and lungs are  such
prominent agents, is  chiefly disturbed by palpitation and syncope ;
the natural, or that  in which the  abdominal organs so generally
co-operate,  by  hysterics ; and  the  animal, extending  through
the range of the  voluntary organs,  by  tetanus and  epilepsy.   In
the prosecution  of the present order, indeed,  we shall see that
this does not hold universally ; that epilepsy,  for instance,  is often
a disease rather  of the stomach or intestines, than  of any  other or-
gan, and that the heart is sometimes affected with rigid  instead  of
with clonic spasm :  but the rule holds generally and  is  not  essen-
tially shaken by these casual  exceptions.
   Dr. Cullen has contended that in all spasmodic affections the brain
is the actual seat of disease, and that they consist  in  some  morbid
modification of its energy.  " The scope  and purpose  of all that  he
has said," he  tells us, " is to establish  the general proposition, that
spasmodic affections, whether they arise  primarily in  the  brain or
in  particular parts, do consist chiefly,  and always in part, in an affec-
tion and particular state of the energy of the brain : and that the
operation of antispasmodic medicines  must consist in  their correct-
ing this morbid or  preternatural state in the energy of the brain, by
their correcting either the state of preternatural excitement or col-
lapse, or by obviating the too sudden alteration of  these states.*
   This proposition seems rather to follow from Dr. Cullen's singu-
*  Vol. i. Orel. n. Gen. v. p. 388. 
206
NEUROTICA.
[CL. IV.-OR. III.
lar doctrine concerning the mutable condition of the  energy of the
brain, and the immutable nature of the nervous power which is pro-
pagated from it by vibrations, than  from the  clear face of facts be-
fore  us.  Spasms, in many  instances, are altogether local;  they are
confined to particular muscles, or particular sets of associate  mus-
cles, and have no effect on the brain whatever so  as to disturb its
energy;  of which we have examples in  hiccough,  priapism, cho-
rea,  and often in palpitation.  They depend upon some irritation
existing not at the origin,  but at the extremity of the nerves: and.
where such is their source, even though the chain of morbid action
should at length reach the  brain and affect its  energy, as in convul-
sions from teething, epilepsy  from worms, or some palpitations  from
ossific  or polypous concretions,  all  the antispasmodics in the world
will afford no relief so long as  the local cause of irritation continues to
operate ; while the moment  this is removed, where it is capable of
removal, as by the use of a gum-lancet or active anthelmintics, all
the powers of the brain become instantly tranquillized ; its faculties
are rendered  clear, its energy is  re-invigorated,  and  its motive
power or sensorial fluid flows forward in an  uninterrupted tenour.
The greater number  of  spasmodic affections,  therefore,  do  not
so much depend upon the state of the brain as of the living fibres that
issue from it, and maintain a  correspondence with it;  for the stream
may  be vitiated while the  fountain is untouched.   We  have  seen,
indeed, in the proem to the  present class, from the concurrent re-
sults of various physiological experimenters,  that  although, while
the organ of a brain exists, it exerts a  certain influence over the
principle of muscular motion, this  principle is  far less  dependent
upon the encephalon than that of general feeling or of the  local
senses: that it is found abundantly in animals  totally  destitute  of a
brain; and that, hence, those possessing a brain  may  be excited not
only  into abnormal and spasmodic, but even  into a  continuation or
reproduction of regular and natural motions of various muscular or-
gans after the brain has been saparated  from  the spinal chain, by
stimuli applied to this chain, or even by  the  artificial  breath of a
pair  of bellows.
   The following are the genera of diseases which will be found to
appertain to the present order :
        T                                 >
        I.  ENTASIA.                CONSTRICTIVE SPAsM.
       II.  CLONUS.                 CLONIC SPASM.
       III.  SYNCLONUS.              COMPLEX  SPASM. 
<;e. i.]
NERVOUS
FUNCTION.
207
                      GENUS  I.


                        ENTASIA.


                   (Zonstnctfte Sjiasm.

IRREGULAR MUSCULAR ACTION PRODUCING CONTRACTION, RIGIDITY, OR BOTH.

Entasia is derived from the Greek  svkwj?, " intentio,"  " vehemen-
tia," " rigor," from em«w, " intendo."   By many nosologists the ge-
nus is called tonos, or tonus, which is here dropped in favour of the
present term, because tonus or tone is  employed by physiologists
and pathologists, in direct opposition to irregular vehemence or ri-
gidity, to import a healthy and perfect vigour or energy of the mus-
cles;  and by therapeutists to signify medicines capable of producing
such or similar effects.
  The genus entasia includes the following species .
1.	ENTASIA	PRIAPISMUS.	PRIAPISM.
2.		LOXIA.	WRY-NECK.
3.		ARTICULARIS.	MUSCULAR STIFF-JOINT.
4.		SYSTREMMA.	CRAMP.
5.		TRISMUS.	LOCKED-JAW.
6.		TETANUS.	TETANUS.
7.		LYSSA.	RABIES. CANINE MADNI
8.	-----	ACROTISMUS.	SUPPRESSED PULSE.
                         SPECIES  I.

               ENTASIA  PRIAPISMUS.

                         Sinapism.

PERMANENT RIGIDITY AND ERECTION OF THE PENIS WITHOUT CONCUPISCENCE.

The specific term is derived from the name of Priapus, the son of
Venus  and  Bacchus,  who is usually thus represented in paintings
and sculptures, but with a concupiscent feeling.  Galen applies the
term also to females,  as importing a rigid elongation of the  clitoris
without concupiscence.
  Spasm is, in all instances, a disease not of vigour but of debility
with a high degree  of irritability:  and there is no case  in  which
this is more striking than in the present species.  It has been found 
208
NEUROTICA.
[CL. IV.-OR. HI.
occasionally in infancy; but It is far more frequently an  attendant
upon advanced years.  It  has sometimes also followed upon cold,
and especially local cold, clap, dysury, and the use of cantharides as
a cure for seminal weakness.  It has at times  been a result of free
living, and  particularly hard  drinking.   The  spasm consists in a
stiff and permanent contraction of the erectores penis, unconnected
with any stimulus arising from a fullness of the vesiculae seminales.
  Dr. Darwin says, he had met with two cases where the erection,
producing a horny hardness, continued two or three weeks without
any venereal desire, but not without  pain.  The easiest attitude was
lying upon the back  with  the  knees  bent upwards.  The corpus
cavernosum urethrae at length became  soft, and in a day or two the
whole  rigidity subsided.  One  of these patients had been a free
drinker,  had a gutta  rosacea on his  face, and died suddenly a few
months after his recovery  from the present complaint.  It is singu-
lar that this spasm should  sometimes continue after death: at least
we  have accounts of such cases in  Marcellus Donatus and other
writers.
  As the disease is a case of both local and general debility, its cure
is in most  instances difficult.   Antispasmodics and tonics are the
only medicines that promise relief, as camphor, opium, bark, warm
aromatics, warm  bathing, cold bathing: but the whole are often
tried without effect.
                         SPECIES  II.

                   ENTASIA  LOXIA.

                         ai&^iteefc.

PERMANENT CONTRACTION  OF THE  FLEXOR MUSCLES ON  THE RIGHT OK
  LEFT SIDE OF THE NECK, DRAWING THE HEAD OBLIQUELY IN THE  SAME
  DIRECTION.

The term loxia is derived from the Greek, m\os, <; obliquus, tortus ;"
whence loxarthrus in surgery, an obliquity of a joint of any kind,
without spasm or luxation.   By the Greeks, however, the term was
specially applied to the  joints or muscles of the neck.
  This disease,  in  its genuine form, proceeds* from an excess of
muscular action,  particularly of the mastoid muscle on the contract-
ed side.   But we frequently meet  with  a  similar effect from two
other causes: one in which  there is a disparity in the length of
the muscles  opposed to  each other, and  consequently a permanent
contraction on the side  on which they are  shortest,  producing the
disease called wry-neck ;  and the  other in which from cold  or  a
strain, there  is great debility or atony on the side affected,  and. 
HE. I.-SP. II.]
NERVOUS FUNCTION.
209
 consequently, an incurvation of the neck on the opposite side,  not
 from a morbid excess, but an overbalance of action.
    This species, therefore, offers us the three following varieties:

 x  Dispars.                  From disparity in the length of  the
    Natural wry-nfeck.          muscles opposed to each other.
 C  Irritata.                  From excess of muscular action on the
    Spastic wry-neck.           contracted side.
 y  Atonica.                 From direct atony of the  muscles on
    Atonic  wry-neck.           the yielding side.

    The first variety is mostly congenital,  though sometimes pro-
 duced by  severe burns  or other injuries.   And a like  effect  occa-
 sionally issues from a  cause that may be  noticed in the present
 place, though not connected with a morbid state of the muscles; a
 displacement of the muscles from an incurvation in the  vertebra1 of
 the neck, by which, though the antagonist muscles be of equal length
 and power, those on the receding side  of the  neck  are kept  on a
 perpetual stretch, while those on the protruding side are in a state
 of constant relaxation.   The other two  varieties are commonly the
 result of cold, or inflammation, or a strain.
   The cure must depend upon the nature of the cause.   In  colds
 and strains, warmth,  the friction  of flannel,  and the  stimulus of
 volatile  or camphor liniment combined  with opium, will be found
 most serviceable as  tending to diminish  pain, and  restore action to
 the weakened organ.  In  direct  spasms the  same  process will also
 frequently be found  useful, but  the application  of cold  water  as a
 tonic and   antispasmodic  will  often  answer better.   Where the
 antagonist muscles are of unequal  length, the case lies  beyond the
 reach of medical practice, and,  if relieved at all, can only be so  by
 a surgical  operation.  If the cervical vertebra? be incurvated, but
 the bones sound, the disease  may not unfrequently be made to yield
 to a skilful application of machinery by the hands of an ingenious
 surgeon.   It sometimes happens, however, that the bones in this case
 are soft  and occasionally carious,  and the slightest motion  of the
 head  is attended with  intolerable  pain.  Setons have been found
 serviceable, with an artificial support of the head: but this kind of
 affection  is often connected  with  a  constitutional softness  of the
 bones, of which we shall have to treat in the first order of the sixth
class,  under the head parostia Jiexilis.
vol.  in.
27 
210
NEUROTICA.
[CL. IV.»OK. HIV
                        SPECIES  III.

              ENTASIA  ARTICULARIS.

                  Muscular  Stftejotnt.

PERMANENT AND RIGID CONTRACTION  OF ONE OR MORE ARTICULAR MUSCLES
                       OR THEIR TENDONS.

The joints of the  limbs  are  as subject to muscular contractions as
the neck :  and, in  many instances, from  like causes :  the following
are the varieties of affection  hereby produced :

a Irritata.                    From excess  of action in the muscles
  Spastic stiff-joint.             contracted.
£ Atonica.                   From  direct atony in  the yielding
  Atonic stiff-joint.             muscles.
y Inusitata.                  From long confinement or neglect of
  Chronic stiff-joint.            use.

  Besides the ordinary causes of  cold, inflammation, and strains, by
which the first  and second variety are produced, the former has
sometimes followed upon a sudden fright,*  upon drying up a cuta-
neous eruption, or checked perspiration.!  Friend, also, mentions a
case in which it  has been cured by a fright  ;\  and Baldinger one in
which it disappeared on the revival of a suppressed eruption which
had given rise to it.§  Rheumatism has often produced it, and parti-
cularly the second variety, in the  joint of the knee and thigh-bone.
  In  a  case  of  the  latter  kind,  it was successfully  attacked by
Richter,||  with a cautery of  a cylinder  of  cotton.  In this and the
third  variety much benefit is  often derived from repeated and long
continued friction with a warm hand, and particularly if illined with
some  stimulant balsam or liniment.   In an obstinate contraction of
the fingers succeeding to a  fractured arm, Dr. Eason  relates an
instance in which the rigidity suddenly gave way to a  pretty smart
stroke of electricity  after every other  mean had failed, and the
patient had the use of his fingers  from this time.1T  Such exercise,
moreover,  or exertion of the limb  should  be recommended  as it
may bear without fatigue.  The cold bath, as an antispasmodic, has
sometimes  been  serviceable  in the first variety, and more fre-
quently, as a  tonic, in the second.

                *  Starke, Klin. Instit. p. 32.
                t Paullmi. Cent. I. 39.
                X  Vit. Gabriel.
                i N. Magazin. Band. xi. 78.
                || Chir. Bibl. Baud. X. 219.
                V  EdiD. Med. Comment, v. p. C4. 
OE. I.-SP. III.]       NERVOUS FUNCTION.                 ^1*

  Most men exhibit proofs of the third variety or chronic stiff-
joint, from a neglect of using many of their muscular  powers, for
nearly a fourth part of the voluntary muscles, from being  seldom
called into full and active exertion, acquire a stiffness  which does
not naturally belong to them,  while many that, by exercise, might
have been rendered perfectly pliant and obedient to the will  have
lost all mobility, and are of no  avail.   Tumblers and buffoons are
well aware of this fact, and it is principally by a cultivation of these
neglected muscles that they are  able to assume those outrageous
postures and grimaces, and exhibit those feats of agility which  so
often amuse and surprize us.  It is a like cultivation that gives that
measured grace and firmness as well as erect position in walking,
by  which the soldier  is distinguished from the clown ;  and that
enables the musician to run with rapid execution,  and  the  most
delicate touch,  over  keys or finger-holes that  call thousands  of
muscular fibres into play or into quick combinations of action, which
in the untutored are stiff and immoveable, and cannot be forced into
an imitation without the utmost awkwardness and fatigue.
                        SPECIES  IV.

               ENTASIA  SYSTREMMA.

                           <&vmnp.

 SUDDEN AND RIGID CONTRACTION AND  CONVOLUTION  OF ONE OR MORS
   MUSCLES  OF THE BODY :  MOSTLY OF THE STOMACH AND EXTREMITIES,
   VEHEMENTLY PAINFUL, BUT  OF SHORT DURATION.

 Systremma, literally  " contortio, convolutio," " globus," is derived
 from evarttQa, " contorqueo,"  " convolvo in fascem."  Stremma the
 primary noun is  an  established  technical term for u strain, twist,
 wrench ;" and the author has hence been induced to add the present
 term to the medical  vocabulary in the sense now offered, for the
 purpose of superseding and getting rid of crampus which has hitherto
 been commonly employed, though at the same time .commonly  repro-
 bated, as a term intolerably barbarous,  derived  from the German
 krampf.  The proper Latin  term is, perhaps, " raptus nervorum ;"
 whence opisthotonia or opisthotonus is denominated by the Latin
 writers, u raptus  supinus."  But raptus  is  upon the whole  of too
 general a meaning to be employed on the present occasion,  unless
 with the inconvenience of another term combined with it.
  The parts chiefly attacked with cramp are the calves of the legs,
 the neck, and the stomach.  The  common causes are sudden ex-
posure to cold, drinking cold liquids during great heat and perspi-
ration, eating cold cucurbitaceous fruits when the  stomach is  infirm 
212                     NEUROTICA.           [CL. 1V.-OR. IIT.

and incapable of digesting them, the excitement of transferred gout
and overstretching the muscles of the limbs, in  which last case it
is an excess of  reaction produced by the stimulus of too great an
extension.   Hence many persons are  subject to  it,  and especially
those of irritable habits, during the warmth and relaxation of a bed,
and particularly towards the morning when the relaxation  is  great-
est, the accumulation of muscular or irritable power  most considera-
ble, and the extensor-muscles of the legs are strained to  their ut-
most length to  balance the action  which the flexor-muscles have
gained over them during sleep.  Cold night-air  is  also a common
cause of cramp, and it is a still more frequent attendant upon swim-
ming, in which we have the two causes  united  of  cold and  great
muscular extension.  An  uneasy position of the  muscles is also in
many cases a sufficient cause of irritation ; and hence we often meet
with very painful cases of cramp in pregnant women down the legs,
or about the sides, or the hypogastrium.
  Where  the  hollow or  membranous muscles  are affected, they
feel as though they were puckered and drawn to a point;  the pain
is agonizing, and generally produces a violent  perspiration :  and if
the stomach be  the affected  organ  the diaphragm associates in the
constriction, and  the breathing is short  and distressing.  If  the
cramp be seated in the more fleshy muscles, they seem to be writh-
ed and twisted into a  hard knot, and a knotty induration is perceiva-
ble to the touch accompanied with great  soreness, which continues
for a  long time after the balance of power has been restored.
  In common cases where the calves of the legs are affected, an
excitement of the distressed muscles into their usual train of exer-
tion is found sufficient: and hence most people cure themselves by
suddenly rising into an erect position.  I have often produced  the
same  effect and overcome the re-action without  rising, by forcibly
stretching out the  affected leg by means of other  muscles, whose
united power overmatches  that of the  muscle  that is contracted.
Warm friction with the naked hand, or, which is better, with  the
hand illined with camphorated oil or alcohol, will also generally be
found to succeed.  A forcible exertion of  some remote  muscles,
which thus  collects  and concentrates  the irritable power  in an-
other quarter will also frequently effect a  cure ; and it  is to  this
principle alone, 1 suppose, we are to refer the benefit which is  said
to  arise from squeezing strenuously a roll of brimstone, which sud-
denly  snaps beneath the hold.  The  brimstone snaps  from  the
warmth of the hand applied  to it; but its only remedial power con-
sists in affording a something for the hand to grasp vehemently,  and
thus excite a sudden  change  cf action.
  Where the stomach  is affected, brandy,  usquebaugh, either, or
laudanum afford the  speediest means of cure ;  and it is often neces-
sary to combine the laudanum with one or the other of the preced-
ing stimulants.  Here also the external application  of warmth, "and
diffusible irritants as  hot flannels moistened with the compound cam-
phor  liniment,  are found in  most cases  peculiarly beneficial.   Ex- 
42E. I.-SP. IV.]       NERVOUS FUNCTION.                  213

citing a transfer of action to the extremities, as by bathing the feet
in hot water, or applying mustard sinapisms to them is frequently of
great advantage ; as is the  use of hot, emollient and anodyne injec-
tion<, whose  palliative power reaches the seat of spasm by sympa-
thetic diffusion,  and  often affords considerable quiet.  Here, also,
the patient should be particularly attentive to his diet and regimen,
confining himself to  such viands as are most easy of digestion, and
least disposed to rouse the stomach to a return of these morbid and
anomalous  actions;  for a habit of recurrence  is soon established,
which it is difficult to break off.
   In pregnancy, where the crampy spasms are often migratory and
fugitive, the  position should frequently be changed,  so as to remove
the stimulus  of uneasiness by throwing  the pressure  upon some
other set of muscles: and if the stomach be affected with gout,
opium, rhubarb, chalk, or  aromatics should be taken on going to
rest.
   The best preventives when the cause is constitutional, are warm
tonics, and habituating the affected muscles to as much exercise as
their strength will bear: and hence the same forcible extension used
in swimming  which produces cramp the first or second time of trial,
will rarely do so afterwards.
   Cramp is also found, as  a symptom, and as one  of  the  severest
symptoms of the disease,  in various  species of colic and cholera;
in which cases it must be treated according to the methods already
pointed out under those respective heads.
                         SPECIES  V.

                  ENTASIA  TRISMUS.

                        ftocfcetejato.

  PERMANENT AND RIGID FIXATION OF THE MUSCLES OF THE LOWER JAW.

This disease is by the French  writers called tic.  The technical
term  is derived from the Greek ryZp,  " to gnash or grind the
teeth ;" which, like the French sysyno.iym, is supposed by the lexi-
cographers to be  an onomatopy,  or  a word formed from the sound
that takes place in the act of gnashing.
  In truth it was to a disease  in which morbid  gnashing formed a
a symptom, that both the Greek and French term was originally ap-
plied ;  for the trismus of the old  writers consisted, not of a rigid,
but a convulsive or agitatory spasm  of the lower jaw; an affection
comparatively trifling, and rarely to be  met with, and when it does
occur appertaining to the clonus of the present system of nosology,
the clonic spasm of authors in general.  And the use of trismus  or 
 214                    NEUROTICA.            [CL. IV.-OR. Ilk

 tic to import a state of muscle directly opposed to that which it first
 indicated,  is  another striking  proof of the  incongruous change
 which is perpetually occurring in the nomenclature of medicine, for
 the want of established rules and principles  to give fixation and a
 definite sense to its respective terms.
   Dr. Akerman is  the  only writer  of reputation I am  acquainted
 with in recent times, who has used trismus in its original intention;
 or rather  who has united  its  original  with its modern meaning.
 For he employs the  term  generically;  and  arranges under It the
 two species of trismus tonicus, being that now under consideration,
 and trismus clonicus, or the  disease it originally denoted.  But this
 arrangement is uncalled for, and inconvenient, and has not been  re-
 ceived into general use : the term trismus being, with every writer
 of the present day, limited to the first of these two species alone,
 notwithstanding the  origin  of the  word.  And  hence, as it is so
 generally and completely understood, there would be an affectation
 in changing it for  any other.   The Germans call it kinnbakkenz
 wange which is precisely parallel with  the  locked-jaw of our own
 tongue.
   Dr. Cullen in the first edition of his nosology, made trismus, and
 tetanus, our next species, distinct genera, but he altered  his opinion
 before the publication of his First Lines, and regarded them as no-
 thing more  than  degrees  or varieties  even  of the same species.
 " From the history of the  disease," says he, " it  will be evident
 that there is no room for distinguishing  the tetanus,  opisthotonos,
 and trismus or locked-jaw as different species of this disease : since
 they all arise from the same causes, and  are  almost constantly con-
joined in the same person."*  In consequence of which, in the later
 editions of Dr. Cullen's Synopsis, in which  the supposed error is
 attempted to be corrected,  the disease  is  introduced with a very
singular departure from nosological  method :  for first, tetanus is em-
 ployed as the term for a distinct genus, defined " a spastic rigidity
 of many muscles ;" and next under this  generic division are  given
 no species whatever but two varieties of degree alone,  to the first
 of which is again applied the name of tetanus, defined " the half or
 whole of the body affected with spasms;" and to the second that of
 trismus ;  defined " spastic rigidity chiefly of the lower jaw."
   Passing by this irregularity of method, the proper view of the
subject seems to lie in a middle course ;  in  contemplating trismus
and tetanus, not as  distinct genera,  or mere varieties of a  single
disease, but as distinct species of a common  genus ; and under this
view it is contemplated in the present arrangement.  Trismus bears
 the same relation to tetanus  as synochus  does  to  typhus;  the two
former, like the two latter, may proceed  from a common cause and
require a similar treatment; and the first  may terminate in the
last.  But trismus,  like synochu^, may  run  its course  alone, and
continue  limited to its specitic symptoms.  And as  Dr.  Cullen has
Pract. of Tliys. Book. in. S*ct L. Chap. i. J mcclxvii. 
GE. I.-SP. V.]
NERVOUS FUNCTION.
215
thought proper to make  synochus and typhus  distinct genera, he
ought at least  to have  ranked trismus and tetanus as distinct spe-
cies.
  Trismus is found in all ages, sexes, temperaments, and  climates.
In warm climates, however, it  occurs far more frequently than in
cold; and chiefl} in the hottest of warm  climates.   Dr.  Cullen ob-
serves, that, the  middle-aged  are most susceptible of the disease,
men more so than  women,  and the robust  and vigorous than the
weakly.  Other animals are  subject to this  complaint  as well as
man, particularly parrots; and from many of the causes * that affect
the human race.
   These causes, for the most part, are dullness and damp operating
upon the body when heated, and hence sudden viscissitudes of heat
and cold; wounds,  punctures, lacerations, or  other  irritations of
nerves in any part of the body, whence it has not unfrequently fol-
lowed on venesection when unskilfully performed,! and  still more
frequently on amputation, worms or other acrimony in the stomach,
and especially  in  those of infants.  We have  thus the  three  fol-
lowing  varieties offered to  us,  which,  however, chiefly differ in
symptoms peculiar to the  period of life in which the  disease is
most disposed  to show itself, or  in the interval between the  casual
excitement and the spastic action:
x Nascentium.                   Attacking infants during the  first
   Locked jaw  of infancy.           fortnight after birth.
Q Algidus.                       Occurring at all ages, after ex-
   Catarrhal locked jaw.            posure to cold and damp, es-
                                   pecially the dew of the  even-
                                   ing, the symptoms usually ap-
                                   pearing within  two or three
                                   days.
y Traumaticus.                  Occurring  as  the  consequence
   Traumatic locked-jaw.           of a wound, puncture or ulcer:
                                   chiefly  in hot climates;  and
                                   rarely  appearing  till   nearly
                                   a fortnight after  local affection.

   The pathology is highly difficult, if not mysterious, and has hence
 been  purposely avoided by most preceding writere.  Dr.  Cullen
 expressly avows  that  he  " cannot in any  measure  attempt it ";.
 There is one  principle, however, to which 1 have frequently had
 occasion to direct the reader's attention  which will help us in a con-
siderable degree to develope something  of its  obscurity, and to ac-
count more especially for so remote a separation between the  seat
 of primary irritation and that of spasmodic  excitement,  which con-
 stitutes, perhaps, its most embarrassing  feature.  The principle  1

   * Bajon. Abhandlungen Von Krankheit aufder Insol Cayenne, Sic.
   t  Delaroche, Journ. de Med. Tom.  xv. p. 213.  Forcstus. Lib. x. Obs. ill.
 Schenck, Obs. l.  i. N. 250.
   X Piact. of Pliys. Book m. Sect. i. Chap. I. $ mcclxix 
216
NEUROTICA.
[CL. IV.-OR. 111.
 allude to is the sympathy that prevails  throughout the whole of
 any chain of organs whether  continuous or  distinct, engaged in a
 common function, and which  is particularly  manifest at its extre-
 mities ;  so that let a morbid action commence in  whatever part of
 the clnin  it  may, the  extremities in many instances,  become the
 chief seat of distress, and even of danger.  We had occasion to no-
 tice this law of the animal economy when treating of parapsis  illu-
 soria, or .that imaginary sense  of feeling and of acute pain in a limb
 that ha? been amputated and is no longer a part of the body, which
 we referred to the principle before us: and farther noticed, by way
 of illustration, the  pain often suffered at  the glans penis from  the
 mechanical irritation of the neck of the bladder by a calculus.   So,
 irritating the fauce* with a feather excites the stomach, and even
 the diaphragm,  to a spasmodic action, and the contents of the organ
 are rejected.  Irritating the ileum, as in ileac passion, produces the
 same  effect  upon  the stomach and  oesophagus;  at the same time
 that the  other extremity of the canal is attacked with rigid spasm,
 and consequently with obstinate costiveness : while in cholera both
 extremities are  affected in a  like way, and we  have  hence both
 purging  and vomiting.  It is to the  same principle  we tare to as-
 cribe  it  that when  the surface  of the body is suddenly chilled,  as
 on plunging into a cold bath, the sphincter of the bladder becomes
 irritated, and evacuates the contained  urine: and,  in  treating of
 of marasmus, we  had occasion to show that while, in one of its  spe-
cies, the disease seems to commence in the digestive, and in another
 in the  assimilating organs, constituting the extreme ends of a  very
 long and  complicated chain of action, it very generally happens that
at which end soever the decay commences the opposite end is very
soon affected equally.
   In a continued chain of nervous fibres, however, this principle of
sympathy which induces remote parts, and particularly remote ex-
tremities, to associate in the same  morbid action, is peculiarly con-
spicuous.  Hence, if a long muscle be lacerated  in any part of its
belly the tendinous terminations are often the chief seat of suffering.
As the ulnar nerve sends off twiggs from the elbow to  supply  the
fore-arm and fingers, a blow on  the internal Condyle of the humerus
gives a tremulous sensation through the fore-arm  and hand:  and as
the ulnar nerve itself is only an offset from a plexus or commissure
of the cervical nerves which also give a large branch to  the scapu-
la, a paralysis of the ring  or  little finger has sometimes been re-
moved by stimulating the scapular extremity by a caustic applied
at the internal angle of the scapula.  In inflammation of the li\ er, a
severe pain is often felt at the top of the shoulder, and in palpita-
tion of the  heart, at the left orifice of the stomach.  Both these  are
to be accounted for by recollecting that the radiations of the phre-
nic nerve extend in an upper line to  the  shoulder, and in a lower
to the  diaphragm, which constitute its extreme points ; and that one
of its branches passes over the apex of the heart.   Now as the  un
der surface of the diaphragm participates, from its contiguity, in an 
 GE. I.-SP. V.]         NERVOUS FUNCTION.                 217

 inflammation of the liver, the top of the shoulder suffers, as form-
 ing the extreme point of the phrenic chain by which these organs
 are connected ; and as the upper surface of the diaphragm is in di-
 rect contact with the left  and  very sensible orifice of the stomach,
 an uneasiness at the apex of the heart becomes the cause of irrita-
 tion to this orifice in consequence of its connection  with  the  dia-
 phragm, and  hence, of necessity,  with the  lower branch of the
 phrenic nerve at its extreme distribution.
   These remarks apply with particular force  to the disease before
 us,  and many others  of the same class with which it has a close ana-
 logy, as tetanus,  neuralgia, lyssa,  and hemicrania.  And, although
 from the intricacy of the intersections and decussations with which
 various nerves pursue their radiating courses, it  is impossible for
 us,  in many instances, to determine  why one line  of connexion suf-
 fers while another  remains unaffected, yet in most instances we
 may be able, by an  accurate survey, to  trace the catenation,  and
 hence to obtain some insight into the physiology of these exquisite-
 ly curious, and complicated disorders.
   In mapping the nervous ramifications which give rise to trismus
 or locked-jaw, we must regard  the ganglionic  system consisting of
 the various branches  of the intercostal  trunk, and the  numerous
 branches which unite with it from the whole line of the spiual mar-
 row, as constituting the centre; and  as, from  this centre, we per-
 ceive ramifications radiating in  every direction to  the face, the en-
 tire length of the back, the upper and  lower  limbs, and the thora-
 cic and abdominal viscera, we see a foundation laid even  by a con-
 tinuous chain, for an association of remote  parts and even extreme
 points in morbid changes,  even  though  we  may not be able, satis-
 factorily perhaps, in  any instance, to trace  out the individual line
 by which the diseased action is  carried  forward, and to separate it
 from other lines with which  it  is inextricably interwoven.  Thus,
 in the case of trismus nascentium, forming the first variety under the
 present species, the irritation of the nerves of the stomach, which
 is very clearly the primary seat of disease  in most cases, is  propa-
 gated directly to the  central branches of the ganglionic system, by
 the tributary offsets which the  stomach  receives from it.  But  we
 have already observed,  that the  chief contribution to this grand
 junction-canal is derived from  the  intercostal nerve itself,  in the
 first  instance an arm from the trigemini or fifth pair of nerves, two
 branches of which radiate upwards, constitute the  maxillaries supe-
 rior  and maxillaries inferior, and are lost in  the muscles of the jaws.
 So that the upper extremity of the nervous  line distributed over the
 stomach is the nerves of the jaws themselves; and hence, agreea-
 bly to the law of the animal economy we have just pointed out, the
 muscles of the  jaws, forming this extremity in  the  chain of morbid
 action, are the organs in which  we may  expect an irritation  of the
nerves of the stomach in  various instances  to  manifest itself most
strikingly.
  In like manner we may account for the second and third varieties
  vol. hi.                    28 
218
NEUROTICA.
[CL. IV.-OR. III.
of trismus, or that produced by a chilly dampness, or irritative vio-
lence applied to the upper or  lower  extremities : for as these  are
all supplied by nerves from the vertebral source, which, as we have
already remarked, gives  off branches from  every aperture in  the
spine to the ganglionic system, and as this system, at its upper end,
terminates in the maxillary branches of ihe  fifth pair of nerves, the
muscies into which these nerves  are distributed constitute one ex-
treme point of a long chain of nervous  action, while those of  the
upper and lower limbs constitute  the other.  And hence the same
law which produces a spastic fixation of these muscles in certain ir-
ritations of  the  stomach, may reasonably be expected to  operate
with  a  like  effect  in certain irritations of the upper  and lower
limbs.  And as the intercostal  nerve, at its first rise from the com-
mon source  of itself  and  the maxillary  branches, receives  also, in
its progress, offsets from  the sixth, seventh,  eighth, and ninth pairs
of cerebral nerves, as well as from all the vertebral, and as all these,
in consequence of such an  interunion and decussation, are  sending
forth branches over the muscles of the back, the chest, and  the tho-
rax, there is no difficulty in conceiving that when a rigid spasm has
once  commenced in the lower jaw, it should be propagated  through
any of the muscles appertaining  to  these parts of the  system, or
even originate  in them from  any of the causes that excite locked-
jaw, and hence lay a foundation for tetanus as well  as trismus, both
as a primary and a secondary  disease.  And I  have touched upon
this subject now that we  may  not have to repeat the present expla-
nation when treating of tetanus in its proper place.
  In  the simplest state of trismus, indeed, there is some degree of
stiffness found at the  back of the neck, and even in the sternum.
The  disease, in some cases, shows itself with sudden  violence, but
more usually advances gradually:  till at length  the muscles  that pull
up the jaw become so rigid, and  set  the  teeth so closely  together
that they do not admit of the smallest opening.
   In tropical climates, for  Dr. Cullen's  remark  that it is most com-
mon  to the middle-aged  only applies to the temperate  regions of
Europe, children are peculiarly subject to this complaint, and with
a few peculiarities which, though producing no specific difference,
are sufficient to establish a vaiiety.   The disease in this case is vul-
garly known by the absurd name of  falling of the jaw.   It occurs
chiefly between the ninth and fourteenth day from birth  ; seldom
after the latter  period.  Without any febrile  accession, and often
without any perceptible cause whatever, the infant sinks into an un-
natural weariness, and drowsiness, attended with frequent yawnings,
and with a difficulty, at first slight, of moving the lower jaw; which
last symptom takes  place  in some instances sooner, in others later.
 Even while the infant is yet able to  opeu its mouth there is, occa-
sionally, an inability to suck or swallow.   By degrees the lower jaw
becomes rigid, and totally  resists the introduction  of food.   There
is no painful sensation;  but  the  skin assumes a yellow  hue,  the 
GE. I.-9P. V.]
NERVOUS FUNCTION.
219
eyes appear dull, the spasms often  extend over the  body,  and in
two or three days the disease  pro^ es mortal.
  The ordinary cause is irriation in the intestinal canal.   Hence
viscid and acrimonious meconium frequently produces it; as worms
are said also to do, some months alter birth.  It seems moreover in
some instances to have followed from irritation in tying the naval
string, or its not being properly attended to  afterwards : in which
case though  the  stomach may be affected by contiguous sympathy,
the disease makes a  near approach to the third or traumatic varie-
ty.   Yet the appearance of the  spastic action is as early as where
the stomach is primarily affected.
   In cold and even mountainous countries this variety is also some-
times found.  " I am informed," says Dr. Cullen, "of its frequently
occurring in the Highlands of Scotland;  but I never  met with any
instance of it in the  low country."*  Whether, according to the con-
jecture of this celebrated writer, it is  more  common  to some dis-
tricts  than  to others, has  not  been sufficiently  determined.  " It
seems," says he, " to  be more frequent in Switzerland  than in
France."   Hot cl mates, however, constitute its principal domain;
and hence it is not very surprising that  Bajon should place  one of
its chief residences at Cayenne ;t or that Akerman should assert  it
to be endemic in Guinea.
  In the second variety  of the disease or that proceeding from cold
or night dew, the symptoms often appear within a day or two after
exposure to the exciting cause.  It is  not common that  the  spasm
extends to the musc-les of the chest or back so as to produce teta-
nus, though there is often an  uneasy  sensation at the root of the
tongue with some difficulty of swallowing liquids after their intro-
duction into the mouth, the disease thus making an approach towards
lyssa or canine madness in its symptoms, as we have just endeavour-
ed to show  that it does in its physiology   According to the observa-
tions of Baron Larrey, indeed, this  approach is in  many instances
very considerable:  for he informs us that on post-obituary examina-
tions he has often found the pharynx and oesophagus much contract-
ed, and their internal membranes red, inflamed, and covered with a
viscid  reddish mucus.  Dr. Hennen, however, does not place much
dependence  upon any such appearances; he admits, nevertheless,
that they are to be  traced occasionally,  though he  ascribes them
more to an  increased flow of blood consequent on increased action
than to any  other cause.J
  In this variety, from the slighter nature of its attack, the  patient
not unfrequently recovers by skilful medical treatment, and there are
unquestionably instances  of  spontaneous  recovery,§  though cases
of this  kind  are very rare.  The intellect remains unaffected, there
* Loc. c.itat. t mcclxxxi.
t Bajon, Abhandlung. von Kranheit. auf der Insel Cayenne, &c. Erp. 1781.
X Piinciples of Military Surgery, 246.
J  Briot, Hist, de la Chirurgie Militaire en France, &c. 8vo. Beganson, 1817. 
220
NEUROTICA.
[CL. 1V.-OR. IIF.
is little quickness of the pulse, sometimes none whatever, and little
or no disorder of any kind, though the bowels are usually very cos-
tive.   If the patient pass the fourth or fifth day  we  may begin to
have  hopes of him; for the spasmodic constriction will then fre-
quently remit, or intermit: but, as even in the last case, it is apt to
return at uncertain intervals, there is still a considerable danger for
many days longer.
   When, as in the third variety, the disease proceeds from a nerve
irritated by a wound or sore of any kind, the  spasmodic symptoms
are much later in showing themselves ; and sometimes do not make
their  appearance till eight or nine days afterwards, occasionally, in-
deed, not at all, till the wound  is healed.  The disease is more dan-
gerous in proportion to the delay ; the adjoining muscles of the face
become more affected, and, as is already observed, the spasms  often
shoot downward  into the back  or chest, and trismus is complicated
with tetanus.   The breathing is nasal and abrupt, the accents are in-
terrupted and slow, and uttered by the same avenue ;  the muscles of
the nose, lips,  mouth, and the whole of the face are violently drag-
ged and distorted, and  the patient sinks from nervous exhaustion and
want of nutriment, the jaw-bone being set so fast  that it will often
break rather than give way to  mechanical force.
  The disease, from this cause, is generally fatal: and  we  are in-
debted to the ingenuousness of Sir James M'Grigor and Dr. Hennen
for a confession that, whatever remedies were employed in the Brit-
ish army, whether in India or in Spain, the mortality was nearly the
same.  But as  the treatment of the present variety and the ensuing
species should  be founded on a like principle, we shall reserve this
subject till we  have entered upon a distinct history of the latter.
                        SPECIES  VI.

                 ENTASIA TETANUS.

                          Eetauus.

PERMANENT  AND RIGID  FIXATION OF MANY OR  ALL  THE VOLUNTARY
     MUSCLES ; WITH INCURVATION  OF  THE BODY AND DYSPN03A.

Tetanus  is derived from rtnuw, which itself is a derivative from
T8«v«, " tendo, extendo."   Like trismus  it is a term common to the
early Greek writers, among whom it  was used synonymously  with
opisthotonus and emprosthotonus, though the two latter were after-
wards employed to express two distinct modifications of the disease.
  From peculiarities in the seat or mode of its attack  this species
offers us the three following varieties: 
GE. I.-SP. VI.]
NERVOUS FUNCTION.
221
x Anticus.                        Tetanus of the  flexor-muscles.
  Tetanic procurvation.            The  body  rigidly  bent for-
                                   wards.
C Dorsalis.                       Tetanus of the extensor-muscles.
  Tetanic recurvation.              The body rigidly bent  back-
                                   ward.
y Lateralis.                      Tetanus of the  lateral muscles.
  Tetanic  transcurvation.            The body rigidly bent  later-
                                   ally.
3 Erectus.                        Tetanus of both the posterior
  Tetanic  inflexibility of the      and  anterior  muscles.   The
     body.                          body rigidly erect.

  The first of these varieties is  the  emprosthotonus of early wri-
ters; the second the opisthotonus; the third the pleurosthotonus of
authors of a later date ; the fourth the proper tetanus of Dr. Lionel
Clarke and a few others.   To these varieties it has been usual to
add   the singular disease called catochus;  which by  Sauvages,
Cullen, and various other  authorities is  regarded  as closely con-
nected with this species.   It has  a near affinity to it unquestionably,
and hence out of deference to concurrent opinions,  it was suffered
to stand as a variety of tetanus in  the first edition of the author's
Nosology, but with a note  intimating that it seems rather to belong
to the genus carus of the fourth order of the present class, and to be
a modification of the species ecstasis, under that genus :  and as this
appears to be  its proper place it will now be'  found arranged  there
accordingly.
  The general physiology,  so far as it seems capable of elucida-
tion, has been  already given under the  preceding species.  The
exciting causes are also for the most part those of trismus ; though
it appears in infancy far less frequently, unless as a concomitant of
that disease.   Damp and cold, therefore, and nervous irritation from
wounds or sores in hot climates and crowded hospitals, are the chief
sources of its production ;  and where these accessories exist, terror
seems to be a  powerful auxiliary, and has alone, in some instances.
been sufficient for its production.   " Passion,  or terror," says Dr.
Hennen, " after wounds and operations, has been known  to produce
the  disease in some":  and sympathy, though a rare cause, in others."
It is said also to have been produced by insolation  or exposure  to
the  direct rays of the sun.*
  Lateral tetanus is very rarely to be met with, and seems  to be
rather a chronic than  an  acute malady.   Fernelius,  who first de-
scribed it,f gives a case in which it  occurred  annually, but only in
the  winter, during which season  the  patient had two or  three par-
oxysms daily, the head was first attacked with a peculiar  vibratory
feeling which gradually descended to the  neck with a sensation of

            * Pathol. Lib. v. p. 372.
            t Medical Observations and Inquiries, Vol. vi. 
222
NEUROTICA.          [CL. IV.-OR. III.
cold, and by the time it reached the scapula, was immediately suc-
ceeded by symptoms of opisthotonus,  and afterwards of lateral con-
traction; durin? which the mind an 1 external senses were unaffect-
ed, but the flexor-muscles were so  firmly fixed  that no antagonist
force of the  bystanders was able to overpower the contortion.
  Nor are either of the other varieties in any  degree, so frequent
as trismus, except where they form a subsequent part of the general
chain of morbid action.   My observant friend  Dr. Hennen, confesses
that during the whole period of his superintending  the British hos-
pitals in Spain he never met with but one case  of emprosthotonus,
and even this he describes as an incurvation that rather approached
it than constituted the disease itself.   " It  was  observed," says he,
"at the same time and in the  same hospital, with  the various de-
grees of trismus : rigid spasms of almost every  muscle of the body,
and violent periodical convulsions, all from similar  injuries  to that
in which it was produced."*
  From the  complicated  manner, indeed, in which tetanus shows it-
self, and its  anomalous attack upon different sets of muscles at the
same time, it seems in many instances to put all the subordinate di-
visions of classification at defiance.  It is, in truth, for the most part
a mixed disease, affecting various and opposite sets of muscles;  and
this in many cases so equally that the spastic  action  of the  flexors
just balancing that of the extensors,  " the patient," to  adopt the
language of Dr. Lionel Clarke, " seems often to be  braced between
opposite contractions."   It is to this form, indeed, that this last very
intelligent writer has limited the name of  tetanus as that  to which
it applies most emphatically.  Like Dr. Hennen,  he asserts that he
had never seen a single  case of genuine emprosthotonus; and that
of the other two varieties, of which he  treats the opisthotonus and
proper tetanus, the  former occurs  most frequently.
  In episthotonus or tetanic  recurvation the symptoms sometimes
show themselves suddenly, but more commonly  advance >lowly and
imperceptibly: the patient mistaking the unusual stiffness which he
feels about the shoulders and cervical  region  for  a crick  in the
neck, produced by cold and rheumatism.   The stiffness, however,
increases, he finds it impossible  to turn  his head on either side
without turning his body : he  cannot open  his  jaws without pain,
and  he  has  some difficulty  in swallowing.   A  spastic and  aching
traction now suddenly darts at times towards the ensiform cartilage,
and thence strikes through to the back, augmenting alithe previous
symptoms to such a degree that  the patient  is no  longer able to
support himself, and is compelled to take to his bed.  The pathog-
nomic symptom in tills variety is the spasm under the sternum which
is perpetually increasing in vehemence; and, instead of  returning,
as at first,  once in two or three hours, returns now every ten or
fifteen minutes; immediately after which all  -the  host  of  concomi-
tant contractions renew  their violence and with additional severity:
* Military Surgery, p. 247. 
»5E. 1.—SP. VI.]
NERVOUS  FUNCTION.
223
the head is forcibly retracted, and the jaws snap with a  fixation
that rarely allows them to be afterwards opened wide enough to
admit the little  finger.   This vehemence  of paroxysms may not,
perhaps, last longer than for a  few minutes or even  seconds:  but
the spastic action prevails so considerably, even through the inter-
vals, that it is difficult for an attendant to bend the contorted  limbs
into any thing like an easy or reclined position.   The breathing is
quick and laborious, and the pulse though calmer and less hurried,
small and irregular.  The face is sometimes pale but  oftener flush-
ed, the tongue stiff and torpid but  not  much furred; the whole
countenance  evinces the most marked signs of  deep distress,  and
swallowing is pertinaciously abstained from, as  accompanied with
great difficulty and often producing a  sudden renewal  of the parox-
ysms.   The  last stage of the disease is truly pitiable.   The spasms
return  every  minute  and  scarcely  allow  a moment's  remission.
The anterior muscles join in the  spastic  action,  but the power of
the posterior is still superior; and hence while  every organ is lit-
erally on the rack from the severity of the antagonism, the spine is
more strongly recurvated than ever, and forms  an arch over the
bed, so that the patient rests only on the back part of the head and
on the heels.  During the exacerbation  of the  spasms the  lower
extremities, even  while they continue rigid, are so violently jerk-
ed that the utmost attention is necessary to prevent the patient from
being projected from his bed: and Desportes gives a  case in which
both the thigh bones were broken from the  violent contraction of
the flexor-muscles during  a momentary remission  of the exten-
sors ;* similar  results  to which  we  shall have occasion to notice
hereafter.
   The tongue is in like  manner darted spasmodically out of the
mouth, and the teeth snapped  suddenly  and with  great force ; so
that unless a spoon covered with soft rags, or some other interven-
ing substance, is introduced between the teeth at such periods,  the
tongue must be miserably bitten add lacerated.  The exertion  is so
laborious that the patient sweats  as in a hot-bath; the pulse is at
this time quick, small, and irregular; the heart  throbs so violently
that its palpitations may be seen ;  the  eyes are sometimes watery and
languid ; but more commonly rigid and immoveable in their sock-
ets : the nostrils are drawn  upward,  and  the cheeks backward to-
wards the ears, so that the whole countenance assumes the air of a
cynic spasm or sardonic grin, while a limpid or  bloody  froth  bub-
bles from the lips. There is sometimes delirium, but  this is not
common; the patient is worn out under  this laborious agony  in a
few hours; though more usually a general  convulsion comes to his
relief and he sinks suddenly under its assault.
   In the erect tetanus, in which there is a balance of spastic action
between the anterior and posterior sets  of muscles, the progress of
the disease is not essentially different.   The march  of the spastic
* Hist, des Maladies de St. JDomingue, n. p. 171, 
224
NEUROTICA.
[CL. IV.—OR. III.
 action,  however,  varies  in  some  degree, as  we  have  already
 observed, in almost every instance  from trismus to tetanus,  and
 from  one modification of tetanus to  another:  yet the course we
 have  now  described is that which  chiefly takes place  where  the
 disease advances in something of a  regular  and uninterrupted pro-
 gress.  Its danger  and duration are commonly to be estimated from
 the degree of violence of the incursion.   Where this is very severe
 the patient rarely survives the third  day, and is sometimes cut off
 on the second, or even in six and thirty or four and twenty hours.
 But, where the attack is less acute, the patient may continue to
 suffer for a week before  he reaches his tragic  termination.  If he
 have  strength  enough  to  survive  the  ninth  day  he commonly
 recovers, for the paroxysms diminish in  violence, the intervals of
 remission are longer, and the muscles being generally more relaxed
 he is able to take a little nourishment.  Through the  whole period
 there  is an  obstinate  costiveness, partly from want  of food in the
 stomach, but chiefly from an association of the mouths of the intes-
 tinal excernents in  the  spasmodic constriction.
   The general  principle  of cure is far more easily expressed than
 carried into  execution.  It is that of taking off  the local irritation,
 wherever such exists, and of tranquillizing the nervous erethism  of
 the entire  system.  The  first of  these  two objects is of great
 importance in the locked-jaw or trismus of infants ; for by removing
 the viscid and acrimonious meconium, or whatever other irritant is
 lodged in the stomach  or  bowels, we  can sometimes effect a speedy
 cure  without any other medicine.  Castor oil  is  by far the  best
 aperient on this occasion, and it  may be  given  both by the mouth
 and in injections.   But  if this  do  not succeed we  should  have
 recourse  to  powerful  anodynes;  and  of  these  the best  by far  is
 opium, which should be administered from three to five drops in a
 dose, according to  the  age of the patient.   Musk and the  host of
 antispasmodics have been tried so often with so  little success, that
 it is not worth while to put the smallest  dependence upon them:
 nor has the  warm or cold bath  produced effects  sufficiently  general
 or decisive, to allow us to lose any time in trusting to their opera-
 tion.   They  may be employed,  however, as auxiliaries;  but our
 sheet-anchor must be opium, which, if the spastic action have made
 much advance when we  first see the patient, should instantly be
 employed in  conjunction with the prescribed aperient.  By taking
 off  the constriction  from the intestinal canal, and thus restoring and
 quickening the peristaltic motion, it may even expedite the dejec-
 tions.
  In trismus or tetanus from wounds or sores, the local irritation is
 not so  easily subdued :  nor is its  removal of so  much importance.
 though in no case of small moment.   But, generally speaking, the
 spastic action is, in  these instances, as much  dependent upon consti-
 tutional,  as  upon topical  irritability,  and when  it has been once
excited it will run through its career, whether the local cause con-
tinue or not.   It is owing chiefly to this fact  that  the best and most 
GE. I.-SP. VI.]
NERVOUS FUNCTION.
225
 active plan of cure so often fails  of success;  and the most cautious
 practitioners hesitate in their prognostications,  whatever  be the
 march  of symptoms,  for the first four or five days.  " From the
 state of the pulse," says Dr. Hennen, " I have derived no clue to
 either the proper treatment or the probable  event: it has, in the
 cases I  have met with, been astonishingly unaffected.   From the
 state of the skin I have been left equally in the  dark.   Sweating,
 which some have imagined critical, 1  have seen  during the whole
 course of the disease, and  attended with a most pungent and pecu-
 liar smell, while in others it has never appeared at all:  and suppu-
 ration, which is generally interrupted,  I  have seen .continue unaf-
 fected by the spasms.  Even the pTocess of healing, which, it would
 be reasonable to conclude, should be altogether  put a stop to, has
 gone on  apparently uninfluenced by the disease : and in the  most
 severe case  1 ever saw, Which occurred after a shoulder-joint ampu-
 tation,  sent into Elvas from before the lines of Badajos, the life of
 the patient  and the perfect healing of the wound were terminated
 on the same day."   So powerfully does the constitutional irritability
 operate in many cases  after the disease  has  once displayed its
 hideous features, and render  the local  treatment of subordinate
 importance.
   In numerous instances, however, a change in the condition of the
 wound has produced a beneficial result; and  hence various means
 have been resorted  to for the purpose of effecting  such a change, as
 local bleeding, anodyne applications to  allay the morbid sensibility;
 resinous,  terebinthinate, or mercurial  stimulants  to excite  a  new
 action; and  amputation of the  diseased limb.  The first of these
 three plans is the ordinary mode  of practice, and in full plethoric
 habits it has sometimes proved favourable  ; the second plan seems
 to have been very generally employed by  Baron Larrey, who occa-
 sionally  used stimulants of a far higher power,  as pencilling  the
 wound with lunar caustic, or an application of the actual cautery.
 Amputation seems to have answered in  a few cases, if we may give
 full credit to those who have chiefly tried and recommended it ;*
 but it is at best  a  clumsy and desperate kind  of remedy ;  and, for
 reasons already assigned, must be often altogether inefficient  if it
 do not add to the constitutional erethism.
  The general  treatment has  consisted in a free  use of opium ;
 salivation ; the hot or cold bath ; and wine  or ardent spirits, in some
 instances so far as to produce intoxication.  Dr. Cross gives a case
 in which, after other medicines had  been used in vain,  and every
 hope seemed to fail, the patient  was inebriated  with spirits, and
 kept in this state for ten days, with the result of a perfect recovery.1
 A generous  use of wine appears  to be almost  indispensable, and,
considering  the  ordinary constitution in which the  disease occurs,
* Silvester, Med. Obs. and Inquir. I. Art. i.
  White, Med. Obs. and Inq. n. Art. xxxn .
t Thomson's Annals of Philosophy, 
226
NEUROTICA.
[CL. IV.—OR. Ill*
the difficulty of supporting the system by common  means, and the
great sensorial exhaustion which is perpetually taking  place, it  is
far from difficult to explain in what manner it operates beneficially ;
but intoxication is a desperate experiment, and, where  it succeeds
once, we  have reason  to apprehend it would kill in a hundred
instances.
  The warm and the cold bath have  each of them a much better
claim to attention; and their votaries  are so equally divided that  it
is  no easy  matter  to say  which is most  strongly  recommended.
The latter demands more general  strength in the system than the
former: but neither of them are  to be depended upon except as an
auxiliary.   The cold bath  has  the authority  of Dr.  Lind in its
favour,*  and  has, in some instances been tried with success in
America.!
  Mercury, in various forms, has  been had recourse  to from a very
early period : and, on the authority of Dr. Stoll, has occasionally been
used for the purpose of  exciting salivation.  On what ground it has
been  carried to this  extent 1  do not know,  except it be that  a
pretty free flow of  saliva from the mouth spontaneously, has, by
many persons, been regarded as a favourable  sign.   The disease,
however, does not seem to be accompanied with any symptom that
can be called critical; and it is hence probable that this spontaneous
flow of saliva is nothing more than a result of the violent action and
alternating relaxation of all the  parts  about  the fauces.  Never-
theless, salivation where it has been accomplished, is said by many
writers to have been serviceable, though I know of no practitioner
who has relied on it alone.  And, in reality, such is the rapidity with
which both trismus  and  tetanus usually  march forward  where they
have once taken a hold on the system that we  have seldom time to
avail ourselves of this mode  of cure, were its pretensions still more
decisive than they seem to be.
  Opium, then, in  every stage and every variety of both tetanus
and locked-jaw, is the remedy on which we are to place  our chief
if not our  only dependence.   But to give it a full chance of success
it should be administered in  very free doses, and it is not easy for
us to be too free in  its use.   In  the Edinburgh Medical Commen-
taries;]; we have a case in which five hundred  grains were adminis-
tered within seventeen  days, which  is about  thirty grains a-day.
But in the West Indies the quantity is often carried with  the  most
beneficial  effects very considerably beyond this.   Thus  Dr. Gloster
of St. John's, Antigua,  gave to a negro,  labouring  under tetanus
from an exposure to the night-air, not less  than twenty grains every
three hours, in conjunction with musk, cinnabar and other medicines:
and continued it with but little abatement for a term of seventeen
* Essay on Diseases ia Hot Climates, p. 257.
t Tallman. Amer. Phil. Trans. I. xxi.
  Cochran, Edin. Med. Com. Vol. m. p. 133.
+ Vol I. p. M. 
GE. I.-SP. VI.]
NERVOUS  FUNCTION.
227
days, in the course of which the pafient took five hundred grains
of this narcotic.   For the first  six days little benefit seemed to be
effected, but after this period the symptoms gradually declined under
the same perseverance in the medicine; and in thirteen days more
they were so much diminished that no further assistance was thought
necessary.
  If there be any  thing which adds to the sedative power of opium
in this  disease it  is  sudorifics,  and  particularly  ipecacuan.   And
upon this subject  Dr. Latham has given a  valuable paper in the
Medical Transactions, in which he offers examples of failure in the
use of James's powder, when used either alone or in alternation with
opium ; but of full success  by uniting the  two powers of the nar-
cotic and the  sudorific, though  he afterwards  preferred ipecacuan
to James's powder, and prescribed it in the form of the compound
powder of this name.  He  gives cases  in  which he employed this
compound  in very severe attacks, and sometimes in what seemed to
be  its last stage  of the disease, with an  immediate  arrest  of its
symptoms, and progressively a perfect restoration to  health.  His
doses consisted of ten grains repeated  every three or four hours.
In no instance was there any unusual inclination to sleep, how long
soever this treatment was  continued, which in one case was for a
fortnight:  nor was there  any  degree  of  sickness, nor any other
inconvenience, except that of a perspiration troublesome from its
excess.*
  It is only necessary to observe further that during the treatment,
either of trismus or tetanus, a  very particular attention should be
paid to ventilate  the chamber  with pure  air:  and  especially  to
purify the air of  close  and crowded hospitals, without which no
plan of treatment in the  world can be of any avail.  We should also
remove, if possible,  the costiveness to which the bowels  are  so
peculiarly  subject,  by some gentle aperient: for  it sometimes hap-
pens, not only in   infantile  trismus  or tetanus,  but  in that from
obstructed  perspiration, or cold  and dampness, that  the primary
cause of irritation is seated in the bowels ; while, whatever accumu-
lation takes place in this quarter, during the course of the disease,
may add to and exacerbate  the general erethism.  At the same time
nothing can be more mischievous than the drastic purges which
practitioners are apt to give at the commencement of this  disease,
consisting of jalap, scammony, and  aloes.   We have  already seen
that the general excitement is so extreme  that the slightest occa-
sional irritation, even that of changing the position of the  head, is
sometimes  sufficient to produce a return of the spasms: and hence
there can be nothing more likely to do it than the griping effects of
such acrimonious medicines.  And it  will be far safer to pass by the
constipation altogether, than to attempt to remove it by such dan-
gerous means.  The  best  medicine  is  castor  oil, which may be
given either by the mouth  or in the  form of injections: and if this
Med. Transact. Vol. iv. Art. iv. 
228
NEUROTICA.
[CL. IV.-OR. HI.
do not succeed,  we may employ calomel.  But the action of the
bowels must only be solicited, and by no means violently excited.
                       SPECIES VII.

                   ENTASIA LYSSA.

                           l&alues.

3PASMODIC CONSTRICTION OF  THE MUSCLES  OF  THE CHEST; SUPERVEMN*
  TO THE BITE OF A RABID ANIMAL ; PRECEDED BY  A RETURN OF PAIN
  AND INFLAMMATION IN THE BITTEN PART : GREAT  RESTLESSNESS, HOR-
  ROR, AND HURRV OF MIND.

The Greek term for rabies was lyssa : and the  antiquity of the dis-
ease is sufficiently established from its being referred to several
times under this name  by Homer in  his Iliad,  who is perpetually
making  his  Grecian heroes  compare  Hector to  a mad-dog %vw
Xv<r<mr»)fx, which is the term used by Teucer; while Ulysses, speak-
ing of him to Achilles, says,

              ------xjtfTsga ii i AT22A JWi/itw.*
              So with a furious Ltssa was he stung.

  The author has ventured  to restore the  Greek term, not only as
being more classical, but as being far more correct than the techni-
cal term of the present day, which is hydrophobia, or water-dread ;
since this is by no means a pathognomic symptom ; being sometimes
found in other diseases ^ occasionally ceasing in the present towards
the close of the career; and, though almost always observable among
mankind, in numerous instances wanting, even from the commence-
ment, in  rabid dogs and wolves.   " Constat repetita," says Sauva-
ges, " apud Gallo-provinciales experientia, canes luposque  rabidos
bibisse,  manducasse, flumen  transasse, ut  olim  Marologii,  et bis
Forolivii observatum,  adeoque  nee  cibum nee  potum  aversari."
The same fact is  affirmed of rabid wolves in a case given by Tre-
court in his Chirurgical Memoirs and Observations.  Dr. James in
like manner  relates the case of a mad-dog that both drank milk
and swam through a piece of water ;t and one or two similar cases
are said to have  occurred among mankind ;J  though even here a
spasmodic constriction of the muscles of the chest, and sometimes of
  * Iliad ix. 237.
  t On Canine Madness, p. 10.
  X Fehr. Naclmcht von einer todslichen Krankheit nach dem tollen Hundsbisss
fiott. 1790, 8vo. 
GE. I.-SP. VII.]
NERVOUS FUNCTION.
229
the throat, seems to have been present.  Dr. Vaughan, indeed, gives
the case of a patient who called for drink through the whole course
of the disease, and only ceased to ask for it a short time before his
death.
  I have  occasionally met, on the contrary, with a few obstinate
cases of hydrophobia, or  water-dread, without any connexion with
rabies: one  especially in a young lady of nineteen years of age, of
a highly nervous temperament which was preceded by a very severe
tooth-ache and catarrh.  The muscles of the throat had no constric-
tion,  except on the approach of liquids, and the patient through the
whole of the disease, which  lasted a week, was  able to swallow
solids without difficulty; but the moment  any kind of liquid was
brought to  her a strong spastic  action took place, and all the mus-
cles about the throat were violently  convulsed if she attempted to
swallow.
   Similar examples are to be found in the medical records, and par-
ticularly one of great obstinacy in  the Edinburgh Medical Essays,
which was  chiefly relieved by repeated venesections,* as the pre-
ceding case was  by large doses of opium.  Hydrophobia is  there-
fore too general and indefinite  a  term to  characterize the genus
before  us, unless we mean to include under it diseases to which it
is by no means commonly applied, and which, in truth,  have little
connexion with  rabies.   Hunauld has, indeed, employed it  in this
extensive signification, and has hence made it embrace no less than
seven distinct species, of which two  only are irremediable.!
   There is, even in the present day, so little  satisfactorily known,
and so few opportunities of acquiring any practical knowledge con-
cerning the  general nature and pathology of rabies  that it. might,
perhaps, be most prudent to imitate the modesty which Dr. Cullen
has set us upon  this subject,  and to  let it pass without a single re-
mark.  Yet the  few following  hints, derived  from the  only three
cases in which the  author has ever  been consulted,  together with
the reflexions to which they have  given rise  in his  own mind, may
afford a little  glimmering light into   the principle  of the  disease,
and give an  opportunity to  succeeding pathologists of describing it
more perspicuously^
   The symptoms enumerated in the definition, and  especially the
constrictive spasm that oppresses the muscles of deglutition and of
the chest generally, sufficiently show that the  present  species of
disease bears a very close analogy to  the two preceding, in the mis-
chief which it excites; and, as by far the most frequent cause of the
two preceding species is the irritation of a wound or puncture on the
surface of the body, it bears  quite as close an analogy  to  them in
the nature of its  cause as in that of its effects.
   We have  seen it to be a law operating throughout  the  anima?
  * Inflammation of the Stomach  with Hydrophobia, Sic. by Dr. J. Innes. E/
Med. Ess. I. p. 227.
  * Discours sur la Rage, et scs Renicdes. Chateaus Gontier. 1714, 17;v<- 
230                     NEUROTICA.           [CL. IV.-OR. III.

system, that if a morbid action commence  in any part whatever of
a continuous  chain  of functions,  or of fibres, it often  produces a
peculiar  impression  upon its extremities; so that the extremities
themselves form in many instances, the chief seat of distress  and
even of danger: and this more especially where the one extremity
of the chain becomes affected in consequence of the primary affec-
tion of the other.   And we have also  endeavoured to  show, from
the general course and intermediate connexions of the nerves which
supply the  surface of the body, and particularly the extremities, that
they constitute a direct fibrous chain, of which those that ore in all
common  cases primarily irritated  by wounds or punctures in the
spastic diseases before us form the one extremity,  and those which
enter into  the muscles of the upper regions of the chest and the
cheeks the other.*   It is not necessary, therefore, to  travel over
the same ground again ; the reader may turn to it at his leisure :  and
he will find that  we have hence endeavoured to trace out something
of the means by  which trismus and tetanus are produced by simple
wounds or  punctures  in the limbs, and especially in an irritable
habit.
  Now if the reasoning be sound, as applied to trismus and tetanus,
it must be  equally good as applied  to lyssa; and will induce us to
expect a  more complicated disease and a still more severe and des-
perate result; as we have, in the present  instance, not merely an
ordinary  and mechanical, but a specific and chemical source of irri-
tation to  encounter,  and so  indecomposible in its nature  that it is
capable of  lurking in  the system, and apparently in the  part where
it may chance to be deposited, for weeks or even  months without
losing  its activity :  of continuing dormant if there be no  sufficient
irritability  of constitution or nervous fibre for it to operate  upon,
and of operating as soon as such a condition may  arrive: for that
some exciting cause is usually necessary to rouse it into  action, will
sufficiently appear in the sequel of this inquiry.  Sir Lucas Pepys,
however, Dr. Bardsley, and various other writers  have made it a
question whether the  virus of rabies is ever originated, or produced
spontaneously, or in any other  way  maintained than  by  a direct
communication from one animal  to another;  while M. Girard, of
Lyons, has  denied that there is any such thing at all, and contended
that rabies  consists in nothing  more than  an acute  degree of local
irritation, and its effects on a highly mobile and  excitable constitu-
tion.  We have  long,  however, had  various  examples on record,
and have lately been furnished with another by Mr.  Gillman, in
which a dog chained up in a yard, and cut off from all  medium of
contamination by other animals, has occasionally been  attacked with
genuine lyssa, and exhibited its most decisive characters.
  Nevertheless,  whilst we are thus establishing that the symptoms
of rabies  are dependant upon a  specific virus, it  may not be foreign
to remark that most animals, when roused  to a high degree of rage,
* See vol. ill. p. 21S. 
GE. I.-SP. VII.]
NERVOUS FUNCTION.
231
inflict a wound of a much more irritable kind than when in a state
of  tranquillity : and we have  numerous  examples in which such
wound has been very difficult of cure, and not a few in which it has
proved fatal, as though at all times under such a state of excitement,
some peculiar acrimony was secreted with the saliva.   Iq the  Ephe-
mera of Natural Curiosities, is an example of symptoms of hydro-
phobia or  water-dread, produced by the bite of a man  worked up
into fury ;* and in the Leipsic  Acta Eruditorum is  another instance
of the same kind,t though neither of them seem to have been fatal.
Meeki-en,J  however, Wolff,§ and Zacutus  Lusitanus||  have each an
instance of such a bite  terminating in death, yet without hydropho-
bia.   Le Cat  gives a case of death produced by the bite  of  an en-
raged duck ;TI and in a German miscellany of deserved repute we
have  another of the same kind.**  The instances, indeed, are innu-
merable, but it may be sufficient  to observe further that Thiermay-
er  gi v es us two cases, one in which the bite of a hen, and another
in  which  that of a goose proved fatal on  or about the  third day,tt
without  hydrophobia:  and that Camerarius has an instance of epi-
lepsy  produced by the bite of a horse.JJ
   Marvellous as these facts may  appear, it is more consistent with
reason to accredit them than to impugn  the host  of  authorities to
whose testimony they appeal.  And it hence seems to  follow, that
the passion of rage, whose  influence is always considerable on the
salivary glands, has often a power of stimulating them, among most
animals, to the secretion of an acrimonious and malignant virus with
which the  saliva becomes tainted.
  Rabies, however, has sufficiently shown  itself to  be dependent
upon a peculiar virus, and capable of producing specific effects ; to
be sometimes  originated, and sometimes received by communication.
Now the only animals which have hitherto been ascertained to have
a power of originating it  are several  species of the genus canis, as
the dog,  fox and wolf, and one species of the genus felis,  which is
the domestic cat;  it is probable, however, there are others belong-
ing to  different classes endowed with a like power;  and some wri-
ters have attempted to bring instances from the horse, mule, ass, ox
and hog, yet they are not instances to be depended upon.  In like
manner, Plater, Doppert, and even Sauvages himself have asserted
the  same of mankind, and have brought forward a few casual cases
* Ann. ix, x. app. p. 249.
tAnn. 1702. p. 147.
$ Observ. Cap. lxvii.
} Observ. Med. Chir. Lib. H. N. 5.
|j Prax. Admir. Lib. m. Obs. 84. 83.
TT Recueil Periodique. n. p. 90.
i:* Sainml. Med. Wahrnehm. B. II. p. 98.
it In Goekelii Consil. et Obs. N. 19.
XX Diss, de Epileps. frcq. p. 15. 
232
NEUROTICA.
[CL. IV.-OR. m.
 in support of such assertion.  These, however, are in every in-
 stance, modifications of empathema, and especially of rage or fright,
 grafted on a  highly irritable temperament, and hence associated
 with hysterical, or some other spasmodic motions.
   Of the remote or predisposing causes of this disease we know no-
 thing.  The excitement of vehement rage, putrid food, long contin-
 ued thirst from  a want of water to quench it, severe  and  pinching
 hunger, a hot  and  sultry state, or some  other intemperament of the
 atmosphere, have  been, in turn, appealed to as probable predispo-
 nents, but the appeal in no instance  rests on any authority.  That
 the stimulus of  vehement rage will often produce a peculiar influ-
 ence on the saliva, and  render it capable, by a bite, of  exciting
 the  most  alarming symptoms of nervous irritation we have just
 shown; but these  symptoms  are not those of lyssa ; and the virus,
 whatever it consists in, appears to be of a different kind.  Putridity
 is, perhaps, the ordinary state in which dogs and cats obtain  the offal,
 on which, for the most part, they feed: they show no disgust to it,
 and it  offers a  cause far too general for the purpose.-  In long voy-
 ages, again, when  a crew has been without water, and  reduced to
 short provisions, dogs have been, in innumerable  instances, known
 to die  both of thirst and hunger without betraying any signs of gen-
 uine rabies.  That a peculiar intemperament of the atmosphere
 may at times be a cause, it is impossible  to deny ; but the disease,
 even when of spontaneous origin, has appeared under,  perhaps,
 every variety of meteorological change,  and seems to be far less com-
 mon in hot and sultry regions than in those of a more moderate tem-
 perature : for it  is not known, except by report, in South  America
 or the West Indies, as I have been repeatedly informed by intelli-
 gent residents in those  quarters ; while  M. Volney tells us  that it
 is  equally  uncommon in  Egypt  and Syria, and Mr. Barrow,  at the
Cape of Good  Hope and in the interior of the country, where the
 Caffres* feed their dogs on nothing but putrid meat, and this often in
 the highest degree of offensiveness.
   It is not improbable  that several of these may occasionally be-
 come exciting causes; but it is hence obvious that  they are not
 competent of themselves to produce the disease.  Some of them in-
 deed have been put to a direct test, and have explicitly proved their
 incompetency.    Thus in the wards  of the Veterinary School at Al-
 fort, three dogs were shut up and made the  subjects of express ex-
 periments.   One was fed with salted  meats,  and totally  restrain-
 ed from drinking:  the second  was allowed nothing  but water;
and the third allowed neither food nor drink of any kind.  The first
 died on the forty-first day of the experiment, the second on the thir-
 ty-third day; and the third on  the twenty-fifth;  not one of them
evincing the slightest symptom of rabies.
   That the specific virus of rabies is less volatile and active  than
 many other kinds of morbid poisons is clear from the fact that it is
never  found diffused in the atmosphere,  so as to  produce  an epi-
demy ; that it never operates on those who are most susceptible of 
"QE. I.-SP. VII.]        NERVOUS FUNCTION.                233

its influence  except when accompanied  with a wound or inserted
into the cutis;  and that, even in  this case, it usually requires in
mankind, and probably also in other animals, some auxiliary excite-
ment to  enable it to carry forward the process of assimilation: for
it rarely happens that all the  men or quadrupeds  that are bitten by
a rabid dog suffer from the inoculation.  Mr. Hunter, indeed, gives
an instance in which out of twenty persons who were bitten by the
same dog only one  received the disease.  This is a  happy circum-
stance, as it affords an important interval for medical treatment, if
we should ever be  so fortunate as  to hit upon any curative process
that may be depended upon.  At the same time I cannot avoid again
to observe that  as  this virus is  less volatile than most others, it is
perhaps less indecomposible than any of them, and hence is capable
of remaining in a  dormant and unaffected state, in any part of the
system, into  which it has been received by insertion, for a far longer
period than  any  other known  contagion whatever.
   When the disease  has once  fixed itself among  a large establish-
ment of hounds, it has been said  that the acrimony of  the poison
becomes more concentrated  and active; operates  through an un-
broken skin, and even taints the atmosphere. There is, however,
no solid foundation  for such an opinion ; and though the disease runs
rapidly from one dog to another, and it may be difficult in many
cases to trace the marks of a bite, yet considering that the smallest
and  most imperceptible scratch of a tooth may be a sufficient me-
dium of infection, and that every inoculated dog adds to the sources
from which it may be derived, there is no difficulty in accounting for
such rapidity of spread without ascribing anomalies to the laws by
which it is  regulated.  Heister, indeed, has given a case of lyssa,
in one of the foreign collections, produced in a man by his having
merely put into his mouth the cord by which the mad dog had been con-
fined : but as in this instance there was probably some ulceration in
the  mouth at the time, there is nothing marvellous in its production.
Palmarius, in like manner, relates the case of a peasant who, in the
last  stage of the disease, communicated it to  his children in kissing
them and taking leave of them.*  Yet unless we could be certain
that there were no cracks or other sores oh the lips, and no eruption
on the cheeks of these children the example affords  no proof.
   I can distinctly state that I have seen the same intercommunication
successively repeated between a rabid young man and a young wo-
man to whom  he was betrothed, and who could not be restrained
from such a  token of affection, without any evil consequences; not-
wishstanding that the patient was labouring at that time under hydro-
phobia and all the severest marks of the disease which destroyed
him in a few hours afterwards, and had also a perpetual desire to spit
his saliva about the room.
   It has, on  the  other hand, been doubted whether  the virus is ca-
pable of propagation from the human subject to any animal even by
      * De Mort. Contagios. p. 266.  Paris 4to. 1518.
VOL. lir.                   30 
234
NEUROTICA.
[CL. 1V.-OR. III.
inoculation: but a bold experiment of M. Magendie and M. Breschet
has completely settled this question;  for on June 19, 1813, having
collected upon  a piece of  linen a portion of the saliva of  a rabid
man in the last stage of the disease they inserted it under the skin
of two dogs that were in waiting, both of them in good health; of
which one became  rabid on the  27th of July, and  bit two  others,
one of which also fell a victim to the disease just  a month after-
wards.
  The general aggregate of the symptoms point forcibly to the ner-
vous system as the immediate quarter  of disturbance.  Such was the
opinion of Morgagni, Cullen, and Percival;  and  such indeed is the
common  opinion of the present day.   By many writers, however,
the effects have been rather referred to the  sanguiferous system,
and regarded as a fever ; Mangor  describes it as a continued fever ;*
;md Rush and many others as an inflammatory affection; Bader as a
fever suigeneris.]  Nor is the difficulty in the least degree removed
by dissection, for nothing can be more at variance than the appear-
ances in different cases.   Generally speaking the fauces and parts ad-
joining exhibit redness  and inflammatory characters.  But while in
some  instances these are so  considerable as to be on the point of gan-
grene, in others there is  no  inflammatory appearance  whatever.
Morgagni has examined and described bodies in both these states.
Rolfine gives  one or two decided cases of  the latter sort:J while
Feriar notices examples in  which the  inflammation of the fauces had
spread over the whole oesophagus aud even the  stomach ;§  and an-
other writer has recorded an instance in which it had descended to
the ileus, which was in a state of gangrene.||  In some cases the en-
cephalon has appeared to be as much diseased  as  the fauces; the
vessels turgid ;  the  plexus choroides blackish;  the ventricles loaded
with water.  Sometimes the lungs have been inflamed,  sometimes
the liver, sometimes  the  vagina; while the blood, according to
Sauvages, has been also found in  a dissolved state, and according to
Morgagni in a  state highly tenacious  and coagulable.   From  all
which we can  only conclude, that owing to  the violence of the dis-
ease, every organ is greatly disturbed, and those the most so that in
particular cases are most  severely  affected.   Riedel asserts that
among dogs a highly offensive fetor of a peculiar character is thrown
forth from every part of the body :f  but I  have not found this re-
mark confirmed by  the veterinary practitioners of our own country;
and it certainly does not apply to mankind, with an exception or two
that seem to depend upon some accidental circumstances ; for Wolf
* Act. Havn. ii.
t Versuch einer neuen Theorie, &c.
X Dissert. Anat. Lib. I. cap. xii.
I Medic. Facts and Observations. Vol. i.
|| X. Act. Nat. Cur. Vol. iv. Obs. 20.
? Act. Acad. Mogtint. Erf. 1757. 
GE. I.-SP. VII.]      NERVOUS  FUNCTION.
235
informs us, that in one of his patients, and a patient that ultimately
recovered, the blood stunk intolerably as it was drawn from a vein ;
and a patient of Dr. Vaughan's complained of a most offensive smell
that issued from the original wound, but of which no one was sen-
sible except  himself.
  Dessault, in his treatise on rabies, tells us that he has often  met
with numerous minute worms in the heads of those who have  died
of this disease; and he hence regards such animalcules as its cause.
But this  writer was a slave to the Linnean hypothesis of invermi-
nation, and applied the same cause to syphilis, which he also sup-
posed  to be maintained by a transfer of vermicules from one indivi-
dual to  another:  and hence proposed to treat syphilis, lyssa, and
itch, as diseases of a like origin, with the common antidote of mer-
cury,  and  gives instances of a success which no one has met with
out  of his own practice.   The cases, however, which he describes
had not  advanced to the stage  of water-dread; and in all of them
he thought it prudent to combine with his mercurial inunction cold
bathing,  and Palmarius's antilyssic powder.
   Vander  Brock,  and after  him,  Rahn,  maintain that the  return of
pain and inflammation in the bitten part, on the onset of the disease,
does not  occur  from any virus which has hitherto been lying  dor-
mant there,  but from the universal  excitement alone.   It may be
observed, however, in opposition to such an opinion, that  this local
affection  is in most instances a prelude to the  general disease, and
forms the punctum saliens from which it issues; as though the con-
tagious ferment had remained  dormant there, and was at length
called  into action by some exciting cause.
   There seems,  nevertheless, to be a slight departure  from  the
general  character of the disease in a few cases, and particularly in
those  that are produced by the bite of a rabid  cat, whether the
latter  have originated it,  or received it from a rabid dog, as though
by a passage  through the  domestic cat the virus undergoes a similar
change to  that  which takes place in the virus of small-pox, when
passing  through the system of an individual which has previously
submitted to  the influence of cow-pox: for,  upon the whole, the
disease appears to evince somewhat less malignity, to be  more dis-
posed  to  intermit, and its spastic symptoms,  and especially that of
water  dread, to be both less frequent and less violent: so that in
respect to symptoms we may perhaps  mark out the two  following
varieties :

x Felina.                    The spastic symptoms less acute and
  Feline Rabies.                frequently intermitting ;  produced
                               by the  bite of a rabid cat.
£ Canina.                    The spastic constriction, for the  most
   Canine Rabies.               part  extending to  the  muscles of
                               deglutition,  which are  violently
                               convulsed  at the  appearance  or
                               idea of  liquids :  produced by  the
                               bite of  a rabid dog. 
231)
\F.r-ROTICA.
[CL. 1V.-0R. HI.
   There is a case of feline rabies, if it be rabies, in Morgagni, and
 which is copied from  him into Sauvages' Nosology, in which the
 above distinction is so strongly marked,  that the author in the first
 edition of his own Nosology, was induced to follow M. de Sauvages'
 mode of classifying it, and  made it,  after him, a distinct species,
 though he deviated from the  name  under which it occurs in this
 justly celebrated writer,  which is that of Anxietas a  Morsu*   The
 history  of  the  enraged cat is not given, nor is it certain that the
 rage  was that of rabies.   The master of the animal was attacked
 and  wounded both by its teeth and  claws.  The symptoms  took
 place four days after the bite, and were confined to spasms of the
 chest without  hydrophobia; nor  do  these seem to have  been of
 great violence, for they are described as " magna praecordiorum anxi-
 etas."   Local and general bleedings were useless:  a  frequent repe-
 tition of the warm bath afforded  relief; but it only yielded to an
 ephemera with copious sweat.   The  intervals were lunar:  for it
returned with the full moon for two years: the bitten part, as usual,
 first becoming highly irritable,  and the spasms or vehement anxiety
 of the prscordia supervening,  which were now relieved by bleed-
ing.   After  this period it returned with every fourth full moon for
 two years more, and then appears to have ceased.
  A  few instances  of intermission, with a return of periodical pa-
 roxysms, produced by the bite  of a rabid dog, are also  to be found
in the medical collections : of which Dr. Peter's case, recorded in
the Philosophical Transactions! affords a striking example, the pa-
roxysm  returning  for  many  months  afterwards, severely once a
fortnight, or at every new and full  moon, and slightly at the  quar-
ters, or in the intervening weeks.  Selle, indeed,  asserts that he
has met with an instance of the same kind of intermission  among
dogs ; and hence where the individual recovers, both  varieties seem
 occasionally to subside in this manner.
  Dr. Fothergill has given two cases of unquestionable affection
from feline  rabies  produced by the same animal.  The cat first bit
the maid-servant, and afterwards the master of the house about the
middle of February.   The wound inflicted on the maid-servant re-
mained open and irritable from the first, and continued to resist eve-
ry application for many months; it healed, however,  at  length, and
no constitutional symptoms supervened. The wound inflicted on the
master healed easily and in a short time, but in the  middle of the
ensuing June, being four  months afterwards, the usual symptoms of
lyssa appeared, yet with comparatively slight and occasional wa-
ter-dread ; insomuch that  the patient,  far from resisting the use of
the warm-bath,  sometimes called for  it,  expressed a high sense of
the comfort it afforded him,  and was able at times  to dash the wa-
ter over his head with his own hands.  It terminated, however,
*  Classis. vn. Ord. i. v. 6.
r  Phil. Trans. 1745. No. 475. 
GE. I.-SP. VII.]
NERVOUS FUNCTION.
237
 fatally, and with the general symptoms of distress  which we shall
 give presently.*
   In the Transactions of the Medical Society of London,t we have
 a highly interesting case of the same kind, which  proved equally
 fatal, in seventy-four days from the time of receiving the injury,
 and fifty-eight hours from the  commencement of the  disease ; all
 the symptoms moreover exhibiting less violence than usually occurs
 in canine madness,  with little  or no water-dread, and consequently
 an ability to drink fluids to the  close of the disease, though the mus-
 cles of deglutition, as well as  those  of the chest,  evinced  always
 some degree of constriction, with  occasional exacerbations.!.  The
 patient was a young lady of eighteen years of age ;  the attack was
 made in the month of January, with both claws and teeth, by a do-
 mestic cat that  was lurking under  the bed, and, which though  not
 known to be ill, had for sometime before been  observed to be wild
 and had been roving in the woods.  The fate of the  animal is not
 mentioned.  The lacerated parts were incised and purposly inflam-
 ed by the application of  spirit  of  turpentine.   The wounds healed
 and the general  health of the patient continued perfect till the be-
 ginning of the ensuing April, when she was suddenly frightened by
 looking out of a window,  and seeing a mad-dog pursued by a crowd-
 ing populace.  This proved an exciting  cause.  She instantly  ex-
 pressed  alarm,  anxiety, and dejection  of mind.  In the afternoon
 she complained  of an unusual stiffness in  moving her left arm, and
 its sense of feeling was impaired ;  she  discovered  an  aversion  to
 company ; the irritations of noise, heat, and light, were offensive to
 her; she avoided the fire, and  forbade a candle to be brought near
 her. The rigidity and insensibility of the affected arm  seemed  to
 shoot in a line from the middle finger  which  had  been lacerated,
 and was accompanied with an  acute pain which terminated in the
 glands of the axilla, where she  complained of a considerable swell-
 ing.  Yet neither of the  hands (for  both had been injured) were
 affected with discolouration, tension, tumefaction, or  any other mark
 of local injury, though a degree of  lividity had been observed upon
 the  lacerated  part of the  finger a short time  before  the disease
 made its  appearance.   She had a  painful constrictive  sensation in
 her chest, and the respiration was interrupted by frequent sighings.
 The spasmodic  symptoms increased,  and at length  the whole sys-
 tem, but especially the lungs, was affected with  violent convulsions:
 the breathing was exquisitely laborious, but the paroxysm  subsided
in about two minutes.  Frequent sickness and  vomiting followed :
 the convulsive spasms about the throat obliged her to  gulp what
 she.  swallowed,  and she  showed a slight reluctance, but nothing
 more, to  handling  a glass goblet.   The pulse was 132  strokes
in a minute; the  skin was cool,  the tongue  moist,  the  bowels
* Neue Betrage zur Natur mid Arzney-wissenschaft. B. m. 118.
t Med. Observ. and Inquir. Vol. v.
X Vol. I. Art. iv.  p. 78. Svo. 1810.
i 
238
NEUROTICA.
[CL. IV.-OR. UI.
open, the  thirst  urgent, without  any tendency to  delirium.  She
was worn out, however, by sensorial  exhaustion and distress, and
at last expired calmly at the distance of time from the attack alrea-
dy stated.
  In the general progress of canine rabies, all the above indications
are greatly aggravated, and the  mind often  participates in the dis-
ease and becomes incoherent.  Whatever be the existing cause, the
wounded part almost always takes the lead in the train of symptoms
and becomes  uneasy, the cicatrix looking red or livid, often open-
ing afresh, and oozing forth a little coloured serum, while the limb
feels stiff and numb.  The patient is next oppressed with anxiety, and
depression, and sometimes  sinks into a melancholy from which no-
thing  can rouse him.  The pulse and  general  temperature of the
skin do not at this time vary much from their natural state.   A stiff-
ness and painful constriction are, however,  felt about the chest and
throat; the breathing becomes difficult, and is interrupted by sobs
and deep sighs, as  the  sleep is, if any be obtained,  by starts  and
frightful dreams.  Bright colours, a strong light, acute sounds, par-
ticularly the  sound  of water poured  from bason to bason,  even a
simple agitation of  the air by  a movement of the bed-curtains, is a
source of great disturbance, and will often bring on a paroxysm of
general  convulsions,  or aggravate the tetanic constriction.   The
patient is tormented with thirst, but dares not drink; the sight or
even  idea of  liquids making him shudder: his eye is haggard, fixed
and turgid with blood from the violence of the struggle :  his mouth
filled  with a tenacious  saliva, in  which we have already shown,
lurks  the secreted and poisonous miasm, and he is  perpetually en-
deavouring to hauk it up and spit it away from him in every direc-
tion ;  often desiring those around him  to  stand  aside as conscious
that he  might hereby injure them.  The sound which is thus made,
from  the great oppression he labours under and his  vehement effort
to excrete the tough and adhesive  phlegm, is often  of a very singu-
lar kind; and, being sometimes more  acute than at others,  as well
as quick and  sudden, and also frequently repeated, like every other
motion of the body, has occasionally, to a warm and prepossessed
imagination,  seemed  to be a kind  of barking or yelping.  And
hence, probably,  the  vulgar idea that a barking like that of a dog
is a common  symptom of the disease.   The restlessness is extreme,
and if the patient attempt to lie down  and compose himself, he in-
stantly starts up again, and looks wildly round him in unutterable an-
guish. " On going into the  room," says Dr. Munckley, describing the
case  of a patient  to whom he  had  been called, and the  author can
bear  witness  to the accuracy of his very forcible delineation, " we
found him sitting up in his bed,  with an attendant  on each side  of
him:  he was in  violent agitation of body; moving  himself about
with  great vehemence as he sat in the bed, and tossing his  arms
from  side to  side    On seeing  us he bared one of his arms, and, strik-
ing it with all his force, he cried out to us with the greatest eager-
ness  to order him to be let blood.   His eyes  were  redder  than the 
GE. l.-SP. VII.]
NERVOUS  FUNCTION.
239
day before ;  and there was added to the whole look an appearance
of horror and despair greatly beyond what I had  ever seen either
in madness or in any other kind of delirium."  The patient  was,
nevertheless, " perfectly in his  senses at this time ; and there was
not the least appearance of danger of his  biting any person  near
him ;  nor, among the variety of motions which he made, was there
any which looked like attempting to snap or bite at any thing with-
in his reach : and they who were  about him had no apprehension
of his doing this."*  The patient had at this time reached the third
day of the disease,  and expired about two hours after Dr. Munck-
ley had left him.
   There  is, however, a considerable difference  in many of the
symptoms which characterize  the progress of this malady derived
from difference of age, idiosyncrasy, or some other casualty, so that
it is possible no two cases precisely parallel each other.   The vo-
lume of the Medical Transactions from which I  have just quoted,
contains three instances of lyssa communicated by different prac-
tioners.   In the first, which is Dr. Munckley's, no notice  whatever
is taken of the  original bite, which was both in the hand and cheek,
from a favourite lap-dog, and the patient does not seem to have had
any  return of  pain  or irritation in  these organs.   In the second
case, which is that of a lad of  fifteen years of age, the bite, which
was in the leg, was so small that it was scarcely perceptible at the
time, and from first to last never  gave the  least uneasiness.t   In
the third case, which  is that of an adult woman, the  disease was
preceded by the ordinary prelude of torpor, stiffness, and tingling
in the bitten part, shooting upwards to the trunk.J  In the first case,
 the patient's mind never wandered to the last  moment of life, which
 is a common character of the disease ; in the second and third, both
 were furiously mad, bit themselves, the bed-clothes, and  whatever
 else  fell in  their way.   In all of them, however, there was a severe
 hydrophobia, and in all of them the pulse did not essentially vary
 from its common standard.  The  first died  on  the  third day; the
 two  last  recovered;  the one  under a  treatment which  consisted
principally of opium, and the other under  that of salivation; leav-
ing it therefore doubtful how far the recovery may be ascribed  to the
 natural  powers of the constitution,  and  how  far  to  remedies  so
 widely different in their nature.    \
   There is, also, in these  three cases, an equal and most singular
 discrepancy in  the interval between the  infliction of the wound
 and the incursion of the disease.  The  first interval was about six
 weeks, which may be regarded as  the  ordinary term : the second
 was  only five days: the third is not set down with  any  degree  of
 precision:  the  patient is only stated  to have been seized " about
 the time that the second horse died" that had  been bitten by the
* Medical Transactions, Vol. n. Art. v. p. 53.
t Medical Transactions, Vol. II. Art. xil. p. 192.
1 Id. Art. xv. p. 222. 
240
NEUROTICA.
[CL. IV.-OR. HI.
same rabid dog : and hence this interval consisted probably of about
a fortnight.
  This discrepancy seems to  depend entirely  upon the nature or
presence of the predisponent  or exciting  cause  that gives energy
to the virus, and without which it may lie, as  we have already ob-
served, for an almost indeterminable  period  dormant, but unde-
composed and still, therefore  as malignant as when first generated.
In the lad who was soonest affected, there seems  to have been a strong
predisposition to the disease from the first moment, and which alone
became an exciting cause; in the woman, who suffered about a
fortnight afterwards, there was probably some  degree of predispo-
sition, but the immediate exciting cause appears to have been over-
exertion  in walking, for we are told that  " she was  seized  as she
was going on an errand on foot, and had walked about two miles."
  There is a  like  uncertainty among  quadrupeds.  We have just
taken the interval often or twelve  days as the common term; but
in the instance just referred to it may have been considerably lon-
ger.   According to Meynall, the disease among dogs appears from
ten days to eight  months  after the  bite.  In Earl Fitzwilliam's
hounds which were bitten, June 8, 1791, the interval  varied from
six weeks to more than  six months: and not much  less in Mr.
Floyer's hounds as described by Dr. James.  It is not therefore to
be wondered  at, that there should be a great uncertainty among
mankind.  And hence we find it has occurred  a week  or fortnight
after the  bite,  three weeks, a  month, and sometimes six weeks, and
even  three  months; after  which  last  period, however,  notwith-
standing occasional instances to the contrary, the patient is generally
considered safe.  There are  two cases published by Dr. Tracher
in the American Medical and  Philosophical Register,* in which the
injury inflicted by the same dog, August 16, 1810,  did not produce
hydrophobia in either instances till nearly  three months afterwards,
namely, November  3,  and November 14, ensuing: and it  is the
more remarkable  that the first case was that of a child  under  four
years of age ; the  second, that of an old man of seventy-three.
Both terminated fatally: in the former case in six days, in the lat-
ter, in seven from the onset of the  disease.
  The academical journals, and monographic writers, nevertheless.
have numerous instances  of the malady appearing after a bite of
many years standing;  sometimes  twelve, eighteen,  twenty, and
even  thirty years :  but the  cases want authority  in most instances.
I shall presently, however,  have occasion to notice one  in which it
occurred and proved fatal more than nine  months  afterwards: and
there is another communicated by  Dr.  Bardsley, to the  Manchester
Society, strongly entitled to credit, however difficult it  may  be to
account for the fact, in  which the attack did not  commence till
twelve years after the bite of a dog supposed to be mad.  The pa-
- Vol. i. p. 457. 
GE. I.-SP.  VII.]
NERVOUS FUNCTION.
241
 tient died in the Manchester Infirmary  with decided  symptoms of
 the disease,  lie had been for some  time antecedently labouring
 under great nervous  agitation and considerable  depression of spi-
 rits : and Dr. Bardsley inclined to ascribe  it to  this cause rather
 than to any specific poison lurking in the system.  But this is to
 suppose that lyssa is capable, under particular circumstances,  of be-
 ing generated spontaneously in the human frame, while Dr. Bards-
 ley, as we have already observed, contends thatit cannot exist, even
 among dogs, except by contact.
   The mode of  treatment is  a field still perfectly  open for trial;
 for at this moment we have  no  specific  remedy  nor any plan that
 can be depended upon, after the disease shows itself.
   Antecedently, indeed, to  this period our course is obvious, and
 particularly if we should be so fortunate  as to  be consulted at the
 time of the  bite : and should consist in endeavouring, by the promp-
 test  and most efficacious means, to prevent the spread of the  dis-
 ease by cutting out  the virus before  absorption  has taken place.
 This has been done in various  ways: for the lacerated part has
 been sometimes amputated  or dissected ;  and at other times totally
 destroyed by the actual or potential cautery.  The  actual cautery,
 by the means of irons heated to whiteness, was  first adopted  and
 recommended by Dioscorides,*  and afterwards by Van  Helmont,
 Morgagni,!  and Stahl: the  potential  cautery seems to have been
 proposed as a less terrific mode of operation, and  has usually been
 accomplished by the means of lapis infernalis or decarbonated soda.
 It is recommended by Schenck,  Pouteau,  and Dr. Mosely.   A no-
 tion, however, has obtained from very early period that the irrita-
 tion produced by a  cautery,  whether actual  or potential, only in-
 creases the  tendency to absorption : and Trampel has endeavoured
 to prove this :J  on which account Hildanus and Morgagni have ad-
 vised excision in combination with the  cautery: the former  pro-
 posing to cut out the eschar as soon as it is formed, without letting
 it remain for a spontaneous  separation ; and the latter, far more ef-
 fectually, recommending that inustion should follow the application
 of the knife instead of preceding it.
  Of these three modes of operating, the potential cautery  is least
 entitled to be depended upon, for it is not sufficiently rapid in its ac-
 tion.   Of the other two it is, perhaps, of little consequence which
 is selected, and either of them will generally prove sufficiently effi-
 cacious alone, if employed early enough  to anticipate absorption,
 and extensively enough to make  sure of extirpating  or destroying
 every portion of the bitten  part.   There  is reason to believe that
in many instances this  has not been done,  so that Camerarius places
as little confidence in  the  actual  cautery as in  the  potential; and
Dr. Hamilton almost as little in excision.  And hence, another rea-
   * Lib. vi.
   t De Sed. et Caus. Morb. Ep. viii. Art. 2G.
   X Beobachtun^en und Erfahrungerr, kr. Band, tu passim.
vol..  Iif.                3! 
242
NEUROTICA.
[CL. IV.-OR. Ill-
son for employing  both means in the manner  recommended by
Morgagni;  in which case we shall find it unnecessary  to  superadd
any of those irritant, exculcerant, or suppurative applications which
have  been  employed by many  practitioners with a view of intro-
ducing a fresh local action, anil maintaining a fresh local discharge,
and which  have,chiefly consisted  of cantharides, camphor,  allia-
ceous cataplasms, resins, turpentine, or as Celsus recommends, culi-
nary salt.*   It  may likewise  be adviseable,  as  proposed by Sir
Kenelm Digby, and since his time  by Dr. Haygarth, to wash the
wound thoroughly with tepid water,  or tepid wine and water, be-
fore the excision is commenced.
  There is also another, and a very easy, and perhaps a very sa-
lutary operation, which I would strenuously  recommend  from the
first, even before the process of ablution.  I mean that of applying
a tight ligature to the affected part wherever it will admit of such
an  application, at a short distance above  the laceration.  I  have
never had an opportunity of trying the benefit  of such a measure
in my own practice ; but analogy is altogether  in its favour,  for it
is well known to be one of the  most important steps we can take in
confining the poisonous effects of the rattle-snake, and other venom-
ous animals, and of mitigating its violence  by the torpor which fol-
lows ;  and it has the sanction of many authorities of deserved cre-
dit  as Hiicquet, Percival, Vater, and Wedel.
  If, however,  the  local plan should prove ineffectual,  our curative
practice, as already observed, is still unfortunately all afloat, and we
have  neither helm to steer  by, nor  compass to direct our course.
There  is,  indeed,  no disease  for which  so many remedies  have
been  devised, and none in which the mortifying character of vanity
of vanities has  been so strikingly  written  on  all of them.  In the
loose and heterogeneous manner in which they have descended to
us, they seem  indeed to have  followed upon one another without
rational aim or intention of  any kind.  Yet, if we nicely criticise
and arrange  them,  we  shall find that this is not the case.
   There are four  principles by  which physicians appear to  have
been guided in their, respective attentions to this disease.   That of
stimulating and supporting  the  vital power so as to enable it  to ob-
tain a triumph in the severe conflict to  which  it  is exposed.   That
of suddenly exhausting the system by severe  bleedings and purga-
tives, as believing the disease to be of a. highly  inflammatory cha-
racter.  That of opposing the  poison  by the  usual antidotes and
specifics to which  other animal poisons were  supposed  to  yield.
And that of regarding  the  disease as a nervous  or spasmodic, in-:
stead of an inflammatory, affection,  and, consequently,  as  most suc-
cessfully to be attacked by an antispasmodic course of medicines and
regimen.
  The very popular use of volatile  alkali  and camphor, may, by
some, be ascribed  to  the first  of these views, as  being  powerfu'
* De Medicina, Lib. v. Cap. xxvii. i 1. 
GE. I.-SP. VII."]       NERVOUS FUNCTION.
243
 stimulants; yet, in fact, they were rather employed from different
 motives, and fall within one or two of the principles of action which
 yet remain to be considered.  But to this  class of medicines, design-
 ed expressly to support the  vital  power,  and enable nature herself
 to triumph in so severe a struggle, belong expressly the warm and
 cordial confections and theriacas  that were at one time in almost
 tmiversal estimation; as also various kinds of pepper given in great
 abundance, oil of  cajeput, different preparations of tin, copper and
 iron, and, in later periods, bark.
   In direct opposition  to this stimulating and  tonic plan, was that
 of suddenly debilitating and  exhausting  the system upon the  hy-
 pothesis that the symptoms of canine rabies were those of violent
 and rapid inflammation.  The practice of submersion in cold water,
 belongs mostly to this view of  the subject, as used a  century ago,
 though in the time of Celsus, it was employed in  a much slighter
 degree to take off the spasm of hydrophobia, and to  quench  the
 thirst that accompanied it.  " Miserrimum genus  morbi;  in  quo
 simul aeger et siti et aquae metu cruciatur: quo  oppressis in angusto
 spes  est.'"*   In this almost hopeless state,  the only remedy (unicum
 remedium) Celsus continues, is to throw  the patient instantly  and
 without warning, into a fish-pond, alternately, if he has no knowledge
 of swimming, plunging him under the water that he may drink, then
 raising his head, or forcing him under it if he can swim, and keep-
 ing him below till  he is filled with the water;  so that the thirst  and
 water-dread may be  extinguished at the  same time.   But there is
 here, continues our  author, another danger, lest the  body of  the
 patient, exhausted  and worn  out by the submersion as well as by
 the disease, be thrown into convulsions: to prevent which, as soon
 as he is taken out of  the pond he is  to be  put into warm oil.t
   The  boWer  practitioners of subsequent times, in pursuing  the
 refrigerating plan, were regardless of convulsions,  and persevered
 at all hazards in reducing the living power to its last ebb; believing
 that the nearer they suffocated the patient without  actually killing
 him,  the  greater  their  chance of success.  Hence Van Helmont
 kept the wretched sufferer under water till the Psalm  " Miserere"'
 was sung throughout,  which under some choristers occupied a much
 longer time than under others; and in the  experiments  of the Mem-
 bers of the Academie  Royale, we meet with  instances of a still more
 dangerous pertinacity ; though success is said to have accompanied
 one or two of them.  Thus,  M. Morin relates  the case of a young
woman, twenty years  old, who, labouring under symptoms of hydro-
 phobia, was plunged  into a tub of water  with  a bushel of salt dis-
 solved in it, and was harassed with repeated dippings till she became
 insensible and was at the point of  death, when  she  was still left in
 the tub sitting against its sides.  In this state, we are told, she was
at length  fortunate  enough to recover her senses;  when, much to

              * De Medicina, Lib. v. Cap. xxvn. $ 2.
              4 Cels. loco citato. 
244
NEUROTICA.
[t;U iv.-or. ill.
her own astonishmept, as well as to that of the by-standers, she found
herself capable of looking at the  water, and even of drinking  it
without choking.*
  With respect to  the  warm oil-bath  which Celsus recommends in
succession to that of cold water, the present author can say that, in
a single instance to which  he was a witness when a young man,  it
produced no benefit whatever.  It was prescribed by a physician in
consequence of the  recommendation of  Celsus,  but who certainly
had not read him attentively, nor was acquainted with the scope of
his reasoning.  For in this case  cold  bathing had not been  tried
antecedently, and consequently there was  no danger of those con-
vulsions for which alone  the Roman  physician  enjoins the  use of
the oil.  The experiment, however, was so far perfect, that the tub
was full of oil and deep enough to reach the patient's chin.
  In connexion with the cold bath thus persevered in to suffocation,
the reducent or  antiphlogistic plan was  still farther forwarded, at
one time, by the use of strong drastic purgatives,  of which colocynth
was, for a long period the favourite ;f and  at other times by a very
bold and  perilous use of the lancet.
  Bleeding has lately  been revived  and  carried to the extent of
deliquium by large and rapid depletions,  and the  operation has been
repeated  almost as  long  as the powers of life  would  allow.  Dr.
Shoolbred, of Calcutta, had two patients  who  recovered under this
process :  but he employed mercury at the same time, and it is by no
means certain either from the history of the patients, or of the dog
by which they were bitten, that the disease was  a genuine lyssa.
  Yet, whatever benefit this practice may possess, it has no pre-
tensions to novelty: for there is  not a single course  of treatment
ever invented for this intractable disease that has been for upwards
of a century more  extensively tried and retried,  both moderately
and profusely, or  excited a warmer  controversy  upon its  merits.
Poupart,  in 1699, espoused the  practice, and gives the case of a
woman, who perfectly  recovered by bleeding her to deliquium, and
afterwards confining her for a year to bread and water.J
  Berger, in  the  same year,  recommended bleeding, but advised
that the blood should be taken from the  forehead.   In the Breslaw
Collections for 1719, is the case  of a cow supposed to  be rabid and
said to be cured by profuse bleeding.   And the Philosophical Tran-
sactions abound  with similar  histories-, some of  them purporting to
have been attended  with similar success, derived  from human sub-
jects :  but most of them too loosely given or too indecided in their
symptoms to be in any measure  entitled  to  reliance.   That of Dr.
Hartley and Mr. Sandys was, at one time, appealed to as demonstra-
tive.   It is the case  of a groom who was bitten by a dog, supposed
to be mad, towards the end of November,  and who sickened about

     * Hist, dc l'Acadamie Royale, Ann. 1709.
     t Hellot, An. de morsis a. raliido Colocyntbis.' Pari*. 1*>7'>.
     + Hist, de l'Acadamie des Sciences.  Ann. 170?, 
GE. I.-SP. VII.]
NERVOUS  FUNCTION.
245
 the middle of January ensuing;  he had an aversion to drink, and
 was  conjectured  to be  labouring under  rabies.  Venesectioa was-
 here trusted  to almost entirely,  and every repetition of the lancet
 seemed serviceable : in consequence of which he lost a hundred and
 twe.ity ounces of blood in the course of a week, by differe'it deple-
 tions, which  consisted of sixteen or  twenty ounces  at each  time.
 The man recovered : but few readers will believe him to have been
 really rabid when they  learn  that although he had an aversion  to
 drink, he swallowed liquids : that his chief symptoms were sickness,
 trepidation, a faultering speech and  memory ; and that, through the
 whole course of the disease, he attended, though with some difficul-
 ty, to his duty in  the stable.*
   The Edinburgh Medical Commentaries are equally replete with
 cases in which the same plan of evacuation had been tried, but they
 are also equally  unsatisfactory.   Thus, Dr. Tilton  informs us that,
 having heard of the recovery of a patient from the disease before
 us, who had bled profusely and almost to death, by an accidental fall
 from an high  place, and a division of the temporal artery, he em-
 ployed venesection freely in a case of his own, drawing off from
 twenty to thirty  ounces at a  time,  and occasionally bleeding to
 deliquium.t  But the symptoms  are here also so doubtful that the
 result is of no importance.
   The practice, therefore, has been not uncommon for at least  a
 century and a half; and had it proved as specfic as some  late
 reports would  induce us  to believe, it must have  descended to us
 with  a wider and  more confirmed reputation, and formed the only
 course to  be relied on.   But the  misfortune is, that however salu-
 tary at times,  it has often completely failed in the hands of unpre-
 judiced and judicious practitioners ; and where  it has succeeded it
 has  generally  been combined  with  other  means  that  have been
 resorted to at  the  same time.  There is a case of failure related by
 Dr. Plummer in the Edinburgh Medical Essays :| but it is not much
 to be relied on, as not more than twenty ounces of blood were lost
 at a  second and accidental bleeding, and only ten a day or  two
 before by  a prescribed  venesection.  Mr.  Peters,  however, who
 employed  profuse and repeated bleedings, sometimes even to deli-
 quium, had, in his day, so little dependence on them alone, that he
 uniformly  combined this  remedy with opium  and  mithridate, or
 other cordials, and in the  case which he has introduced into  the
 Philosophical Transactions, he ascribes the success which accom-
 panied his plan to this  combined mode of treatment.§   In like
 manner, Mauchart, as quoted by Biihlmeier, while he advises bleed-
ing,  and to  an extent proportioned  to the length  of the interval
between the infliction of the wound and the attack of the paroxysm,
* Phil. Trans. Year 1737-8.
t Vol. vi. p. 432.
X Vol. v. Part ir.
•' Phil. TmnF. 1745. No. .;? 
246
NEUROTICA.          [CL. IV.-OR. Uh
 (and where the patient is of a melancholy temperament, even to
 deliquium,) advises, at the same time, that the bitten part be scari-
 fied ; and  when this  also has bled till nothing but serum escapes,
 that the wound be dressed with mithridate, theriaca, or  rue, and a
 defensive  plaster put  over it,  and that the  patient  take pills,
 compounded of mithridate  and other materials, to the number of
 nine every day for nine months, keeping himself in  a free perspi-
 ration,  and cautiously changing his linen.
   In the case of dogs, venesection,  how liberally soever made  use
 of, does not seem to  be  of much benefit.  It has lately been the
 subject of a series of experiments at Paris, under the superinten-
 dence of MM. Magendie, Dupuytren, and  Breschet, who have car-
 ried  it to deliquium, but  without any  success  whatever.   And
 hence,  though it  has unquestionably been  serviceable,  in  many
 cases, the practice cannot be regarded as a specific.
   The  poison of  rabies has, by a numerous  body of pathologists,
 been contemplated as of a nature akin to the poison of other vene-
 mous animals, and particularly serpents ; and consequently, best to
 be opposed by the usual remedies and specifics to which these  are
 found most effectually to yield.  And hence, in the first  place, the
 use of the radix Mango of Koempfer, (ophiorrhiza Mungos, Linn.)
 still  supposed to be a specific for the bite of the  cobra di capello
 and the rattle-snake.  In India and Ceylon it is used to the present
 day  as  an antidote against the bite of the mad  dog:  Koempfer
 highly extols it, and Gremmius, who practised with great reputation
 at Colurabo, employed it very largely.
   Acids and alkalies belong to the same class of antilyssics.  Of the
 former Agricola, who was hostile to the depleting system, preferred
 the muriatic  acid, and regarded  this as  a  specific*  even  when
 restrained  to  a topical application.   Poppius preferred the sul-
phuric ; but by far the greater number of practitioners the acetous
was held in most esteem.  Many combined this last with butter and
 used it both internally and externally : Wedel, with other materials ;
 '•'• as a cure," says  he,  " for the bite  of a mad dog let the patient
 drink vinegar, theriaca, and rue."t
   The general suffrage,  however,  was  far more  considerable  in
favour of the alkalies, and especially of ammonia or volatile  alkali.
There is  some reason for this  preference.  It is well known that
 ammonia is a valuable medicine,  whether applied  externally or
internally, in a variety of  animal poisons.   1 have successfully used
it  more  or  less diluted  in  various instances,  as  a lotion  against the
 sting of gnats, wasps, bees and vipers; and I have seen it of  great
 service in checking the poison  of  the rattle-snake, and restraining
 the extent of the  inflammation.   On the Continent, and especially
in  France, the usual form in  which ammonia was formerly employed
 in cases of lyssa,  was that  of the  eau  de luce, a caustic  spirit  of
* Chirurg. p. 391.
t Eterc. ijeiniot. Pathol, dp. 3. 
GE. I.-SP. VII.]
NERVOUS FUNCTION.
247
 ammonia prepared with quick-lime combined with rectified oil of
 amber, rendered more easily miscible  by being rubbed into half its
 weight of soap.   This was in general employed both externally and
 internally,* though, in the Journal de Medicine, we have several
 reports of a successful use of it when confined to an internal trial
 alone : especially one related by M. Hervet,t and another by M.
 Rubiere.J
   Mercury, from its proving a specific in syphilis,  and  more espe-
 cially  from its specific action on the salivary glands, the immediate
 outlet of the poison of rabies, has had a  strong claim to general
 attention ;  and  has  been  very extensively  tried in various forms,
 and acquired a high degree  of reputation.   It was first  recom-
 mended  by  Desault of Bordeaux in 1736,  and  afterwards  very
 confidently by Dr. James in our  own country, as a certain cure for
 man and other  animals.   He  used it both as a prophylactic at the
 time of the bite, and an antidote at the commencement of the disease.
 He employed it as  well externally as internally ;  but his favourite
 form was that of the turbeth mineral, in the shape  of pills.   He has-
 published  in the Philosophical  Transactions, a full account of his
 success with this medicine on Mr.  Floyer's  hounds,  after they had
 made  a trial of every other  favourite and fashionable  remedy in
 vain.  These dogs, as we have already  observed, were affected with
 a severe hydrophobia, which has been denied by some writers to be
 a symptom of the disease as  appertaining to quadrupeds.  All the
 hounds, we are  told, that were salivated with the mercurj', in what-
 ever stage of the malady, recovered, and the rest died.§   His expe-
 riments on mankind are less complete : for they amount  to not more
 than three, and  in each  of these the medicine was employed as a
 preventive, shortly after the  infliction of the bite ; and hence, as
 the patients never became rabid, we cannot be  sure  that they had
 received the contagion, or would  have had  the  disease,  had the
 mercury never  been  employed.   The muriate of the  metal  was
 another favourite form, which by Loisy, was used together with
 inunction.
  The grand object was to excite a speedy salivation, and maintain
 it so long as there was supposed to be any  danger;  and especiallv
 where the  administration had been delayed till the paroxysm  had
 shown  itself.   Frank, Girtanner, De Moneta, Raymond and a host of
 writers upon the subject, deny, not only that mercury is a specific,
but that it has ever produced a cure, in whatever  way it may have
been employed.   Kaltschmid, on the contrary, with an unjustifiable
  * Sage, Erfahrungen, &c. p. 49.
   Guettard,. Memoires sur diffeientes parties des Sciences et Aits. Pnris. 17fi8
p. 122.
  t Journ. de Medicine. Tom. lxh.
  X Id. Tom. r.xiv.
  » Phil. Trans. Vol. xxxix. Year 1735-K. 
248
NEUROTICA.
[CL. 1V.-OR. 111.
 confidence, calls it remedium indubium ;* End De Choiseul a methodc
 sure et facile.]  In the fortieth volume  of the Journal de Medicine
 there is a relation  in  which mercurial inunction seems to have
 been successful in a genuine  case, and I have heard of one or two
 other instances that  have occurred in our own country.
   As diuretics were supposed  to possess a  strong  alexiapharmic
 power,  or that of expurgating the system from  animal poisons in
 general, these have  also had their votaries, and been in high repu-
 tation,  as a remedy  for lyssa.   Cantharides were at one time  the
 favourite medicine under this  head, or some other stimulant insect
 of the coleopterous order, as the meloe, lytta, or one or two species
 of scarabaeus ; which, like mercury and ammonia, were sometimes
 taken internally alone, and sometimes  applied  topically also, to keep
 up a perpetual irritation.  Bohadsch  tells us  gravely,  that the dis-
 ease will always  yield to ten cantharides powdered and introduced
 into the stomach :| Monconys, that the  powder should be continued
 from the bite  to the  time in which we may reasonably  expect
 the symptom of hydrophobia;  and adds that  this  medicine, which
 was  regarded as  an  arcanum in his day, was a remedy of publicity
 over all Greece.§  He  might have extended his theatre; for Egypt
 was as well acquainted with the general principle of this practice as
 Greece or Hungary;  and it is a positive exhortation of Avicenna,
 that whatever diuretic was employed  should be carried to its utmost
 acrimony,  even to the discharge of bloody urine.||
   The  ash-coloured  liverwort (lichen  terrestris cinereus Raii}) was
 another diuretic of great popularity,  and which seems at length to
 have triumphed over the stimulant insects, and to have superseded
 their use;  on which account Linneus  changed its trivial name from
 cinereus to  caninus.   In our own  country, this medicine was at one
 time peculiarly in vogue.  It was given in powder, with an equal
 quantity of black  pepper, a drachm  and a half of the two forming
 the dose for an adult, which was  taken for four mornings fasting, in
 half a pint  of warm cow's milk ;  the patient,  however,  tvjb first to
 lose  nine or  ten ounces of blood, and afterwards to be  dipt in  cold
 water for a month together, early in the morning.  And such was
 the general confidence in this plan, or rather in the antiiyssic power
 of which the lichen was supposed to  be the most  active principle,
 that its  virtues formed one of the most common subjects of  eulogy
 in the  Philosophical Transactions at the time when Mr. Dampier
 introduced  it to public  notice at an early period  of the history  of
the Royal Society;! while, at the earnest solicitation of Dr. Mead,
  * Dissertatio de Salivatione mercuriali, ceu indubio prscservationis et curationis
remedio adversus tabicm cauinam.  Jan. 17G0.
  t Nouvelle Methode, sure et facile, pour le t.aitement de spersonnes attaquccs
de la Rage.  Paris, 1756.
  X Posit. Zoolog. in Klinkosch. Diss. Select.
  i Voyages, i. p. 406.
  || Lib. iv. Fen. vr. Tr. iv.
  " Mechanical Account of Poi«ons. Art. .'!. 
OE. I.-SP. VII.]
NERVOUS  FUNCTION.
249
 the  powder was admitted in the year 1721 into the London Phar-
 macopoeia,  under the title of Pulvis antilyssas; who declares, that,
 " When united with the previous venesection, and subsequent cold
 bathing, he had never known it fail of a cure,* though he had used
 it a  thousand times in the course of thirty years' practice."
   How far  emetics may be serviceable general trial has not,  per-
 haps,  been sufficient to determine.  They  have often  been found
 capable of relieving spasms of the throat, and enabling the patient
 to swallow  liquids when  every other plan has failed.   They were
 hence  recommended by Agricola, but only, perhaps on account of
 their  violence  upon a weakened frame,  as a sort of forlorn hope,
 for he does not advise them till after the thirrl day.   Dr. Satterley,
 however,  has given a case in the Medical Transactions, which he
 regarded as rabies, in which vomiting was employed from an early
 period of the disease, and with very decided advantage.! But there
 seems to be a doubt whether the patient here referred to, laboured
 under genuine lyssa.  He had been bitten three months before  by a
 dog, but the fate of the dog was not known : the cicatrix betrayed
 no uneasiness or irritation precursive to the disease,  or during its
 course : the hydrophobia was remittent, or intermittent, so that the
 patient drank liquids at times with tolerable ease; the spastic action
 ran to a greater extent over the muscular system than usual, so as
 at one time to produce emprosthotonus, and the patient did not ex-
 pire till at least a week after the attack: all which are very unusual
 symptoms in lyssa, and have seldom, if ever, been combined in the
 same individual.
   In lyssa,  however, the nervous system appears to be that which
 is by far the most severely tried, and to which the disease  may be
 most distinctly referred.   And hence it is  not to be wondered at
 that antispasmodics and sedatives should also have been  had re-
 course to very  extensively, and obtained a very general suffrage.
 In effect, whatever benefit in this disease has at any time been de-
 rived from ammonia, camphor, or cold  bathing, it is more  easy to
 resolve  their palliative or remedial  power into the principle of
 their being  active antispasmodics, than to any other mode of action.
 The more direct antispasmodics and sedatives, however, employed
 in this malady were musk, opium, bella donna, nux vomica, and stra-
 monium.  The last has  chiefly  been tried in India, where three
 drachms and a half of the leaves infused in a very large portion of
 water or other common  drink, and swallowed daily for three days
in succession after the bite, was, at one time, a very approved and
popular remedy.
  Musk and opium, however, are the antispasmodics which have
been chiefly depended upon in Europe.  They have  sometimes
been given in very large doses  alone, but more  generally in union
with  other  medicines.  Cullen seems doubtful  of  the  powers of
          k Chirurg. parv. Nurub. &c. 8vo. 1643,
          1" Vol. iv. p. 348.
VOL. in.              32 
250
NEUROTICA.
[CL. I\ --OR. HI.
 either, apparently from not having  had sufficient  opportunities of
 witnessing the disease,  and their  effects  upon it, and hence refers
 us, in both instances,  without venturing upon any decisive  opinion
 of his  own, " to the labours  of the learned and industrious  Societe
 Royale of Paris, who  have taken much  pains, and employed the
 most proper means for ascertaining  the practice in this disease."*
 With respect to musk he admits,  however,  that Dr. Johnston has
 given us two facts  that are very much in favour of its power:  and
 " I have," says he, " been informed of an instance in this country,
 of some large doses of musk having  proved a cure  after symptoms
 of hydrophobia  had come on."t  Hilary says, " In these  cases it
 acts as a sudorific;" and Gmelin regarded it as a specific antidote.];
   Opium, in like manner, when employed alone, was given in large
 doses,  and we have numerous cases on record  in which this, like the
 preceding  medicines, is said to have operated a cure,§  But unfor-
 tunately neither musk nor opium,  in whatever quantity employed,
 have been found successful in general practice.  Tode more espe-
 cially  has  pointed out the inefficiency  of the former, in the largest
 doses  referred to ;|| and Raymond  has confirmed his  remarks.1T
But a late experiment of Professor Dupuytren of  the Hotel-Dieu,
lias given a still more striking and incontrovertible proof of its. utter
iuefficacy, if not in all cases  of the  disease,  in certain states and
circumstances.  Surlu, a man aged twenty-four, had been bitten  by
a dog sufficiently proved to be mad, had been cauterized immediate-
ly afterwards, and been discharged as supposed  to be cured.   In
about a month from the time  of  the  bite, he was attacked with
rabies  in its  severest  symptoms,  and  conveyed to the hospital.
Opium was the medicine determined upon, and as the constriction
of the throat  prevented it from being given  by the  mouth,  a gum-
my solution was injected into  the veins, for which the saphaena and
cephalic were alternately made use of.   Two grains of  the  extract
were in this manner thrown in, and the patient was in some  degree
tranquillized for an hour or two : the dose was doubled towards the
evening of the same day.  It was repeated at intervals, and at length
increased to eight  grains at a dose.  The relief it afforded, how-
ever, was never more than temporary : and he expired on the fifth
day from the incursion.**
  From this inefficiency of opium and  musk  separately, they have
often been united to strengthen their effect; or either of them has
been combined with camphor, oil  of amber, inunction  with olive
  * Materia Mcdica, Vol. 11. p. 252. 380.             t Id.
  X Diss, de specifico antidoto novo adversus cffectus morsus canis rabidi.  Tub.
1750.
  !■ Dantic, Gazette de Same, 1777. p. 51.
  || Annalen, ix. p. 33.
 ' Med. Observ. and Inquiries, Vol. v.
    Orfiln. Traitc sur les Poisons. &c. 
GE. I.-SP.  VII.]
NERVOUS FUNCTION.
2:>1
oil,* or bleeding.  Musk was also at one time very generally com-
bined with cinnabar, and  in  this  form supposed  to be peculiarly
efficacious.  The famous powder employed by the natives of Ton-
quin, and introduced into this  country by  Mr.  Cobb, on which ac-
count it was called pulvis Cobbii or Tunguinensis, consisted of six-
teen grains of musk with forty-eight  giains of cinnabar, mixed in a
gill of arrack   This taken at a dose is said to have thrown the pa-
tient into a sound sleep and  perspiration  in the course of two or
three hours; and where it did not, the  dose was repeated till such
effect was produced.   And this medicine also  was regarded as a
specific  during  the short  career of its triumph,  and  a cure was
commonly supposed to follow  the administration of the medicine.
   The sedative power  of several of the  preparations of arsenic,
however, had perhaps a fairer  pretension  than any of these, and
especially as, like mercury, it has for ages been employed with de-
cided benefit in Asia, in the case of syphilis.  Agricola mentions its
use in his day,t but the forms  in which it was  then employed were
rude and incommodious, and they do  not appear to have been fol-
lowed with much success.  It is to be regretted, however, that even
in the elegant and manageable form of Dr. Fowler's solution, it has
not been found to be more efficacious.  It has of late  years been
tried in various cases, and particularly with  great  skill, and in full
doses, by Dr.  Marcet, but  in every  trial it  has  disappointed our
hopes.
   Under this head I may also  observe that  the Prussic acid-has oc-
casionally been had recourse to, but without any  apparent benefit.
In the form of the distilled water of the prunos lauro-cerasus, it was
not long since made a subject  of experiment at Paris by M. Dupuy-
tren, who injected this fluid into the veins of  various dogs, and ap-
pears to have done so in one  instance into those of a  man : but in
every case without affecting a cure.
   There are two or three  other  remedies which it is difficult  to
arrange, but which have also  acquired  a considerable  celebrity in
the cure of lyssa; and hence it is necessary to notice  them.
   The first is  the Ormskirk medicine, so  called from  its  preparer
Mr. Hill of Ormskirk, supposed, for the inventor could  not be pre-
vailed upon to  publish  his secret,  to consist  of the following ma-
terials : powder of chalk,  half an  ounce ; armenian  bole,  three
drachms; alum,  ten  grains;  powder of  elecampane-root, one
drachm; oil of anise, six drops.  The single dose thus compounded,
is  to be taken  every morning for six times in a glass of water with
a small proportion of fresh  milk.   If  this be the real formula, and
the analysis of Dr. Black concurred with that of  Dr.  Heysham in
determining it to be so, the inventor  seems to have contemplated
the specific virus to be an  acid, for the  basis  of this preparation is
 * Vater, Pr. de Olei Olivarum efncacia contra morsum eanisrabittsieNpcriir.cn-
n Dresdae facto, adstrncta, Viteb. 17"j0.
 * Comment, in Popp. p. 54. 
252
NEUROTICA.         [CL. IV.-OR. Ill*
unquestionably an alkaline earth.   And with regard to its occasion-
al efficacy, the latter writer, following the general current of opi-
nion of the day,  informs us that  this  has been so thoroughly estab-
lished by experience, that there can be no room to doubt it.  Dr.
Heysham himself, however, admits of various cases in which it
failed, while  in many  instances  his  successful ones  do not afford
proofs of an existence of the  genuine disease*
   The second of the anomalous  remedies  I  have  just  referred,
might possibly have been introduced under the head of the common
antidotes for the bites of venomous animals ; but as it has reputed
powers in some degree  peculiar to itself, it is best to notice it sepa-
rately.   This  is  the alyssum, or  alysma  Plantago (madwort plan-
tain,) of established reputation in America as a specific for the
bite of the rattle-snake, where it seems to rival the imprescriptible
claims of the ophiorrhiza Mungos, though  its juice is generally
given in  combination with that of the common horehound—an ad-
dition that certainly does not promise much accession to its strength.
   This species of alyssum has for some ages been a popular remedy
for canine madness, especially in  the  north  of Europe : and in a
late communication to Sir Walter Farquhar  in  the Russian tongue,
translated and  published in Mr. Brande's Joumal,t we are told that
it still retains  its popular sway and reputation  over a great  part of
the Russian empire: and that in  the government of Isola it  has
never failed of effecting a cure  in  a single instance for the last five
and twenty years.  The preparation is simple : the root is reduced
to a powder, and the powder is to  be eaten by being spread over
bread and butter.  Two or three  doses are  said to be sufficient in
the worst cases : and will be  found  to cure mad  dogs  themselves.
   The next remedy I have to notice is also of extensive  use in the
present day, and comes  before us with no mean  authority.  Whilst
the medical practitioners of the East, are pursuing their plan of ab-
stracting  rabid blood from the system, as the surest means of curing
canine madness,  the physicians of Finland have undertaken  to ac-
complish the same effect by introducing rabid blood into the morbid
frame.  In the second number  of the  Hamburgh Medical Reposi-
tory, Dr. W. Rithmeister of Powlowsk in Finland, has given an ar-
ticle in which  he has collected a multiplicity  of striking cases and
various authorities in proof that the blood of a rabid  animal, when
drunk, is a specific against  the canine hydrophobia, even where
the symptoms  are  most  strongly marked.  The rabid wolf-dog, or
other quadruped, is, for this  purpose, killed,  and its blood drawn
off and collected as an  antiiyssic ptisan.  Dr. Rithmeister's com-
munication contains  a  letter to  himself from Dr. Stoekmann  of
White Russia,  confirming  this account, and  stating the practice to
be equally common and  successful in his own country.
* Diss. Med. Rabie Canina, 8vo.
f Journal of Sciences and the Arts, No. ix. p. 142. 
t.F.. I.-SP. VII.]
NERVOUS FUNCTION.
253
  I will only add, that a discussion has lately taken place between
two Italian physicians of  distinguished reputation, Professor Brug-
natelli of Pavia, and Professor Valetta of Milan, upon the  virtues of
chlorine as an antidote for the disease in question.  The former has
strongly recommended it ;* and  the  latter has denied that it is of
any use :t in answer, however, to which denial,  Professor Brugna-
telli has adduced various  authenticated  facts, by which what he
calls the specific powers of the  chlorine have been established  and
verified.J
  1 have thus endeavoured, upon a subject of so  much  interest  and
importance, to put  the reader into  possession of the general his-
tory of the  practice  that  has hitherto prevailed; and he will at
least allow that if the  result be highly unsatisfactory—as most un-
satisfactory it is—such conclusion  does not result from idleness on
the part of the medical profession.
  But how are we to reconcile the clashing and contradictory state-
ments which the present analysis unfolds  to us ?  This is  a question
of easy solution.  Yet there are many circumstances which ought
to be borne in  memory, and that will, in  a certain degree, account
for such opposite views and decisions without rudely  impeaching
the veracity of any of the  experimenters.
  In the first place, it is possible that the morbid poison itself, like
that of plague or intermitting fever, may vary in  its degree of viru-
lence,  in certain idiosyncrasies, certain countries, or certain seasons
of the year: and hence that a  medicine which has proved useless
in general practice,  may succeed in  particular persons,  particular
places, or at particular periods : or, if inactive in itself, may be em-
ployed in so much milder a degree of the  disease that the consti-
tution may be able, in most or many instances, to  triumph over it by
its own powers alone.
  It is a just remark of Celsus  that omnis fere morsus  habet quod-
dam virus ;§  and we have already given proof that this is particu-
larly the case when the animal that bites is labouring under the in-
fluence of violent rage or other sensorial excitement: the symptoms
incident upon which produce a severe effect upon  the nervous sys-
tem, and often simulate those of genuine lyssa.  And hence, there
can be little  doubt that these symptoms  have often been mistaken
for  lyssa, and have given a celebrity to the medicines employed for
their cure to  which  they were never entitled.  In  various cases,
as we have  already  seen, the  disease  commences almost  coeta-
neously with the external injury, or inoculation : in others, not till
months or even years afterwards.  In some instances  the first symp-
toms of the disease show  themselves in  the bitten part,  and even
this in a  very different  manner, for  there may be  a troublesome
* Giornale de Fisica, &c. Pavia, Dec. 1816.
t Biblioteca Italiana, Gennaj. 1817.
X Giornale di  Fisica, &c. Pavia, Febbraj. 1K17.
'  De Medicina, Lib. v. x. 
254                     .NEUROTICA.           [CL. IV.-OR. IIr.

sense of  numbness, or of irritation; and this irritation may be con-
fined  to the cicatrix, or travel up the limb, and produce acute pain
or spastic action :  while in other instances there is no local affec-
tion whatever through the entire progress of the malady.   Ordina-
rily speaking, hydrophobia, or water-dread, is one of the most com-
mon,  as well as one of the severest symptoms of the disease;  yet
there are instances, even  where the rabies has  terminated  fatally,
in which water-dread  has not been once complained of.  Most com-
monly again, on an early examination after death, the fauces  and
parts  adjoining are found  red and inflamed : but we  have already
observed that Morgagni dissected patients in which there was no
such  appearance  whatever.  And in two bodies  examined after
death by Dr. Vaughan, the fauces, oesophagus, stomach, diaphragm,
and intestines, were all in  a natural state.
  There can be little or no doubt, moreover, where many persons
are bitten in quick succession by the same  rabid  animal, that  the
poison is not equally introduced  into all of them.  In some cases it
may be expended  entirely upon the earlier victims, and hence the
rest, though  bitten, may be free  from the virus;  while  in others
where the teeth have to pass through various foldings of clothes, it
is possible  that the virus which  still remains  may  be  wiped off
in its  passage, and the laceration be  nothing more than a clean
wound from the first.  And in all such cases a sanguine experimen-
ter, without  allowing  for these  circumstances,  will be apt  to per-
suade himself, whatever medicine he makes use of, that the absence
of the disease, is owing to  the efficacy of the  plan or the  medicine
he has prescribed, and which he is hence tempted to hold up to the
world as an  antidote or specific.
   Some of these remarks will best explain the very different results of
the same mode of treatment, in the eleven patients entrusted in 1775
to the care of M Blaise of Cluny, after having been dreadfully bit-
ten and torn by a mad wolf.   The principal remedy was  mercurial
inunction, though  combined with antispasmodics.   The  mercury
was carried  on in  all  of them to salivation, and  the treatment con-
tinued for above a month, in those that lived long enough for this
purpose.  One died with  great  horror and  water-dread  about  the
twelfth day  from the injury, and after the mercury had began to  act.
A second perished under hydrophobia, furious, and  at length coma-
tose, just at  the close  of a  month, his mouth and gums being slightly
affected by the mercury.  A  third died nearly six weeks after  the
commencement of the mercurial  plan, having been taken away by
his friends on the eighteenth  day apparently in a state  of doing
well.   The  remaining eight,  after having exhibited greater or  less
symptoms of spasmodic affection, but never amounting to hydropho-
bia, are said to have recovered,  and were discharged accordingly *
but in a subsequent work M. Blaise  informs us, that even  one of
Methode eprouyee pour la traitement de la Race. 
GK. I.-SP. VII.]         NERVOUS FUNCTION.                25J

Ihese died in a  paroxysm of hydrophobia six weeks after his  dis-
charge, and supposed restoration to  health.*
  In all these cases the success is ascribed to the action of the mer-
cury, and the want of success to some irregularity or other commit-
ted by the patient while under  medical care.  The  enormities,
however, are in  general rather far fetched, and not very convin-
cing.  Thus, in  the  last of the above cases, it is ingeniously observ-
ed that the man who had been so long discharged as well, four days
only before  the  symptoms of hydrophobia  appeared on him,  had
thrust his arm down the throat of an ox which was  said to be mad ;
though no proof is offered that the ox was really mad, nor is it pre-
tended that even this  reputed  mad ox  inflicted any bite  upon the
arm whatever.   Who  does not see, that  in all these cases the mer-
cury may have been guiltless of exercising any controul ? that those
who died may have  died in consequence of an effective lodgement
of  the virus in  the  wound inflicted, and that  those  who survived,
may  have survived  because it obtained no admission to the  bitten
part?
   It is, moreover, highly probable that a spontaneous cure is occa-
sionally effected by the strength of the constitution,  or the remedial
power of nature alone.  The  fact appears to be, that  the disease
requires about six or seven days to run through its course, at the
expiration of which period the  system seems to be exonerated by
the outlet of the salivary glands, of the  poison with which it is in-
fested.  And hence,  if by any means it be able to sustain and  carry
itself through this period, without  being totally exhausted of ner-
vous power in the course of so protracted and prostrating a conflict,
it will obtain a triumph over the  disease  : and any prescribed medi-
cine  made use of on  the occasion  will seem to have effected the
cure, and will run away with the credit of having done so, till  subse-
quent  instances dissolve the charm, and prove beyond contradiction
the utter fatality of  its pretensions.
  I have already had to observe that the contagion of lyssa, though
highly malignant,  is  neither very volatile nor very active,  and in
every instance,  perhaps, requires some  exciting or predisponent
cause to enable  it to take effect: but, as it seems to be more inde-
composible than any other contagion we are acquainted-with, it is
capable of lying latent and undissolved for months, if not years, till
it meets with a cause  of this kind. And hence the very long and uncer-
tain interval  which sometimes occurs between the attack of the rabid
animal and the appearance of rabid symptoms, has often proved anoth-
er source of deception ; of  which we have a singular example in
Mr. Nourse's case, related in an early volume of the Philosophical
Transactions  ;t which states that  a lad, who had been bitten in  the
thumb by a mad dog,  took morning and evening for forty  days a
ilram of the pulvis antilyssus already described, and bathed  in  the
*' Hist, de la ^ociote de Medicine. Tom. n.
  No. 44J. 
 256                    NEUROTICA.           [CL. IV.-OR. IIf.
                   •
 sea for ten days in succession.  He was in due time reported to be
 well, and the cure was altogether ascribed to the specific virtues of the
 antiiyssic powder.  He was shortly afterwards cut for the stone, from
 which also  he recovered:  nineteen months  after which  operation,
 however, he was attacked with hydrophobia and the other symptoms
 of canine madness, and fell a victim to their violence.   Had this
 patient died under the  operation  of lithotomy, or from  any other
 circumstance in the interval, the  virtues of the antily-sic powder
 would  have  obtained a complete, and indeed a rational triumph in
 this  instance :  and even now there may be a question whether the
 appearance  of the disease was not retarded by the plan pursued:
 though its specific power can no longer be maintained for a moment.
 The occasional exciting cause which, in this  instance, at length
 gave activity to the dormant virus, is not pointed out  to  us.   But it
 is difficult, if not impossible, to account, without such a cause, for the
 quickening of the lurking seminiura of the poison at this  time rath-
 er than at any other.  And  the following  valuable remarks of Dr.
 Perceval, occurring in his manuscript comment on the author's vol-
 ume of Nosology in relation to  this subject, are in full illustration of
 the same opinion.
  " A  wine porter was attended, in Dispensary practice, for a low fe-
 ver : after a time appeared symptoms of lyssa; and much inquiry elici-
 ted the recollection of his having been slightly bitten by a dog six
 weeks  before.  In the interval  ha was convicted of some  fraudulent
practice in the cellar of his master, to whom he owed great obliga-
tion, and was dismissed with disgrace.   Anxiety on this event seem-
 ed to produce  the fever which  terminated in lyssa.
  " Lately  an officer  in our  barracks was bitten by a dog, whose
 madness being recognized, the bitten part was excised immediately;
 after an undisturbed interval of two months he was advised to go to
 England to dissipate the  recollection of the accident: there he exer-
cised himself violently in hewing wood; felt pain in the hand which
had been bitten; embarked  for  Ireland; had  symptoms of hydropho-
 bia on  board the packet, and died soon  after his arrival.
  " I have  lately seen a case of hydrophobia  treated  ineffectually
by most profuse bleeding and large doses of opium.   Here too the
bitten part was extirpated by  caustic  within an hour.   He was a
man of steady mind, nor could any occasional cause be assigned for
bringing the poison into action, except that  a bilious  diarrhoea was
 suddenly checked.
  " From the  varying period of attack we might infer that  the in-
 fluence of occasional causes is very considerable.  In the last patient
 hydrophobia supervened exactly five weeks from the time of  the
 bite : he lost a hundred  and eight ounces of blood in  twelve hours
 which  sunk  him much; violent perspiration,  and at length delirium,
 attended  the water-dread;   during  the  last twenty-four  hours he
 swallowed, and recovered,  his  senses ;  and died slightly  convulsed
 whilst  cutting  an egg.   These cases seem to point out agitation of
 mind and feverish excitation as powerful occasional cause*." 
GE. I.-SP. VII.]        NERVOUS  FUNCTION.                25?

  In a disease so intricate as  lyssa a very complex treatment is by
no means  unpardonable: but it  may fairly, I think, be  questioned
whether the complexity and the energy of  the means  employed to
produce a cure may not, rather, in some instances, have had an op-
posite effect,  and have hastened  and  confirmed a fatal issue.  A
patient bitten by a mad dog, having in vain tried and persevered in
the use of the Ormskirk  medicine, was next put under the joint
care of Dr. Watson and Dr. Fothergill.   Having been bled standing,
as long as he  could stand,  he was next immersed in a warm bath,
where he was  ordered  to remain till he again became faint; a
clyster of milk and water with a drachm of Dover's powder dissolv-
ed in it was  injected as soon he was removed from the bath; half
an ounce of mercurial ointment was at the same time rubbed into
the legs and thighs, and three grains of thebaic extract given in the
form of pills:  two grains being ordered to be continued  every hour
till he became sleepy.
   To stand the brunt of a treatment thus vigorous would demand  no
ordinary constitution, even without the co-operation of any  disease.
But  that the  wretched  sufferer should sink (as he did, in a few
hours) under the assault of such a malady and such a mode  of cure,
cannot be matter of surprize to any one.
  The whole  subject  is afflictive, as well in respect to its treatment
as its progress.  But how, after  all, is a young practitioner to pro-
ceed when he meets  with a case of  rabies?  This is a most im-
portant question  ; and the following remarks, submitted  with great
deference as the result of  some little  personal experience, and  no
small degree of reflexion, are meant to meet it, and to  point out the
path, which,  in the  present unsettled state of  the subject  it may,
perhaps, be most expedient to adopt.
  From the whole of the  preceding survey it is sufficiently clear
that we have no direct specific for the cure of the disease; and hence,
whatever plan we employ must  be palliative only.  It appears also
that  the disease  consists in a poison of a peculiar kind capable of
assimilating some of the animal secretions to its own nature, and
that the new.matter, or contagion, hereby produced continues to  be
eliminated for five or six days principally, if not entirely, from the
excretories of the salivary glands, as the inflammation of gout un-
loads itself on  the extremities, and the specific matter  of exanthems
on the surface generally: and that, at the expiration of this period,
or as soon as such  depuration has been effected,  the disease abates,
and the patient is restored.  It appears, also, that the disease is one
of the most dangerous in the  whole catalogue of nosology,  and that
few patients recover  from  it under any plan of medicine  that has
ever  been devised: but that nevertheless some  patients have re-
covered under almost every  mode of  treatment  however incongru-
ous and contradictory to other modGs ; and hence, that  many cases
of restoration  must be rather referred  to a natural, or spontaneous
cure, than to the virtue of medicines.
  In this state of things it  seems reasonable that our first intention
   vol. m.                    33 
258
A EL ROTICA.
[cL. IV .-OR. IiT-
should consist, as in various other kinds of animal poisons communi-
cated in the same manner,  in supporting the systein generally, and'
the nervous  part of it more particularly, so that  it may not sink
under the violent  excitement and augmented secretion which the
organ of the nerves has to  encounter during so perilous a struggle.
And it is to  this principle we have to resolve all the  benefit which
has at any time been  found to result from the use of the stimulant
theriacas and  other cordials of the  old  practitioners.  On this  ac-
count ether,  ammonia, and camphor have a strong claim upon our
attention, and  especially the two  last as  they  may be given in a
solid  form.   All the  pungent spices belong to the same class, as
cardamum-seedsr and  capsicum, and  may be adverted to as auxilia-
ries ;  nor should wine  or even ardent spirits be refrained from, if the
patient can  be induced to  swallow them;  moderately through the
entire course of the  disease,  but liberally  and profusely  as  his
strength declines.  Our grand object must be  to keep him alive,
and prevent a fatal torpitude in the sensorium for a certain number
of  days, at any expence of stimulants, or of subsequent debility.
Wine is  profusely given with great success in the  bite of the most
v.enomous serpents of the East, and analogy justifies us in proposing
it in  the present instance.
   Our next intention should be to diminish, as much as possible, the
spastic action of the chest and fauces, and to prevent a return of the
exacerbations.  And  to this  end as much quiet and composure as
we can possibly procure,  under  so  restless  a state of body, seems
imperatively called  for,  and is  far more likely to be serviceable
than the fatigue of taking  the patient repeatedly out of bed for the
purpose of plunging him either into a hot or a cold bath.  And though
 opium has  never of  itself, perhaps, produced a cure, it seems ad-
 visable to try it in liberal doses ;  and the more so as several of the
 cases already adverted to afford a direct proof that it is capable, oc-
 casionally, of producing some degree of tranquillity for a short peri-
 od.  In  employing it, however, it  seems  most reasonable, from
 analogy, to combine it with some diaphoretic, and  particularly with
 ipecacuan in the form of  Dover's powder, since,  at all  times, the
 animal frame is most disposed to be quiet and  free  from irregular
 actions when  there  is a  general moisture upon  the  surface.  In-
 many cases of  rabies such a state of body has  been found unques-
 tionably favourable ; and in one of the instances already quoted from
 the Medical Transactions, the  benefit was so striking that the prac-
 titioner could not avoid regarding it as critical.  U is possible, alsoT
 though no great stress can be  laid upon this remark, that a part of
 the virus itself may be hereby eliminated, i;s in various other cases
 of animal poisons.
    To obtain and encourage such elimination should indeed be ous
 first object, if we  had any means of  accomplishing it upon  which
 we could fully depend.  This, however,  we have not;  but, as the
 quarter to  which the virus is  directed is  the salivary glands, cf
 which, indeed, we have full proof in consequence of the saliva be- 
GE. I.-SP. VII.]
NERVOUS FUNCTION.
259
ing the fomes of the poison apparently as soon as it becomes elabo-
rated; and as we have a medicine which  possesses a specific influ-
ence  on this organ, and is capable of augmenting its f-ecretion to al-
most  any  extent, it seems of the  utmost importance that, while we
endeavour to support the system, and  to  allay the nervous irrita-
tion,  we «hould endeavour at the same  time to quicken  the elimi-
nation of the morbid  matter, by exciting the salivary emunctories,
and thus  probably also carrying  it off in a diluter and less irritant
form.  It is difficult to withhold  one's  assent to all the  numerous
instances  of cure  which are so confidently asserted to have follow-
ed upon the use of mercury carried  to the point of free  salivation.
And hence, without  allowing this medicine to be a specific more
than  any  other, we may indulge a reasonable hope  of its forming a
good auxiliary, and should  employ it freely, either externally, in-
ternally, or in  both modes simultaneously; but with as  little distur-
bance to  the  patient as possible, till a copious  ptyalism is the re-
sult.
   Fever, or inflammatory action, does not necessarily belong to lys-
sa in any stage :  and  the present mode of treatment is  altogether
grounded upon this principle.  Either, however, may become inci-
dentally connected with it from the  peculiar  state of the habit
or some other cause.   Hence, as a preventive, the bowels should
be  kept moderately open;  and wherever there is any just appre-
hension of plethora, or a turgid state of the vessels, and  particular-
ly of the brain, blood should be drawn freely from  the arm, and, if
necessary, be  repeated.  We have already seen  that such a state  of
congestion is sometimes  produced even at  the onset,of the  disease,
and is so  forcibly felt by the patient himself, that  he earnestly in-
treats the  medical attendant to bleed  him.  Such  intreaty should,
perhaps, never be urged in vain: but the bleedings to  deliquium,
which have of late years been so strongly recommended, are a rash
and dangerous  practise, unfounded on analogy, and by no means
rest on any sufficient  assurance.
   Such, in the doubt  and darkness that at  present beset us concern-
ing the real physiology of lyssa,  seems to  be the  safest and most
promising path we can pursue, when called upon for aid  in so afflic-
tive a malady.   Our best time for action,  however, and  almost the
only time  we  can improve, is immediately on the infliction of the
wound : a tight ligature  above which, with  the double  precaution
of excision and cauterization, may in general be  regarded as an ef-
fectual preventive.   1 do not know, indeed, that the profession is
acquainted  with any other.   It has, however,  been proposed  in
France, to fight off the poison of lyssa by pre-occupying  the ground
with the poison of a viper, upon  the principle of combatting vario-
lous with vaccine matter: and for this purpose it has been suggest-
ed that the part bitten by a mad dog should be again bitten a little
below the wound, as  soon as may be, by a venomous serpent whose
virus, from its  greater activity, will, in  most cases, be  certain of
making the lead, and  may, it  is presumed,  guard the  constitution 
260
NEUROTICA.
[CL. 1V.-OR. III.
 against any subsequent effects from the  wound  of the mad dog.
 I have not, however, heard that this proposal has  ever been car-
 ried into eflect,  and the claim of ingenuity is most probably the
 whole it will ever have to receive.
   I ought not, however, to conclude without noticing one very ex-
 traordinary fact in the economy of morbid poisons,  and especially
 of that before us,  which  I  have had confirmed  by the  testimony
 of several  veterinary practitioners entitled to credit.  It  is, that
 no dog who has ever had the distemper, as it is called, which  is
 the canine  catarrh or influenza, has been  known  to  become  rabid
 spontaneously, though he is capable of receiving the  disease by the
 bite of another dog.   If this be  true,  for which, however, I can-
 not fully vouch, we have certainly another instance of morbid poi-
 sons mortally conflicting  with  each other; and it might be worth
trying how far inoculation with the matter of canine catarrh might
succeed in protecting a human subject after the infliction of a  rabid
bite ; though in the dog, perhaps, from a stronger  predisposition to
 rabies, it seems to be  impotent.  In South America,  rabies,  as al-
ready observed, is altogether unknown,  and I have hence been anx-
 ious to learn  w lether the distemper be unknown there also: and,
in answer to this inquiry, it has been told me, by several intelligent
 residents in that quarter, that this last disorder is so common and so
 fatal,  that two thirds of the dogs littered  there perish of it while
 pups: a  remark which still further confirms  the  home-report con-
 cerning its  influence on rabies, and sufficiently explains the nou-ex-
 istence of the latter on the shores of the Plata.
                       SPECIES VIII.

              ENTASIA ACROTISMUS.

                       iEhiUfrtasgnrss.

FAILURE, OR CESSATION OF THE PULSE, OFTEN ACCOMPANIED WITH PAIS IS
  THE EPIGASTRIUM ;  THE PERCEPTION AND THE VOLUNTARY MUSCLES RE-
  MAINING UNDISTURBED.

Acrotismus is literally " defect of pulse," from *s»T«s, " pulsus " with
a privitive x  prefixed : whence the technical term crotophus 'or cro-
tophium, importing  « painful pulsation or throbbing in the temple "
Asphyxia  is the  term employed for this disease by Ploucquet, and
would have been used in the present arrangement but that it  has
been long appropriated to import suspended animation or apparent
death; a total cessation, not  of the  pulse only, but of sense and vol-
untary motion. 
GE. I.-SP. VIII.]       NERVOUS FUNCTION.                 2b 1

  This failure  or cessation of pulsation sometimes extends over the
whole system, and is  sometimes confined  to  particular parts.  In
every case it imports an irregularity in the action of the heart, or of
the vessels that issue from it,  and in most cases, an irregularity pro-
ceeding from local or general weakness, and dependent upon a spas-
modic disposition hereby produced in the muscular tunic of the vessels.
Of this last cause we have a clear proof in the universal chill and pale-
ness that spread over the entire surface  in the act of fainting or of
death, to  which fainting bears so striking a resemblance.  Except,
however, in the agony of dying the spasmodic constriction for the
most part soon subsides, and the arteries recover their proper free-
dom and diameter.  Yet  this, is by no means the case always, for
in violent hemorrhages, and  especially hemorrhages of the  womb,
the  rigidity has sometimes continued for several days, during the
whole of which time the  heart has seemed merely to palpitate, and
there has been no pulse whatever.  Morgagni relates a case  of this
kind which extended to a much longer period, but at length termi-
nated fatally :* and examples  are by no means uncommon in which
it has existed for three,t four, or even five daysj before death.
   Other irritations, besides that of weakness,  have occasionally led
to a like spastic state of the arteries.  The stimulus of an aneurism
of the aorta has produced it in the  brachial arteries, so that there
has been no pulse  in the wrists: and gout or  some acrimony in the
stomach  has operated in like manner on  the arterial  system to  a
much greater  extent.   The cause,  however, is not always  to be
traced, and hence  Marcellus Donatus has given an instance which he
tells us was unaccompanied with any disease whatever ;§ the irrita-
tion  probably  having  subsided.  Berryatt, in the History  of the
Academy of Sciences, has furnished us with a very singular exam-   •
pie of this disease which  was general as well as chronic, and conti-
nued through the whole term of life.  In all which cases, however,
though the  heart itself should seem to participate in the pulseless-
ness, we are not to  suppose that it  is entirely without any alterna*
tion of syncope and diastole,  but only that its  action  is indistinct
from weakness or irregularity.  In treating of the nature  of the
pulse  in the  Physiological Proem  to the third class, we  observed
that  it is in some persons unusually  slow and  has been found,  as
measured by the  finger, not  more  than ten  strokes in a  minute  :||
and that in  many of these cases the  cause of retardation seems to be
a spasticity  or  want  of pliancy in the muscular fibres of the heart or
 arteries, or  both, rather  than an actual  torpor which is also  an oc-
casional cause.  I have never met with any case in which  the or-
 dinary standard of  the pulse was  not more  than ten  strokes in a
* De Sedibus et Causis Morb. Ep. xlviii. Lugd. Bat. 4to. 1767.
t Pathology, p. 25.
+ Pclargus, Med.  Jahngange, Band. v. p. 2.3.
}  Lib. vi. cap. ii.  p. 620.
||  Vol. ii. p. 16. 
262
NEUROTICA.
[CL. IV.-OR. Ill,
minute; but I have at this time a  patient of about thirty-six years
of age, whose  pulse  has not exceeded twenty-four or twenty-six
strokes, and has often been below these numbers.   He is a captain
in the Royal Navy, of a sallow complexion and bilious tempera-
ment : till of late he  enjoyed good  health, but about three years
since was attacked with a fit of atonic apoplexy from which he re-
covered with difficulty.  At an interval of a few weeks  from each
other, he had several other  fits ; on recovering from  the last of
which he instantly married a young lady to whom he had for some
time been engaged.
  He has now been married about fifteen months, has a healthy in-
fant  just born, and has had no fit whatever.  His spirits are good,
and he is residing by the sea-side, which situation  he  finds agree
with him best.   Dr. Latham gives a  similar example in a merchant
whose pulse, though never intermissive, seldom,  for ten or twelve
years that he had known him,  exceeded thirty-two beats in a min-
ute ; occasionally was  as slow  as twenty-two, and at one time only
seventeen.   " I  once," says Dr. Latham " attended him through a
regular fever,  when his pulse was  not  more  than sixty, notwith-
standing the disease ran  on for at least a fortnight with a hot and
dry skin, white and furred and  parched tongue, and occasional deli-
rium."*
  In many of these anomalies there is not only  no perceptible pulse
or a very retarded one, but often intermissions more or less  regular,
and occasionally a want of  harmony  between the stroke in some of
the arteries compared with that in  others.  Reil gives a case  in
which the  heart, the  carotids,  and the radial arteries all pulsated
differently :| and Beggi another, in which the acrotism, or want of
pulsation, extended over the entire frame with the exception of the
heart, which pulsated violently .J
  This species is strikingly exemplified in the biographical sketch
of Mr. J. Hunter, drawn up and prefixed to his volume on Blood and
Inflammation by Sir Everard Home.   Mr. Hunter for the four pre-
ceding years had annually suffered  from a fit of  the gout in the
spring.  In the year 1773, this  did not return, and having, on a par-
ticular occasion, been.greatly affected in his mind, " he was attack-
ed," says Sir Everard Home, " at ten o'clock in the  forenoon, with
a pain in the stomach, about  the pylorus : it was the sensation pe-
culiar to those parts, and became so violent that he  tried change of
position to procure ease; he  sat down, then walked, laid  himself
down on  the carpet, then upon chairs, but could  find no relief: he
took a spoonful of tincture  of  rhubarb, with  thirty  drops of lauda-
num but without the smallest benefit.  While he was walking about
the room he cast  his  eyes  on  the looking glass, and observed his
countenance to be pale, and his lips white, giving  the appearance

      * Med. Trans. Vol. iv. Art. xx.
      t Memorabilia clinica. Vol. n. Fasc.  I. 6.  Hall. 1792.
      + 0:m. Pacchioni. Rom. 4to, 1741. 
OE. I.-SP. VIII.]
NERVOUS FUNCTION.
265
of a  dead man.   This alarmed him and led him to feel for his pulse,
but he found none in either arm.  He now  thought  his complaint
serious.  Several physicians of his acquaintance :  Dr. William Hun-
ter,  Sir George Baker, Dr. Huck Saunders, and Sir William For-
dyce, all came but could find no pulse: the pain still  continued, and
he found himself,  at times, not breathing.  Being afraid of  death
soon taking place  if he did not breathe, he produced the voluntary
act of breathing:  his working his lungs by  the power of  the will,
the sensitive principle with all its effects on  the machine, not  being
in the least affected by the complaint.  In  this state he continued
for three quarters  of an hour, in which time  frequent attempts were
made to feel the pulse but in  vain.  However, at last the pain les-
sened, and the  pulse returned, although at first but faintly, and the
involuntary breathing  began to take place.  While in this state
he  took Madeira, brandy, ginger, &c. but  did  not  believe  them
of any service,  as the return of health was very gradual.  In two
hours he was perfectly recovered."*
  This is one of the most extraordinary cases on record,  consider-
ing the extensive group of important functions that were jointly af-
fected, and the total freedom  of-the rest: and nothing  can  more
strikingly prove how close is  the sympathy  that in many instances
prevails between discontinuous organs.   The chief  disease seems
to have prevailed  in the heart, the  chief pain  in  the stomach on
its upper side ;  and for this we may, perhaps, account, from a law
of the animal economy  we have so  often of late had occasion to
keep in view, by which a morbid action affecting one  extremity of
a nervous fibre, or bundle of fibres, is,  under  particular circum-
stances, most severely felt at the other extremity : for as one  of the
branches  of the phrenic nerve passes over  the apex of the  heart,
and  is afterwards  continued to the  diaphragm which maintains so
intimate an association with the stomach, it serves as a direct line
of communication  between each of these organs; and the painful
impression  imparted to the end of  the nervous twig that rests on
the heart may, by  this law, be transferred  to its other extremity
that  lies so contiguous to the upper part of  the stomach.
  The nature of the pain and the collateral symptoms seem suffi-
ciently to show that this disease was of a spasmodic kind : for  the
deficiency of pulse was subsequent  to, and consequent upon the pain,
and ceased upon its removal,  while the  deadly paleness of the face
gave proof of a constriction of the capillaries.
  So far as my own experience has  extended, such failures of the
pulse, whether consisting in  a total suspension, or  a  preterna-
tural retardation, and attended with acute or with very little  pain,
are dependent upon a diseased state  of the  larger arteries, or  the
larger viscera  of  the  thorax  or  abdomen,  and  generally lead to-
sudden death.  The case of the captain of the navy  which I  have
  * Sir E. Home's life of Mr. Hunter prefixed to tlie Treatise on Blond, Sir. u:
xlvi. 
264
NEUROTICA.
[CL. IV.-OR. HI.
just related and which was drawn up something more than a twelve-
month ago, I may now apply to, while the present  text is printing,
in illustration of this remark : for I have just been  informed by his
sister that while  at  Swansea, apparently  in  as  good health as he
had ordinarily enjoyed for several years,  he was attacked with a fit
of apoplexy which carried him off in  less than an hour.   Such, too,
was the fate of Dr. Latham's patient, for we are told that" one day,
when in complete health, as he then  considered himself, he drop-
ped down in  the street, and expired."  And so sudden was the de-
cease of Mr.  J. Hunter,  that feeling  himself unwell while  in  the
course of his professional  attendance at St. George's Hospital  he
went into an  adjoining room, gave a deep groan, and dropped down
dead.
  In all cases of this  kind, therefore, the  mode  of treatment must
depend upon the nature  of the exciting or predisponent cause as
far as we are able to ascertain  it.   Where the  cause is constitu-
tional, a sober, quiet and regular habit  of life, with a due attention
to the  ingesta and egesta, and particularly to a  tranquillized state
of mind, will often enable the  valetudinarian to reach  his three-
score and tenth year, with cheerfulness and comfort: but he must
content himself with

           ----the cool sequestered vale oflife,

and not form a party in its contentions, and its  glitter,  its  bustle.
and " bus}  hum."
  Where the affection appears  to be dependent upon a  particular
state of any one of the larger thoracic, or abdominal organs, as the
heart itself, the lungs, the stomach  or the liver, our attention must
be specially directed  to the nature of the primary disease.  And
in these cases it is often  essentially relieved  by some vicarious ir-
ritation, as a  seton or issue, a  regular fit of the gout, a cutaneous
eruption, or a painful attack of piles.   During the paroxysm itself,
the most powerful and diffusive  stimulants  should  be had recourse
to, as brandy, the aromatic spirit of ammonia, or of ether, which is
still better, and opium in any of its forms. 
GE. II.]
NERVOUS  FUNCTION.
265
                     GENUS  II.

                         CLONUS.

                       Clonic Sjiasm.

 1'ORCIBLE AGITATION OF ONE OR MORE MUSCLES IN SUDDEN AND IRREGULAR
                            SNATCHES.

 The Greek terms, xXom and xXenxrn, import agitation, commotion,
 concussion.  The clonic, or agitatory spasms  form two distinct or-
 ders in Sauvages, and a single genus in Parr.  The first is unneces-
 sarily diffuse ;  the second is too restricted.   The two orders of
 Sauvages are in the  present  arrangement  reduced to two  genera,
 and constitute  that immediately  before us, and syn< lonus, or that
 which immediately follows.   Dr. Cullen seems at one time to have
 had a desire of distinguishing the diseases of both  the^e genera by
 the  name of convulsions ; and of limiting the name of spasms to the
 permanent contractions or rigidities of the muscular fibres produced
 by spastic action, constituting the different species  of the preceding
 genus.  " I think it convenient," says he, in his First  Lines, " to
distinguish the terms  of spasm and convulsion, by applying  the
 former strictly  to what has been called the  tonic, and the latter to
what has been called the clonic spasm."   Yet the whole are  treat-
 ed of in his nosological arrangement under the common name of
spasmi, and even in his First Lines, notwithstanding this distinction,
under that of " spasmodic affections without fever."  These spas-
modic  affections  are, indeed, subsequently divided into a new ar-
rangement of "spasmodic affections of the  animal functions;—of the
 vital;—and of the natural:" throughout which an attempt is still made
to separate the term convulsion from that of spasm, and apply it to
all clonic or agitatory motions of the muscles, while convulsio is,
nevertheless, retained in the synopsis, as the technical name of that
single species of disease which is  colloquially called convulsion-fit,
 and not extended to any others.   There is doubtless a  difficulty in
drawing the line between entastic and clonic spasm in  many cases,
from the mixed nature of the symptoms;  but if it be felt of impor-
tance to take terms out of their general meaning, and tie them down
 to a stricter interpretation,  such interpretation should be rigidly
 adhered to, or some degree of confusion must necessarily ensue.
  To understand the real nature  of the spasms we  are now enter-
 ing upon, it may be expedient to  recollect that the  nervous  power
 or fluid appears to flow  naturally, as indeed we have already ob-
served in the Physiological Proem to the  present class,  by minute
jets, or in an undulatory course, like  the  vibrations of a  musical
-:hord.  But the movement is so uniform, and the supplv so regular.
  VOL. IM              31 
266
NEUROTICA.
[cl. iv.-or. nr,
in a state of health, and where there is no fatigue, that we are not
conscious of any discontinuity of tenour, and can grasp as rigidly and
as permanently with a muscle as if there were no relaxation in its
flow of power.  To prove  the  nature of the influx, however, no-
thing more is necessary than to reduce the muscle from a state of
healthy tone to a state  of languor, or to wear it  down by fatigue;
for in this condition all the  muscles tremble, and the stoutest man is
incapable of extending his arm with a small weight in  his hand, or
even of raising a  glass of wine slowly to the mouth, without a mani-
fest, and even a painful oscillation.
  The flow of the nervous power, in a state of health, is augmented
by the application of various stimulants  both mental and corporeal.
The ordinary mental  stimulus is the will,  but  any other mental
faculty  when  violently  excited  will  answer the  same  purpose,
though the action which takes place in consequence hereof, will, ia
some degree, be irregular,  as proceeding from an irregular source,
and  will  in consequence make  an  approach to the character of
spasms;  of .which a violent  excitement of almost any of the  pas-
sions afford  examples  sufficiently evident, and especially the pas-
sions of fear and  anger, under the influence of which it is sometimes
found impossible  to keep a single limb still.
  The ordinary corporeal stimulants are the  fluids which are natu-
rally applied to the  motory organs themselves.  Thus  the air we
breathe becomes  a sufficient excitement to the action of the lungs,
the  flow of the blood from  the veins a sufficient excitement to that
of the heart, while the descent of the feces maintains the  peristal-
tic  motion of the  intestinal canal.
  Where these stimulants  are regularly  administered, and the or-
gans to which they are applied are in a state of health, the  alter-
nations of jets and pauses in the flow of the nervous power, as we
have already remarked, are  uniform.   But in a state  of diseased
action, whether from a morbid secretion  of the  fluid, or  a morbid
condition of the fibres  that are to be influenced by it, this uniformity
is destroyed, and in two very different  ways: for first, the nervous
energy  may rush forward  with a force  that  prohibits all pause or
relaxation whatever, and this too in spite of  all  the power of the
will;  and we have then a  production of rigid or  entastic spasms, or
those abnormal contractions in different parts of the body  of which
 the preceding genus  furnishes us  with  abundant examples : and,
next the pauses or relaxations  may be  too  protracted; and  in this
 case every movement will be performed with a manifest  tremor.
 Where this last is the case, moreover, the succeeding jet, from the
 accumulation of nervous power that necessarily follows upon such
 a retardation, must  at  length take  place  with an inordinate force
 and hurry ; and the movement in the voluntary muscles,  when at-
 tempted to be controled by the will, must be irregular  and often
 strongly marked with agitation,  giving us examples  of convulsive
 or clonic spasm.   And as,  moreover, in such a state of the nervous
 system or of any part  of it, there will often be found a contest be- 
t,E. II.]             NERVOUS FUNCTION

tween the retarding and the impelling powers; the spasm will not
unfrequently partake of the nature of the two, the nervous energy,
after  having been irregularly  restrained in  its  course, will rush
forward too impetuously, and for a few moments without any pause ;
and we shall  have either a succession of constrictive and  clonic
spasms in  the  same muscle  or sets of muscles, or a  constrictive
spasm in some  parts, while we have a clonic spasm in others: and
hence those violent and ramifying convulsions which we shall have
more particularly to notice under the ensuing genus.
   A sudden and incidental  application of any irritant  power what-
ever, to  any of the  muscular fibres, will throw them  into an irre-
gular action not only in a morbid  state,  when they are  most prone
to such irregularities, but even  in a state  of health.  Hence the
involuntary jerk that takes place in all the limbs  when a boat, in
which we  are sailing at full speed, gets  a-ground  without our
expecting  it,  or we are assailed unawares with a smart  stroke of
electricity.
   Now, whenever a forcible and  anomalous movement of this kind
has once  been excited in  any chain of muscular fibres whatever.
there is  a strong tendency in them to  repeat the same movement
even  from  the  first: and when from accident or  a continuance of
the exciting cause  it has actually  been repeated, it forms a habit of
recurrence that is often broken off with great difficulty.   Hence the
convulsive  spasm of the hooping-cough always outlasts the disease
itself for some weeks, and is best removed by the introduction of
some  counter-habit obtained by a  change of residence, atmosphere,
and even  hours.  A palpitation  of the heart first occasioned by
fright, in an irritable frame,  has  in some cases continued for many
days afterwards, and in a few instances become chronic.
  A habit  of sneezing has sometimes been  produced in  the same
manner, and has followed upon an obstinate  catarrh; after  which
ihe slightest stimulants, even the sneezing  of another  person, has
been  sufficient to call up fresh paroxysms, and in some cases which
I  have seen of very long and  troublesome continuance.
  Hiccough affords us another example  of the same tendency to a
recurrence of muscular abnormities.  This is usually produced by
some  irritation in  the  stomach, not unfrequently  that of fullness
alone  : the  irritation is by sympathy communicated to the diaphragm,
which is thrown into  a  clonic spasm, and the spasm  being a few
times repeated, the series of hiccouping becomes so established, as,
in many instances, to be broken through  with considerable difficulty.
  It is to these physiological laws  that most of the affections we are
now about to enter upon are referable ;  and the concentrated view
we have thus taken of their operation, will render it less necessary
for us to dwell at much length upon any of them.
  The genus clonus comprises  the six following species:

1. CLONUS SINGULTUS.                HICCOUGH.
-   ' '  ■ «TBRNUTATIO.             ♦JVRF.ZINO.
26? 
268
XF.l ROTICA.
[or., iv.-on. in.
          PALPITATIO.               PALPITATION.
          NICTITATIO.               TWINKLING OF THE EYE-LIDS.
          SUBSULTUS.               TWITCHING OF THE TENDONS.
          PANDICULATIO.            STRETCHING.




                         SPECIES 1.

                 CLONUS  SINGULTUS.

                          Ultccottflh.

CONVULSIVE CATCH OF THE RESPIRATORY MUSCLES, WITH SONOROUS INSPI-
             RATION ;  ITERATED AT SHORT INTERVALS.

Though the spasmodic action in this affection  exists chiefly in  the
diaphragm, the principal seat of the disease is the stomach, when
strictly  idiopathic ; an observation which  was long ago made by
Hippocrates, and has in recent times been more copiously dwelt
upon by Hoffman
  Debility is perhaps the ordinary remote cause, and irritability,
or some accidental stimulus the exciting. Thus excess of food,  and
especially in a weak stomach, is often a  sufficient stimulus:  and
hence the frequency of this complaint among infants.
  For the same  reason it is occasionally produced  by worms, acid-
ity, or bile in the stomach.   External  pressure  on the stomach is
another exciting cause : and hence it has sometimes followed, on an
incurvation of one or more of the ribs,* or of the ensiform cartilaget
of the sternum  produced by  violence, and  pressing on the coats of
this organ.  The  stomach, however, is not at all times the only
organ in which the morbid cause is seated that excites the diaphragm
to this spasmodic action.  The liver is frequently to be suspected.
" I have often,"  says Dr. Perceval, in his manuscript  notes  on  the
volume of Nosology, " found hiccough symptomatic of an enlarge-
ment or inflammation  of the  liver on the upper convex side."   It
also frequently follows upon strangulated hernia ; and, according to
Mr. John Hunter, in numerous instances accompanies local irritation
after operations  of various kinds.   It has sometimes  attended  the
passage  of a stone  in one of the ureters, and has continued through
its entire course.f
  The affection is often very troublesome, but it cures itself in
ordinary cases, and where  the  exciting  cause is lodged   in  the
* Schenck, Lib. m. Obs. 49. ex Fernelio.
t Bonet. Sepulchr. Lib. m. Sect. v. Obs. 8. Appex.
X Darwin, Zoonom. iv. i. i. 7.
 
«.E. II.-SP. I.]
NERVOUS FUNCTION.
269
stomach;  for the spasmodic action very  generally  removes the
accidental irritant; and if not, the  disorder usually yields to very
simple antispasmodics, as a draught  of cold  water,  or a dose of
camphor or  volatile  spirits.  Where these  have failed, a nervous
action of a different kind, and which seems to operate by revulsion,
has often been found  to succeed, such as holding the  breath, and
thus producing a voluntary spasm of a rigid and opposite kind in the
diaphragm ;  or a violent fit of sneezing.   An emetic,* will some-
times answer  the  purpose;  and  still  more  effectually, a sudden
fright, or  other emotion of the  mind.t  If  these do  not  prove
sufficient, we must call in the aid  of opium : and  in the intervals
have  recourse to  tonics internal  and external,  the  warm bitters,
bark, pure air, exercise, and cold bathing.
   We have already pointed out the tendency which these irregu-
lar actions  have to form a habit, and the more so in proportion to
the   general weakness* and irritability  of the frame ;  and  hence,
indeed,  their arising so readily in the later  stages of typhus and
other low fevers, and their continuing to the last ebb of the  living
 power.
   Even where the constitution is possessed of a tolerable share  of
 vigour,  hiccough is too apt to become  a chronic and periodical
affection ; and as the  frequency of the spasm is also usually increased
with the frequency of the series, it has sometimes become almost
incessant, and defied every kind of medical treatment that could be
devised.  As a chronic  affection  it has been known  to return at
irregular periods from fourj to four and twenty years ;§ and as a
permanent  attack to continue  without ceasing  for eight,||  nine,1T
 twelve days,** and even three months.tt    Dr. Parr tells us that he
 once  knew  it continue for a month with scarcely any  intermission
even at night.  " The sleep," says he, " was at last  so  profound
 that the convulsion scarcely awoke the patient."   In a few instances
 it has proved fatal.  Poterius mentions  one ;\\ and another, pro-
 duced by  cold beverage,  occurs  in  the Ephemerides of Natural
 Curiosities.§§
   In the Gazette de Sante for 1817, is the case  of a young girl who
 had been tormented for six months with an  almost incessant hic-
cough.  It ceased during deglutition, but re-appeared  immediately
* Rigaud, Ergo solvunt Singultum Vomitus et Sternutatio.  Paris 1601.
t Riedlin, Lin. Med. 1696. p. 276.
X Bartholin, Hist. Nat. Cent. n. Hist. 4.
♦ Alberti, Diss. Casus Singultus chronici viginti quatuor annorum. Hal. 1743.
|] Riedlin, Cent. I. Obs. IS.
II Act. Nat. Cur. Vol. v. Obs. 108.
** Tulpius, Lib. iv. cap. 25.
tt Schenck, Lib. in. Obs. 49.  ex Fernelio.
XX Cent. n. Obs. xxvii.
H Eph. Nat. Cur. Dec. m. An. i. Ob*. 48. 
270
NEUROTICA.
[CL. IV.-OR. III.
afterwards.  The sleep was frequently disturbed.  M. Dupuytren.
on being consulted, after antispasmodics and the warm bath had fail-
ed, applied an actual cautery to the  region of the  diaphragm, and
the hiccough immediately ceased : but perhaps terror operated in
no slight degree in this mode of cure.
                        SPECIES  II.

              CLONUS   STERNUTATIO.

                         Sliming.

IRRITATION  OF  THE NOSTRILS,  PRODUCING SUDDEN, VIOLENT, AND  SONO-
            ROUS  EXPIRATION THROUGH THEIR CHANNEL.

Sneezing is a convulsive motion of the respiratory muscles, common-
ly excited into action by some irritant applied  to  the inner mem-
brane of the nose; in the course of which the air from the lungs is
sonorously  forced  forward in this  direction as the  lower jaw is
closed at the time.  " In sneezing," says Dr. Young,  " the soft pa-
late seems  to be the valve which, like the glottis in  coughing, is
suddenly opened, and allows the air to rush on with a greater ve-
locity than it could have acquired without such an obstruction."*
   It is  a common and rarely  a severe  affection in its ordinary
course.   But from the habit  which irregular actions of the irritable
fibres are perpetually apt to  assume, as we have already explained,
and particularly in a relaxed and mobile state of them, sneezing has
occasionally become a serious complaint.  Forestus, Horstius, Lan-
cini, and many  of  the German  medical miscellaneous collections,
give instances of its having  been sometimes both permanent and
violent;  sometimes periodical;  and a  few  cases having  proved  fa-
tal ;  which last termination is confirmed by Morgagni.   The Ephe-
merides  Naturae Curiosorum contain one instance in  which the
sneezings continued for three hundred times in  a single  paroxysm.
   The ordinary irritants operating immediately on the Schneideri-
an membrane or that which lines the  interior of  the  nostrils, are
sternutatories, a sharp pungent  atmosphere, indurated mucus, the
acrimonious fluid secreted in a catarrh or measles, or a morbid sen-
sibility of the Schneiderian membrane itself.  But the severest cases
have usually been produced by sympathy with some remote organ,
as an irritable state of the lungs, stomach or bowels.  For the same
reason sneezing often accompanies  pregnancy and injuries  on the
head, and sometimes the last stages of low fevers; and is reported
to have  proved a sequel to repelled itch.   The benediction former-
•  Med. Literat. p. 107. 
(iE. II.H5P. II.]
NERVOUS FUNCTION.
271
ly bestowed with so much courtesy on the act of sneezing is said to
have been congratulatory on account of its frequent  violence : but
we do not seem to be acquainted with  the real  origin of this cus-
tom.
  As sneezing is a symptom of catarrh, if it be repeated for some
time with quick succession in an irritable habit that  has  been fre-
quently affected with catarrh, it will sometimes, in the most singu-
lar manner, call sympathetically into  action the  whole circle  of
symptoms with which it has formerly been associated, and the pa-
tient will seem at once to be labouring under a very severe cold.  An
instance of this singular sympathy has occurred to me while writ-
ing.   The  patient is a lady of  about fifty  years of age,  in good
health, but of a highly nervous temperament.  She began to sneeze
from some trifling and transient cause,  and,  having continued to
sneeze  for five or  six times in rapid succession, her eye-lids became
swollen, her eyes  blood-shot, and full of tears, her  nostrils discharg-
ed a large quantity of acrid serum, her fauces were swollen and ir-
ritable, and a tickling and irrepressible cough completed the  chain
of morbid action.  The sneezing at length ceased,  and, within a
quarter of an hour afterwards, the whole  tribe of sympathetic symp-
toms ceased also.
  Sneezing in its ordinary production, though a convulsive, is a na-
tural and healthy action, intended  to throw  off instinctively from
the delicate membrane  of the nostrils, whatever  irritable or offen-
sive material may  chance  to be  lodged  there.   But  when it pro-
ceeds from a morbid cause, or becomes troublesome  from habit, we
should use our endeavours to remove it.
  When the complaint  is idiopathic and acute, or,  in other words,
when the  Schneiderian membrane is  morbidly sensible, or stung
with some irritant material, it may be relieved by copiously sniffing
warm water up the nostrils, or throwing  it up gently with a syringe,
or forcing  up pellets of lint moistened with opium dissolved in warm
water, the pressure of which is  sometimes of as much  service as
the sedative power of the fluid itself.  If this do not succeed, leech-
es or cold epithems should be applied to the nose  externally.   But
a free  and spontaneous  epistaxis, or  hemorrhage from the  nostrils,
effects the best and speediest cure, of which Riedlin has given an
instructive instance.*   It  has been  prevented from returning by
blisters to the temples and behind the ears, and  frequently sniffing
up cold water in the course of the day.  It has also been attempted
to be cured by pungent sternutatories, so that the olfactory nerves
may be rendered torpid and even paralyzed by over exertion; but
this has rarely answered : for when once a morbid habit is establish-
ed, it does not require  the primary cause or stimulus for  its con-
tinuance.
  When the complaint  proceeds from sympathy, the most effectual
means of removing it is by ascertaining the state of  the remote  or-
* Lin. Med. 1695. p. 148. 
272
NEUROTICA.
[CL. IV.-OR. III.
gan with which it associates, and removing the  stimulus that  gives
rise to it.  This, however, cannot always be done ;  and in such case-
camphor in free doses will often prove a good palliative, and  if thi>
do not succeed, we must have recourse to opium.
                        SPECIES  III.

               CLONUS PALPITATIO.

                         IJalpttatton.

        SUBSULTORY VIBRATION OF THE HEART OR ARTERIES.

Palmus or palpitatio is used in very different senses by different wri-
ters.  By Cullen and Parr it is limited to a vehement and irregular
motion of the heart alone.  By Sauvages and Sagar it is applied to
an irregular motion "in the region of the heart."  By Linneus it is
denominated " a subsultory motion of the heart  or a  bowel—cordis
viscerisve ;" and by Vogel is defined " a temporary agitation of the
heart, a bowel, a muscle, a tendon, or an artery."
  The first of these views is too contracted, for palpitations or quick
abnormal beats are felt almost as frequently in  many other organs,
and particularly those of the epigastric  region.  Yet as in these it
seems in every instance,  however  complicated  with other symp-
toms, to depend upon  a morbid state  of  the heart itself, or  of the
arteries which supply them, or are in their vicinity, the definitions
that extend palpitations to other organs  than the heart and arteries,
as separate  from these, appear to be as much too loose and out of
bounds as the first definition is too limited.
  The  view now  offered  takes a middle course: it contemplates
palpitation as  dependent on a diseased action of the  heart alone, or
of the larger arteries  alone, or of the one or the other associating
with some organ more or less remote: and hence lays a foundation
for the three following varieties :

  x Cordis.           Palpitation of the heart.
  £ Arteriosa.        Palpitation of the arteries.
  y Complicata.       Complicated or visceral palpitation.

   The vibratory and  irregular action, which we  denominate palpi-
tation of the heart, is sometimes sharp  and strong, in  which case
it is called a throbbing of  the  heart,  and  sometimes soft and fee-
ble when it is called a fluttering of this organ.   Both may possibly
proceed from two  distinct  causes; the  one a morbid irritability of
its muscular fibres, or some sudden stimulus applied to it, either ex-
ternal or internal, by which its systole becomes harsh and unpliant, 
    CE. II.-vSP. III.]       NERVOUS FUNCTION.                  2/o

    and evinces a tendency to a spastic fixation ;  and the other  an irre-
    gular motion of the entire  organ of the  heart in the pericardium,
    by which it literally strikes against the chest: the cause of which
    we do not always know,  though we see it very frequently occasion^
    ed by a sudden and violent emotion of the mind, and have reason to
    believe that it  is often a result of the spastic systole or contraction
    of the heart which we have just noticed.  When, however, the sub-
    stance of the heart is thus  irregularly acted upon, and jerked back-
*   ward and forward  from a cause extrinsic to itself, the palpitation is
    confined to the pericardium, and the pulse does  not partake of the
    abnormity.
       The  last is, perhaps, the  most common proximate  cause of the
    palpitation of this organ, and we are  indebted to Dr. William  Hun-
    ter for having first  pointed it out to us.   The heart, in its natural
    state, lies loose and pendulous  in  the pericardium:  and  when the
    blood which it receives is, from an  irritation of any kind, thrown
    with a peculiar jerk into the aorta, the moment it  reaches  the cur-
    vature of this trunk it encounters so strong a resistance  as to pro-
    duce a very powerful rebound in consequence of the aorta being the
    first point against the spine: the influence of the heart's own action
    is now,  therefore, thrown back upon itself, and this organ, in conse-
    quence  of its being loose  and pendulous, is  tilted  forward against
    the inside  of the  chest, between the fifth and sixth ribs on the
    left.*
       The rebound of so strong a muscle as the heart against the  inside
    of the chest must depend for its violence upon  the violence of the
    jerk with which the blood is spasmodically  thrown into the aorta;
    and this has often been so powerful as to be distinctly heard by by-
    standers.!  Castellus has given an example of this sonorous effect:
    and Mr. Dundas has observed it in various cases.  " The action of
    the heart," says the latter, " is  sometimes so very strong as  to  be
    distinctly heard, and to agitate the bed the patient is in so violently,
    that his pulse has been counted by looking at the motions of the cur-
    tain of the  bed."f   1 have already observed, under the genus pap.op-
    sis, that the point of a knife when introduced into the cornea, for
    the extraction of a cataract, has, occasionally, been broken off by a
    spasm of the muscles of  the eye.   And we  shall hence  hear with
    less wonder that the heart has sometimes palpitated with a  force so
    violent,  as to dislocate,§ or  break  the ribs,||  for both are stated to
    have occurred  on  respectable authorities,  and, in  one instance, to
 *  See J. Hunter On Btood. p. 146. note.
 t  Castellus, P. Vascus. Exercitat. ad affectus Thoracis. Tr. ix. Toloso. 1614.
4to.
    Lettsom, Med. Soc. Lond. Vol. r.
    A Vega, De Art. Med. Lib. in. Cap. 8.
 X  Trans. Medico-Chirurg. Soc. I. 27.
 i  Horstu n. 137—139.
 ]| Schenck, Observ. 215. ex Fernelio.
  voi-  in.               35 
274                     NEUROTICA.           [CL. IV.-OR. IlJu

rupture its own ventricles.*   Upon the wonderful power of the soft
parts, or rather of the muscles over  the  bones, when thrown into'
vehement spasmodic action, we had occasion to observe in the Phy-
siological Proem to the present order :  and it is hence that we have
sometimes had examples of the humerus, and other long bones, being
broken  by a convulsion-fit.  A contraction of the left aurico-ventri-
cular opening is sometimes found to produce the phaenomenon of a
double pulse.t
  I have said that we are not always acquainted with the remote or
exciting causes of the palpitation of the  heart.  Violent emotion
of the mind, as already observed, is a frequent excitement, and one
or  two others  have  been already indicated.   The remote causes
are rarely  to be discovered" till after death, and for the most part
seem to consist in a morbid structure  of the heart itself, or the peri-
cardium, by which  last the muscular walls of the  heart have either
been obstructed in their play, or have had too much liberty of ac-
tion.  The heart  has sometimes been found ossified in  its general
substance, as in the case of Pope Urban the VHIth ; and more fre-
quently in its valvules or its connexion with the aorta.  It has some-
times been thickened and has grown to an enormous size—in one
instance to a weight of not less than fourteen pounds. J  A case oc-
curred to the present author not long ago  in  a young lady of four-
teen, in whom it reached  half this weight, and was  the cause of a
most distressing palpitation, as well as of a general dropsy. By close
confinement and quiet, and the use of elaterium and scarification to
carry off the water,  she  recovered an apparently good share of
health; but the exercise of  dancing, a few months afterwards, pro-
duced a recurrence of all the symptoms in  a  more  violent and ob-
stinate degree, and she gradually fell a sacrifice to them.
  In other cases the heart  has been peculiarly  small and contracted,
chiefly, perhaps, in the diseasejof tabes, or marasmus ; and conse-
quently there has not  been a sufficient capacity for the regular influx
of venous blood.
  The space of the pericardium has often been morbidly diminish-
ed by inflammation, or an undue growth of fat; and hence, again,
the heart has been impeded  in  its  proper action;  while  occasion-
ally it seems to have been  filled, or  nearly so,  with a dropsical
fluid.
  To these causes may be added a schirrhous or other morbid struc-
ture of the lungs, and, perhaps, of the spleen, liver, stomach or  in-
testinal canal; for  it is a frequent accompaniment upon most spe-
cies of parabysma: and in these cases appears as  a  symptomatic  af-
fection alone.   For reasons already assigned it is also an occasional
symptom in hydrothorax : during which  it shows itself in a  very
* Portal, Memoires de Paris, 1784.
t Hodgson on the Diseases of Arteries and Veins.
t Eph. .Nat. Cur. Dec. in. Ann. in. Obs. 16*5 
CE. II.-&P. HI.]          NERVOUS  FUNCTION.               2/J

violent degree upon mental agitation, especially  that produced by
fright or vehement rage.
   We  should not, however, be hasty in  deciding upon any structural
affection  of the heart, or  of any of the larger organs that closely
associate  with it, nor in reality upon any incurable cause whatever.
For it  has not unfrequently happened that a palpitation of long
standing,  and which has been regarded as of a dangerous kind, has
gradually gone away of its own accord,  and  left us altogether in the
dark.   Dr. Cullen gives a confirmation of this remark in the follow-
ing very  instructive case :   " A gentleman  pretty well advanced in
life, was frequently attacked with palpitations  of his heart, which,
by degrees, increased both in frequency and violence, and thus con-
tinued  for two or  three years. • As the patient was a man  of the
profession he  was visited by many physicians who were  very una-
nimously  of opinion that the disease depended upon an organic af-
fection of the heart, and considered it as absolutely incurable.  The
disease, however, after some years, gradually abated both in its fre-
quency and violence, and  at length ceased altogether; and since
that time, for  the space of seven or eight years, the gentleman has
remained in perfect health, without the slightest symptom  of his
former complaint."*  A case precisely similar, and in a profession
al gentleman somewhat beyond the middle of  life,  also,  has occur-
red to the present author,  with a spontaneous  termination equally
as favourable.
   The same alternating spasmodic motion into which the muscular
substance of the heart is occasionally thrown by one or other of the
causes thus glanced at, seems, at times, to  take  place  in  some of
the larger arteries, and extends to a greater or less length in pro-
portion to the nature of the cause or the extent of  the morbid irri-
tability by which they are affected,  producing the second variety
before us.  That a morbid irritability may exist in a part of an arte-
ry while  the rest is free from any such  condition is easy to be con-
ceived, since a like partial irritability is often found to exist in or-
gans in which we are capable  of tracing it in the most  manifest
manner.  Yet even in arteries themselves we can sometimes ascer-
tain the same  to the conviction of our senses;  as for example in the
case of phlegmonous  inflammation;  in which, also,  we  find it ac-
companied with  the throb or alternating spasm and relaxation which
constitutes what is meant by palpitation.  In a healthy and ordina-
ry flow of the blood through the arteries it is very  well known that
there is no sensible series of contractions and dilatations whatever;
and we have already  observed in the Physiological Proem to the
third class that there is no  actual change of bulk of any kind,  and
that it is the pressure of  the  finger or of some  other substance
against the side of an artery that alone  produces a feeling of pulsa-
tion.!   In  a  phlegmonous inflammation, however, everyone is sen-

        * Mat. Med. Part. n. Chnp, viu, p. 357.
          Vol. n. p.14. 
276
NEUROTICA.
[CL. IV.-OR. h'l.
 «fible of a considerable change in this respect; for there is often a
 very smart and vibratory pulsation while the affected part is in per-
 fect freedom, and no finger is applied to it:  and that this is a pulsa-
 tion unconnected with the regular pulsation  of the heart is perfect-
 ly clear, because it is frequently less uniform,  rarely, if ever, syn-
 chronous with it, and, in most instances, twice as rapid.   We have
 here, therefore, a full proof of a local excess of irritability in an  ar-
 terial tube, and of a palpitation, or alternating spasm and relaxation,
 as  its effect.
   Yet inflammation is but one cause of such  subsultory action, or of
 the irritability which gives rise to it.   With other causes we are
 not much acquainted  ; but we have reason  to  believe  them  very
 numerous, and wherever they exist, the artery operated upon will
 evince  the same kind of vibratory throb,  though, in general, the
 stroke will not be found quite so smart as that  which takes place in
 the pulse of a phlegmon.   It may appear singular that  this  abnor-
 mal action, whether of the  heart or arteries, should evince so much
 punctuality in its vibration, but there is often a wonderful tendency
 to punctuality in all intermissive  affections whatever.   We see it in
 hemorrhoidal discharges,  in gout, and above  all, in intermitting fe-
 vers : and till the cause of such punctuality is  explained in this last
 instance, it will be in vain to expect an explanation in  the case be-
 fore us.
  In very irritable habits, or, perhaps, where  there is a morbid sen-
 sibility  through the whole of the sanguiferous  system,  the  palpita-
 tion will not unfrequently shoot  from  one artery  to  another; and
 one or two cases are  given  in the Ephemerides of Natural Curiosi-
 ties,* in which it appears  to have  been  universal.   It was so,  in-
 deed, in the very irritable organization of that singularly constitut-
 ed  character J. J. Rousseau, if we may credit  the account he gives
 of himself in relation  to this subject:  for he tells us, that after a pe-
 culiar paroxysm of high corporeal excitement, he became, all of a
 sudden, sensible of a pulsation in every part of his body, which from
 this time accompanied him  without  intermission:  and  he adds,
 somewhat  extravagantly,  that the throbbing  was so  distinct and
 strong that he was. often capable of hearing as well as feeling it.
  The temporal arteries are peculiarly apt to concur in this migra-
 tory throbbing, and occasionally the carotid;  and  the throbbing  of
both is sometimes synchronous with that of the heart and sometimes
successive  to it.  Mr. Dundas has  observed that this affection  of
 the carotids  is most common to  persons in the prime of life ; and
that,  on dissection, the heart is  often found enlarged in  its size,
but without  any increase  of muscular  power;  an  assertion col-
laterally supported by the  case of the young lady described under
 the preceding variety.  We here, also, sometimes meet with poly-
 pous  concretions, and very  generally adhesions to the pericardium.
  And it is highly curious and interesting  to notice the ramifying
* Eph. Nat. Cur. Dec. i. Ann. vi—vn. 
GE.H.-SP. III.]
NERVOUS FUNCTION.
277
  chain of morbid action of which the heart sometimes forms the first
  link.  I have at this moment a lady under my care, of delicate con-
  stitution and highly nervous habit, in the third month of pregnancy,
  who has for several weeks past been  uniformly attacked in  the
  evening with a violent palpitation in the heart, that  continues for
  nearly an  hour or upwards; it is  then transferred to the  temples
  which throb with as much  violence  and for as long a  period  of
  time ; vertigo follows with a  tendency  to deliquium, immediately
  after which there is  a general reaction in  the system; the skin  be-
  comes heated and at first very dry; but  the dryness at length yields
  to a gentle diaphoresis which concludes  the morbid series,;  for the
  patient, at this time becoming tranquil, drops into a sound  and  re-
  freshing sleep, and  wakes free  from all these  symptoms in the
  morning.
    In this case, also, there is a considerable tendency to that univer-
  sal subsultus or alternating spasm of the  arterial system to which we
  have just adverted:  for all the arteries  of the  extremities pulsate
  or palpitate whenever accidentally pressed upon by any substance,
  though it requires this additional stimulus to  excite the spasmodic
  action.
    Arterial  palpitation, however, is to be  found,  though not more
 frequently, still far more alarmingly in the epigastric region than
 in the head; and appears to  proceed  from some  particular ex-
 citement of  the  aorta,  the superior mesenteric, or some branch
 of the  coeliac artery.   Its beat  has  here  some  resemblance to
 that of an  aneurism of  these  vessels,  and  has  often  been pro-
 nounced to be such without the slightest foundation, to the great
 terror of the  patient, and  consequently to a  considerable  exacer-
 bation of the  disease.  It may, for the  most part, be easily dis-
 tinguished from an aneurism by being destitute of any circumscribed
 pulsatory tumour, that can be ascertained by a pressure of the fin-
 ger ;  by a smarter vibration in the arterial stroke; and by that de-
 gree of irregularity in the return of the stroke by which palpitation
 is distinguished from  pulsation.  In some cases,  indeed, the line of
 the affected  artery can  be distinctly felt and  followed up to a con-
 siderable length; and the vibration has occasionally been  so strong
 as to be visible to the eye, even at some  distance, when the surface
 of the epigastric region has been exposed to view.  " From a good
 deal of experience  upon this subject," says Dr.  Baillie,  " 1 am
 enabled to say  that the increased pulsation of the  aorta in the epi-
 gastric region, very  rarely depends upon any disease  of  the aorta
 itself, or of its large branches in that place ;  and that this occurrence
 is almost constantly of very little importance."*  This distinguished
 physiologist tells us further  that he has had an  opportunity of ex-
 amining the  state of the arteries in the epigastric region after death,
in two  persons who had this pulsation very strongly  marked, and
who died from other diseases.   In  both cases all the arteries were
* Med. Trans, iv. xix. 
278
NEUROTICA.
[CL. IV.-OR. m.
 perfectly  free from every appearance of diseased structure.  He
 was, also, some years ago, consulted by an old man upon a paralytic
 affection; who afterwards  spoke to him incidentally concerning a
 palpitation of'the kind before us, to which he had been subject for
 upwards of twenty-five years.  The throb, on  examination,  was
 distinctly to be felt; and on the patient's first perceiving it, and ap-
 plying to Sir Caesar Hawkins, Mr. Broomfield, and Dr. Hunter, the
 two former  had declared it  to be an  aneurism, while the latter,
 more  modestly, confessed that he did not know what it was.
   Dr. Baillie,  in the article  now alluded to, has imitated the mo-
 desty  of Dr. Hunter.  " It is, perhaps, difficult," says he, "to ascer-
 tain, in many instances, the causes of this increased pulsation of the
 aorta in  the  epigastric region :  but in most cases it will be found to
 be connected with an imperfect digestion, and an irritable constitu-
 tion."  And  hence,  whatever may improve  the digestion,  and  ren-
 der the  constitution less  irritable, will be of use in  mitigating the
 complaint: and above all, it will be found highly serviceable to re-
 move  the  patient's  anxiety on the subject,  whenever  it can fairly
 be done.
   But the throbbing or  pulsatory motion is  often communicated to
 other  organs than the sanguiferous vessels, and forms that variety of
 affection to which we have given the name  of complicated palpita-
 tion.  This is  clearly dependent, in many cases,  upon the vicinity
 or close  connection of  such organs with the heart or  arteries  that
 form the seat of disease ; and it may also in other cases be produc-
 ed, as  ingeniously conjectured by Dr. Young, upon an accumulation
 of  fluid in the pericardium or thorax,  which  transmits a  pulsatory
 motion from  the heart itself to whatever other organ, or surfa.ce of
 a cavity  such fluid may reach ; in the same manner as the fluctua-
 tion produced  by a  slight blow given to one side of the abdomen,
 when distended with water, is distinctly propagated to  the opposite
 side.   In the case of a middle-aged woman, of a rheumatic habit,
 labouring under symptoms of general dropsy,* " a palpitation," he
 tells us,  " was  observed in the right  hypochondriac region, and on
the right side of the neck, which exhibited a vibratory motion more
rapid and less regular than that of the pulse  felt at the wrist; and a
similar vibration was observable in the heart itself: the pulsation in
the neck was not confined to the jugular veins; it was more forcible
and extensive  than  it could  have been  if it had originated from
those vessels;  and it had  more the appearance of a violent throb-
bing of the carotid artery; although in the axillary artery the pulse
was comparatively regular and natural."   Dr. Young found, never-
theless, upon making a strong  pressure on the right side of the neck
with a single finger,  that the motion of  the carotid artery was very
perceptible, and totally independent of that of the superficial parts,
being precisely synchronous with the pulse at the wrist, although it
required  considerable attention to distinguish it from  the more ir-
* Med. Trans. Vol. v. Art. xvii. 
<3E. II.—SP. DI.]         NERVOUS FUNCTION.                £79

regular palpitation.   The  symptoms, however, of a dropsy of  the
chest or pericardium in this patient appear to have been  obscure;
and at  the time when the general hydropic enlargement, which  had
been much reduced in the course of the autumn, began to increase
towards the end of October, the palpitation was considerably less,
as well as the pulsations in the abdomen and neck, though  the  mo-
tion of the heart was still fluttering, the pulse  at eighty,  intermit-
ting and very  irregular.  On the death of the patient, which  oc-
curred soon afterwards, a considerable  quantity of  fluid was found
in the  pericardium, in the  right cavity of the thorax, and in  the
ventricles of the brain,  but little or none on the left  side of  the
chest: the heart was inconsiderably enlarged, and some of its valves,
as also some of those of  the pulmonary artery, were much ossified,
so that the free passage of the blood was impeded.
   I have said that palpitation is  sometimes dependent upon a mor-
bid irritability  cf the sanguiferous system in general.   In some in-
stances, however, we find it rather dependent upon a morbid irrita-
tion and debility of the entire frame, and consequently connected
with a very irregular performance of many or all the functions of
the body.   Of this highly complicated state of the disease we have
a striking example in Dr. Batemen's history of himself as given in
one of the volumes of the Medico-Chirurgical Transactions,* which
he ascribes to a poisonous action of mercury employed  on his  own
person copiously in the form of  an unguent to relieve an amaurosis
of the  right eye, and which seems to have produced something of
the mercurial  erethism described by Mr. John Pearson,! as taking
place in some  singular idiosyncrasies, already noticed by us under
the head of Syphilis.J  In this case the heart and arteries were
equally subject to subsultory and violent motions,  sometimes sepa-
rately, and  sometimes synchronously, but inaccordantly as to  the
number of the throbs in  a given time, and almost perpetually ac-
companied  with a most distressing sense of languor  and sinking.
There was  also a very irksome cough,  an occasional sense of  con-
striction across the  region of the diaphragm, and such a difficulty of
respiration as to  render  an erect position at night imperatively ne-
cessary.   Life  was,  in this case,  unquestionably a forced state of
being,  and  all  the stimuli of the external senses and  of the  will
seemed necessary to excite  the sensorial organ to a secretion of
vital fluid sufficient for the mere preservation of life^   And hence,
during sleep, or as soon as these stimuli were cut off, there  was
such an increase of languor, irregular action of the heart,  and
sinking, as though in the act of dying, that it was at times  necessary
notwithstanding  the  extreme drowsiness of  the  patient  from  a
previous and long continued watchfulness, to interrupt  the sleep
  * Vol. ix. p. 227.
  t Observations on the effects of various articles of the Materia Medica in Lu<*s
Venerea, ch. xii.
  X Vol. H. n- 562. 
280
>.EUROTICA.
[CL. IV.-OR. III.
 every two minutes; since by this time or even sooner, the failure
 of the pulse  and the appearance  of  the  countenance indicated a
 superveniog deliquium.  The  powers  of the  stomach, from the
 repeated paroxysms of the disease seem to have declined rapidly.
 Frequent supplies of food and cordials, as  spiced wine, appeared at
 first serviceable in warding off the languor; but at length nothing
 but  fluids  could be  taken and retained  without  increasing the
 disturbed action of the heart.  Yet so  extreme was the  sense of
 sinking and immediate dissolution, that, on one occasion, after a
 quarter of an hours sleep, air was  importunately demanded, and
 three glasses of undiluted brandy were drank in five  minutes, with-
 out much relief; and afterwards ammonia and ether repeated every
 ten minutes for two hours ; when the paroxysm rapidly declined after
 a  copious  discharge  of limpid urine.  The  disease  continued a
 twelvemonth before the patient  felt, in any essential degree, amend
 ed:  and little benefit was derived  from medicines  of any kind.  It
 is well known, however, that  this acute pathologist, and excellent
 man, has since fallen a sacrifice  to a return of the complaint.
   In  a disease  produced  by so great a diversity  of causes,  often
 obscure, and very generally complicated with other  affections, it is
 impossible  to lay down any one plan of treatment that will apply to
 every case.  Our first endeavour should be to  ascertain, as far as
 we may be able, whether the palpitation be idiopathic or sympto-
 matic ; and if the last, while  we endeavour to palliate the present
 distress,  our attention should  chiefly  be directed  to the  primary
 malady.  If acrimony or any other  morbid  state of the stomach or
 bowels be  suspected, this, as far as possible, should be removed;
 and if  we have reason to suppose hydrothorax or any other kind of
 dropsy, the  means hereafter to  be recommended for this tribe of
 complaints  should be  resorted to from the  first.  In pregnancy, the
 disease  will most probably cease upon a  cessation of this state of
 body, and usually, indeed,  ceases during  the  latter months, or after
 the period  of quickening.   And  if it  seem to be chiefly dependent
 upon  a general  irritability of the sanguiferous system, or  of the
 whole constitution, the sedative antispasmodics, tonics, and especially
 the metallic, quiet of mind as well as of body, regular hours,  light
 meals, pure air,  and such  exercise  as  agrees best with the indivi-
 dual, will often produce an essential service and sometimes effect a
 radical cure.
   Much  of this  plan  will also be requisite where  we have reason
 to apprehend some structural affection of the heart  or larger blood-
 vessels :  and when, from any incidental excitement  the irritation is
 here more than  ordinarily troublesome, recourse must  be  had to
 narcotics.  Opium is by  far  the  best where  it agrees  with the
 system :  but its secondary effects are often  very distressing, and we
 cannot employ it.  In such cases we must find out, by trial, what is
 its best succedaneum : the hop, henbane, hemlock, and prussic acid,
have  all been  essayed in their  turn,  and  sometimes one has suc-
ceeded  where the  rest have  all failed.  But upon the whole the 
oe. ii.-sp. in.]
NERVOUS  FUNCTION.
281
 henbane has answered  far better, and more generally  under the
 author's own hands; and in one or two instances of great obstinacy
 he has known it effect a perfect cure, when all the rest had  been
 tried in succession and had totally failed.
   In Dr.  Bateman's case, however,  which was peculiarly severe
 and complicated, the henbane though it seemed serviceable at first,
 taken  in doses of from three to five grains of the extract every
 njght, gradually lost its effect even  when repeated three  times  a
 night in doses of five grains at a time.   The tincture of hop, in
 doses of thirty drops,  every six hours, was next tried, but produced
 no other effect  than a slight drowsiness.   Musk seemed  most
 successful in  draughts of ten  grains  each;  yet even this was of
 transient duration,  and  was  abandoned as of no use.  Where the
 palpitation is accompanied with a distressing tendency to  deliquium
 I have occasionally relieved  it by camphor pills,  with the  ammo-
 niated tincture of valerian or the aromatic spirit of ether.
   The disease has occasionally been carried off by a sudden attack
 of some other complaint, as gout, herpes,  diuresis,* or the formation
 of an abscess : and hence, setons, and issues have been recommended
 and have occasionally  proved serviceable.   Zacutus Lusitanus found
 the latter produce a radical cure in a  palpitation of the heart which
 he ascribed to the rapid  healing of some chronic ulcers.*  Schenck
 advises the wearing a bag of aromatics at the pit of the  stomach ;t
 and hence, perhaps, the origin of camphor-bags  as a specific for
irregularities of the heart of another kind.
                        SPECIES  IV.

                CLONUS  NICTITATIO.

                STfofnfcltng of tftr SSgMOrs.

          rapid and vibratory motion of the eve-lids.

To a certain extent, twinkling or winking of the eyes is performed
every minute without our thinking of it.  It is a natural and instinc-
tive action for the purpose of cleansing and moistening the eye-ball,
and  rendering it better fitted  for vision.  Dr.  Darwin has  some'
ingenious remarks upon this subject.   " When the cornea," says he,
" becomes too dry it becomes  at the same time less transparent,
which is owing to the pores of it being then too large ;  so that the
particles of light are  refracted by the edges of each pore instead of
passing  through  it; in  the  same manner  as light is refracted by
             * Prax. Hist. Lib. via. Obs. 30.
             t Lib. n. Obs. 216.
VOL. III.                    36 
282                     NEUROTICA.            [CL. 1V.-OR. UI.

passing near the edge of a knife.  When these pores  are  filled
with water, the cornea becomes again transparent."*  Moisture .s
indeed, a frequent cause of transparency in various bodies; and
hence,  in  dying people whose eye-lids  are  become torpid and
do  not  nictitate, the  cornea is  sometimes so  dry that its  want of
transparency is visible to by-standers.  So  when white paper is
soaked in oil, and its pores filled with this fluid from an opake body
it becomes  transparent, and radiates the  light that is thrown upon
it:  air itself is most transparent  when as much moisture is dissolved
in it as it will hold; when void  of moisture, indeed, it forms a dry
mist, which is  occasionally met with in the morning, and  through
which distant  objects are seen indistinctly; while, on the contrary,
when distant objects are seen with perfect clearness it is a sign of
rain.   In a mist, distant objects  are also seen indistinctly ; yet here
the moisture is not dissolved in the atmosphere but merely suspended,
and formed  by the  attraction  of cohesion into collected  spherules.
We may hence account for the want of transparency in  the air,
which is seen  in tremulous motions over corn-fields on hot summer-
days, and over brick-kilns, after  the flame is extinguished, while the
furnace still remains light.  It  is this dryness and  want of trans-
parency in the atmosphere over the summits of hot and arid hills,
in a bright  unclouded sky, as in Italy,  which constitutes  what is
called by the painters  the blue  shade of  light, and which is copied
in most pictures of Italian scenery.
  The ordinary use of nictitation is  therefore  obvious:  but there
are many   persons who wink  or twinkle  their eyes  far  more
frequently   than is necessary for the purpose of moistening the
cornea, and in whom it forms an unsightly habit.   This has usually
been produced at first by some  local  irritation, as inflammation or
dust in the eyes, which quickens the natural action, and,  where the
stimulus is  considerable, renders it irregular and convulsive.  If
indeed the  stimulus be very vehement, the nature of the  spasm is
changed, and  the  eye-lids, instead of irregularly opening and shut-
ting with great  rapidity,  become rigidly closed; and such is the
force  with  which the  orbicular muscles contract themselves on
some occasions that they will snap a steel instrument that  happens
at the time  to be introduced between them; a fact that, as we  have
already observed, has in one  or two instances occurred in perform-
ing the operation for extracting a cataract, during which the knife
has been broken short off.
   We have seen in many of the preceding species of diseases with
 what ease morbid actions are continued  when once introduced into
 an organ:  and hence when any permanent irritation of the eye has
 excited and maintained for some days or weeks a quick  repetition
 of twinkling,  this  iterative action will  often  be found  to  become
 habitual, and  remain after the irritation  has  subsided.
* Zoonom. CI. I. i. 4. 2. 
GE. II.-SP. IV.]         NERVOUS  FUNCTION.               ^oJ

  This morbid habit has been  sometimes cured  by a powerful ex-
ertion of the will; but more generally by using one eye only at a
time, and closing the other:  the open eye being employed in ex-
amining  an object  for a  considerable period with  great attention
and steadiness.   A minute examination of the stars at night through
a telescope has  a like corrective tendency and may be employed
for the same purpose.
                         SPECIES V.

                CLONUS  SUBSULTUS.

                         EfottcJunfls.

          SUDDEN and irregular snatches of the tendons.

 This affection is  to  the  tendinous  extremities of the muscles, in
 which the principle of irritation is often  apt to accumulate, what
 palpitation is to the irritative fibres of the heart and arteries: and
 hence, as we have already seen, it is  included under  the  general
 term of palpitation by Vogel.
   We witness these starts or twitchings most frequently in extreme
 stages of debility produced by atonic fevers, and especially just be
 fore the act of dying.  They are,  in such cases, weak convulsions
 interruptedly  undulating  from one  limb  or  part of a limb to an-
 other, too feeble to raise the limb  itself,  although sufficiently pow-
 erful to give slight but transient swellings  to the belly of a  muscle,
 and consequently a slight involuntary flickering to its tendons.  In  /
 the ordinary close of life they are  the precursors of the fatal scene,
 the harbingers of the  dying struggle,  and generally indicate that
 the will  has lost  its  hold, and  the  power of sensation is  rapidly
 ceasing : thus affording another proof, if other proofs were wanting,
 to those adverted  to in the Proem to the present Class, that the ir-
ritative  fibres are capable of secreting their peculiar fluid for them-
selves, and of maintaining their function,  under particular  circum-
stances, for a much later period  than the organs of  perception and
sensation, occasionally, indeed, for some  hours after the  death of
every other part of the body.  And as debility and irritability often
exhibit a  joint march, the subsultory motions are apt to  become
stronger, as the regular motion of  the pulse becomes weaker, and
at length work up those agonizing  convulsions under  which the lit-
tle and  loitering flame of life  is  sometimes  extinguished  instan-
taneously.  Such twitchings of the  tendons, however, do not always
prove fatal: for they often show themselves where the case is not
so extreme: and  hence, they may occasionally  be allayed   by cor«
dials,  antispasmodics, and warmer sedatives, and are altogether lost
in a favourable turn of the disease. 
284
NEUROTICA.
[CL. 1V.-OR. HI.
   It occasionally happens, that  the  debility producing these  weak
 convulsive actions is local, and habitual;  and in such  cases they
 may be seen to  agitate and play over  a limb without any influence
 on the system generally, and without much injury to the limb  itself.
 Such a state of nervous  constitution may be produced by accident,
 but  it is for the  most part strictly idiopathic: and  there  are few
 practitioners,  perhaps, who have not met with  examples of it.  Dr.
 Darwin gives us an instance  in  the  following  words: " A young
 lady, about eleven years old, had for five days had a contraction of
 one  muscle in her fore-arm, and another in her arm, which occur-
 red four or five  times every minute ; the muscles were seen to leap
 but without bending the arm.  To counteract this new morbid ha-
 bit, an issue was placed  over the convulsed muscle of her arm, and
 an adhesive plaster wrapped tight like  a bandage over the whole
 fore-arm, by which the new motions were immediately destroyed,
 but the means were continued some weeks to  prevent a return."*
 The author has  sometimes seen it about one of  the shoulders, but
 the extremities are its most usual seat; and he  was lately consulted
 by a lady of a strikingly irritable habit, who was  suddenly attacked
 with it both in her hands and feet,  so as to throw her into a con-
 siderable degree  of alarm.  Upon  inquiring into  the patient's age
 and state of health, he was informed that she was  between forty and
fifty, that menstruation was on the point  of leaving her, and had of
late appeared very irregularly, and that  she had a considerable op-
pression in her head.  The cause  was  therefore obvious, and the
cure was not difficult; for it yielded  to a  moderate  venesection,
and an habitual attention to the state of the bowels
                        SPECIES VI.

              CLONUS PANDICULATIO.

                       ^anfcfcttlatton.

transient elongation of the extensor muscles, usually with deep
              inspiration and a sense of lassitude.

This is, perhaps, the slightest modification of spasmodic actions, but
as it often occurs, as in  nausea on the first stage of a febrile pa-
roxysm, whether the will consents or not, and  is frequently and ir-
regularly repeated,  it cannot but be regarded as belonging to the
present family on many occasions.  The muscles chiefly concerned
are the extensors  of the  lower jaw and of the limbs: the particular
kind of pandiculation to which the first of these movements gives rise
v Zoonomia, Catenation^Sect. xvn. !. 3. 
GE. II.-SP. VI.]
NERVOUS FUNCTION.
285
 being called  oscitancy, yawning or gaping ; and that produced by
 the second stretching.  The muscles are  excited to  this peculiar
 action by a general feeling  of restlessness or disquiet;  and the
 spread of the action from one  muscle or set of muscles  to another
 is from that striking sympathy or tendency to catenate in like move-
 ments which we so often behold in different parts of the body with-
 out being able to  explain.  It is possible,  however, that  the syn-
 chronous motion of the muscles of the lower jaw, and of the limbs,
 for it is rarely that yawning and stretching do not accompany each
 other,  may  be dependent  upon the  same  line of  intercourse  by
 which trismus so often accompanies a wound in one of the  extremi-
 ties,  and  which we have already attempted to illustrate:  the irri-
 tant power in the one case, leading to a  fixt or entastic;  and in the
 other to a transient and  clonic spasm.
   Pandiculation, considered physiologically, is an  instinctive  exer-
 tion to recover a balance of power between the  extensor and flexor
 muscles,  in cases in which  the former have been encroached upon
 and held  in subjection by the latter.
   A  very slight survey of  the animal frame will show us  that the
 flexor muscles have, in every part,  some  preponderancy  over the
 extensors; and that this preponderancy  is  perpetually counteracted
 by the stimulus of the instinct or of the will.  We see it, from the
 first stage of life to the last, and most  distinctly in those states, in
 which there is most feebleness, and consequently in which  the con-
 trolling powers are least capable of exercising and maintaining a
 balance.  In the fetus,  therefore, in which the' weakness is most
 pressing,  the  power of instinct is merely rising  into existence, and
 no habit of counterpoise established  in  the nascent fabric, every
 limb, and part of every limb capable of bending,  undergoes some
 degree of flexure, and the entire figure is  rolled into a ball as the
 hedge-hog habitually rolls himself,  even after birth.  As the fetus,
 however, increases in size  and age, and  the powers of instinct, sen-
 sation, and volition become more perfect,  this  general conflexure
 produces  occasionally a sense  of uneasiness; and hence every par-
 turient mother is  sensible of  frequent internal  movements  and
 stretchings of the little limbs of the fetus to take off the uneasiness
 by restoring some degree  of balance  to the  antagonist  powers.
 After birth, and during wakefulness,  the stimulus  of the  will,  di-
 rected rather to the extensor than the flexor muscles, renders the
 counterpoise  complete for all  the purposes for which it may be ne-
 cessary.   But the  moment  we repose ourselves in  sleep, and the
 will becomes inactive and withdraws its  control, the flexor muscles
 exercise their preponderancy afresh,  though in a  less degree than
 in fetal life, since  the  extensors, from habitual use, have  acquired
 a more than proportionate increase of power.  The preponderancy.
 however,  when long exerted, still produces some degree  of dis-
quiet, and hence," occasionally during sleep, and still more vigor-
 ously, the moment we begin to awake, we  instinctively rouse the
extensor muscles into action ; or. in other words, yawn, stretch the 
286                      NEUROTICA.           [CL.  1V.-OR. III.

limbs, and breathe deeply, to  restore  the  equipoise that has  been
lost during unconsciousness.
  In all these cases, pandiculation is a natural action; it is an effect
produced by the will when it is called  to the  particular state of
these two sets of muscles, or by the instinctive or remedial power
of nature, which supplies its place, when it is dormant or inattentive,
to restore ease to a disquieted organ.  But in an  infirm  or debili-
tated  condition of the system, it evinces a morbid and convulsive
character, and takes place without our being able to prevent it even
when the  will uses its utmost  effort to resist instead of to encou-
rage it.
  How  far its repetition may be of use in the  shivering fit of an
ague, or in a nauseating deliquium of the  stomach it may be difficult
to say.  Yet we are at no loss to account for its frequency of recur-
rence :  for as the whole  system is, in such circumstances, thrown
into a sudden  prostration of strength, the extensor-muscles in con-
sequence of being naturally  weaker than  their antagonists, must be-
come soonest exhausted, and give way with a more than  ordinary
submission to their power.   And hence we behold a painful retrac-
tion over the whole system, and the preponderancy assumes a rigid
and spastic  character:  and  we may fairly  conclude that  much of
the yawning and stretching that ensues is for the purpose of getting
rid of the constrictive spasm, though these  counteractions  them-
selves often run, in the attempt, into a spasm of another kind,  and
become convulsive.
  Yawning  and stretching,  then,  are among  the  signs of debility
and lassitude.   And hence, every one who resigns himself inglori-
ously to a life of lassitude and  indolence will be sure to catch these
motions as a part of that general idleness which  he covets.  And in
this manner a natural and useful action is converted into a morbid
habit; and there are loungers to be found in the world, who, though
in the prime of life,  spend their days as well as their nights in a
perpetual routine of these convulsive movements over which they
have no power; who cannot rise from the sofa  without stretching
their limbs, nor open their mouths to answer a plain question without
gaping in one's face.  The disease is here idiopathic and chronic:
it may, perhaps, be cured by a permanent exertion of the will,  and
ridicule or hard labour  will generally be found  the  best  remedies
for calling the will into  action. 
GE. III.-SP. I.]       NERVOUS FUNCTION.                 287



                     GENUS  III.


                       SYNCLONUS.

                     Sgnclom'c Syasm.

TREMULOUS, SIMULTANEOUS AND CHRONIC AGITATION OF VARIOUS MUSCLES',
              ESPECIALLY WIEN  EXCITED BY THE WILL.

We  have  already observed that clonus imports " agitative," of
" tremulous motion of the muscles;"  and hence synclonus means
necessarily their " multiplied conjunctive, or compound agitation, or
tremulous  motion."   The term is, therefore, intended to denote a
group of diseases more complicated  in form, of more  extensive
range, or more connected with the general state  of the constitution
than  those of the preceding genus;  and it runs  parallel with the
clonici universales of Sauvages as far as  they can be said correctly
to belong to this family. The  species  included under this genus
will be found to be the following:

     1. SYNCLONUS TREMOR.             TREMBLING.
    2. ■--------- CHOREA.              ST.  VITUS's DANCE.
    3.---------BALLISMUS.             SHAKING PALSY.
    4. --------- RAPHANIA.             RAPHANIA.
    h. ■--------- BERIBERIA.             BARBIERS.
                         SPECIES I.

               SYNCLONUS  TREMOR.

                         2Trrmftititfi.

SIMPLE TREMULOUS AGITATION OF  THE HEAD,  LIMBS, OR BOTH ;  MOSTLY
                 ON  SOME VOLUNTARY EXERTION.

The proximate cause of this disease is an irregular secretion or flow
of irritable power into the motory fibres of the muscles that consti-
tute its seat.   It is hence strictly a disease of nervous debility,
either general or local: debility produced  by sudden exhaustion, as
in the case of great muscular fatigue, from violent exercise, severe
cold,  or a vehement  exertion of the passions, and particularly the
passions of fear and rage; or debility produced slowly and insensibly
by causes of tardy operation, as an injudicious use of mercury, lead,
opium or other mineral and narcotic poisons; an habitual excess in 
288
NEUROTICA.
[CL. IV.-OR. III.
 hard drinking or sexual commerce,  and, in some idiosyncrasies, an
 immoderate  indulgence in tea.  And,  as  this disease is a result of
 debility, it necessarily  occurs as a symptom on  the  general  spasm
 and prostration of strength that so peculiarly distinguish the acces-
 sion of an ague-fit, and the interrupted flow of sensorial power that
 takes place in paralysis.
   There are some persons, however, in whom the same convulsive
 action exists  habitually without any morbid state of any other or-
 gans, or any other inroad upon the general health.  I once knew a
 lady, considerably beyond the middle of life, who  was strikingly
 affected with this complaint,  insomuch that the  slightest  voluntary
 exertion of any of the  muscles threw the head and arms  into as
 great a tremor as if they had been hung  upon wires,  but who en-
joyed at  the  time,  and had for a long term of years continued to
 enjoy, as perfect  health as possible in every other respect;  was
 lively, cheerful, animated, possessed  of brilliant powers of con-
 versation, and able to use a more than ordinary  portion of exercise
 without fatigue.
   The earlier  part of her life had  been passed in  India, but  her
constitution did not appear to have suffered from this circumstance;
and so gradual was the  attack of the affection, that though she  had
laboured under it for many years, she could not date its commence-
ment from any  given point of time.   She at length died at the  age
of seventy-two or seventy-three, her corporeal powers progressively
declining, and laying a  foundation for  a general dropsy, while  her
mind continued firm to the last.
   In all cases of this  kind the course of  the nervous fluid  in its
passage  through  the  motory  fibres of the  affected  muscles, is
morbidly interrupted  at every jet,  and where  the organ  or  the
constitution is in a state of debility,  it  flows also less abundantly as
well as less uniformly.   We  have already observed that  this fluid,
in its natural course, flows only by waves or vibrations, and conse-
quently with  an interposing pause or relaxation  after every efflux:
but that the pause is instantaneous, and the supply so regular as to
answer the  purpose of a  permanent  and continuous tenour.   In
clonic tremor the pauses are, however, prolonged, and for the most
part irregular  or  untrue  to themselves; and  the' greater  the
retardation and  irregularity  the  more marked  and alarming  the
spasmodic shake.
  In the case just adverted to, there was no other diseased action
whatever;  the nervous  fluid  was unquestionably supplied in suffi-
cient abundance, and the pauses, though prolonged, were uniform;
and it was singular to observe the influence the will  possessed over
the affected muscles under these circumstances, and how completely
they were  still under its control: for in consequence of the unifor-
mity of the morbid interruptions, and  from  the force  of habit,  I
have seen this  patient, in the midst of a  shaking that  threatened
every moment to overturn whatever she took hold  of,  raise a  cup
brim-ful  of tea, or a glass brim-ful of wine to her lips by way of
experiment, without spilling a single drop. 
GE. III.—SP. 1.]
NERVOUS FUNCTION.
289
  Where the corporeal health is so little interfered with as in the
presen;  case, a course  of  medical treatment  might,  perhaps, do
more mischief than benefit.   But where the constitution is generally
affected, or the muscles that form the  seat of the  convulsion are
manifestly debilitated,  general and  local tonics  and stimulants may
sometimes  be tried with advantage, though they frequently fail of
producing  any  good  effects.  Sea-bathing and horse-exercise,  a
generous diet, change of air and scene, may be found useful auxilia-
ries in the  general treatment; and long  continued and daily  friction
by  a skilful rubber, ammoniacal embrocations,  blisters, setons, and
a course of voltaism or electricity offer the best promise, as topical
means of relief.  The  affected limbs may also be put into a  train of
gradual exertion for  the  purpose of obtaining both strength and
steadiness: and to this end the  head or  shoulders may be occasion-
ally made to balance an easy weight for  a given period of time, and
the hands to suspend  or carry a  wine-glass or tumbler  brim-ful of
v ater.
                         SPECIES  U.

               SYNCLONUS  CHOREA.

                    St. Situs's iSancc.

ALTERNATELY TREMULOUS AND JERKING MOTION OF THE FACE, LEGS, ANB
  ARMS, ESPECIALLY WHEN VOLUNTARILY CALLED INTO ACTION ; RESEMBLING
  THE GRIMACES AND GESTURES OF BUFFOONS J  USUALLY APPEARING BEFORE
  PUBERTY.

The term chorea from %o£os " chorus" " ccetus saltantium,*'  is com-
paratively of modern date in its application to the present disease,
nor is it easy to determine satisfactorily who first employed  it.   It
was  first  more  limitedly denominated  chorea sancti viti, under
which limitation it occurs in Sydenham, and  is still known  in
popular language,  being  called in colloquial English,  St. Vitus's
Dance, and in colloquial French, Dance de St. Guy.   According to
Horstius the name of St. Vitus's Dance was given to this disease, or.
perhaps, more probably to a disease possessing some resemblance to
it, inconsequence of the cure produced on certain women of disorder-
ed mind, upon their paying a visit to the chapel of St. V itus, near Ulm,
and  exercising themselves in dancing from morning to night, or till
they became exhausted.  He adds that the disease returned annually,
and  was annually cured by the same means.
  The marvellous accounts  of this dance,  as related by old writers.
are amusing from their extravagance.   The paroxysm of dancingl
we  are told, must  be kept up whatever be the length of the time^
   vol. in.                 37 
290
NEUROTICA.
[CL. IV.-OR. Hf*
lill the patient is either cured or killed ; and this, also, whether she
be young or old, in a state of virginity or of parturition ; and in the
growing energy of the action we are further told that stools, formsT
and tables are leaped over without difficulty if  they happen to be
in the way.   Felix  Plater gravely tells us  that he knew a  woman
of Basle, afflicted with this complaint, who, on one occasion danced
for a month together :* and the writers add  generally that it  was
hence  necessary to hire musicians to play in rotation, as  well as
various strong sturdy companions to  dance with the patients till
they could stir neither hand nor foot.f
  The nearest approach to this kind of gymnastic medicine which
I am acquainted  with in  modern  times, is a  singular case of the
same disease described  by Mr.  Wood in the seventh volume of the
Me.iico-Chirurgical Transactions.   The morbid  movements were
in measured time, and constituted a sort of regular dance as soon as
music was struck  up, but ceased instantly upon a change of one time
to another, or upon a more rapid roll of the drum, which was the
instrument employed on the occasion, thftn the  morbid movements
could keep up with.  Advantage was taken of the last part of  this
very singular influence, and the  disease  was  cured by a perse-
verance in discordant or too rapid time.  This form of the disease
appeaj's to have  a  near relation  to the taranlismus  of Sauvages,
which  is the carnevaletto  delle  donne of  Baglivi, all  of them
probably nothing more than modifications of the  present.   Linneus.
and after him Macbride, from  the epithet  of  sanctus, as  applied to
chorea, or a belief that such affections-are induced by the immediate
agency of a superior order of  beings, have applied to it the name
of  hieroxosos, or " morbus sacer"'—a name,  however, which, by
earlier  writers, ivas appropriated to convulsion-fits.
   In Galen chorea seems to  be included under a disease which he
carls scelotyrbe, literally, " cruris turba or purturbatio,"—u commo-
tion of the leg ;" and his description which is as follows, is extremely
accurate.   " It is a species of  atony or paralysis, in  which a man
is incapable of walking straight on, and is turned round to the left,
when the right leg is put forward, and to the right, when the left is
put forward,  or alternately.  Sometimes he is incapable of raising
the foot, and hence drags if awkwardly as  those that  are climbing
up steep cliffs."
   One  of the  best  general descriptions  which have been given
us  of chorea, is the  following  of Dr. Hamilton, contained in  hi*
valuable  treatise  on  the  utility  of  purgatives: '; Chorea Sanc-
ti  Viti attacks boys and  girls  indiscriminately; and  those chief-
ly  who are of a weak constitution, or whose  natural good health
and vigour have been impaired  by confinement,  or by  the  use
 of scanty or  improper nourishment.   It  appears most  common-
* De Mentis alicnat. Cap. iii.
v Paiacels. De Morb. Anicntium. TracUi.
  Sbeuck. De Mania. Lib. i. 
 VE.III.-SP.il.]       NERVOUS  FUNCTION.                 2^1

ly from  the  eighth  to the  fourteenth year.   I  saw it in  two
young women  who were from sixteen to  eighteen years of age.
The approaches of chorea arc slow.   A variable and often a raven-
ous appetite, loss  of usual vivacity and playfulness, a swelling and
hardness of the lower belly, and, in  general, a constipated state of
the bowels, aggravated as {he disease  advances, and slight, irregular,
involuntary motions of different muscles, particularly those of the
face, which  are  thought  to  be the  eflect of irritation, precede
the  more violent  convulsive  motions,  which now attract the at-
tention of the  friends of the patient.
   " These convulsive  motions vary.   The muscles of the extremi-
ties and  of the face,  those moving the  lower jaw, the head, and thr-
trunk of the body, are, at different  times,  and in different  instan-
ces, affected by it.  In this state the  patient does not walk steadily;
his gait resembles a jumping or starting; he sometimes cannot walk
at all, and seems palsied ;  he cannot perform the common and ne-
cessary motions with the affected arms.  This  convulsive  motion
is more or less violent; and is constant except during sleep,  when,
in most instances, it ceases altogether.   Although different muscles
are sometimes successively convulsed, yet in general, (he  muscles
affected in the early part of the disease remain so during the course
of  it.   Articulation is now impeded,  and  is frequently •complete-
ly suspended.    Deglutition is also  occasionally performed  with
difficulty.  The  eye loses  its lustre  and  intelligence; the  coun-
tenance is pale and expressive  of  vacancy and languor.  These
circumstances give the patient a fatuous appearance.  Indeed-there
is every reason to believe that when the  complaint  has. subsisted
for some time, fatuity to a certain extent interrupts the exercise of
the mental faculties."
   Thermaier  gives a case in which  it  was  connected with a deep-
ly melancholy temperament, and  the limbs were  in a state  of con-
stant snatching and  trepidation :* but  this is a  rare  concomitant;
nor is fatuity  a constant sequel of it even in its most obstinate and
chronic form.   The present author has met with various  instances
in  which  the disease  has  continued with  considerable  violence
from an  early period to  old  age,  without  making any   inroad
whatever on the mind, or even spreading to any other joints, limbs,
or muscles, than those at  first aflccted.  He once knew a man un-
der the habitual influence of this complaint who was a good orator,
always reasoning with great clearness, and delivering himself with
much animation.  The movements of  his arms were indeed in un-
graceful snatches, and  the muscles of the neck frequently evinced
a like convulsive start, yet not so as to interrept the flow  of his pe-
riods, or to abridge his popularity.   He knew  another person fur
many years severely afflicted  with the same  complaint,  who was
au excellent musician, public singer, and composer of music; an;1.
this, too, notwithstanding that he was  blind from birth.   The  per-
son alluded to is the  late Mr.  John Printer of the Foundling Hospi-
Co-av). Lib. ii, ^n. >::. 
292
NEUROTICA.
[CL. IV.-OU. Hi.
tal.  In walking he was always led on account of his blindness and*
used a staff on account of the unsteadiness  of his steps;  but, not-
withstanding every exertion, his gesticulation was extreme, and so
nearly approaching the antics of a buffoon, that it was often difficult
for a spectator to suppress laughter.   Yet in singing and playing he
had a perfect command over the muscles of the larynx and of the
fingers; his tones were exquisitely  clear and finely modulated;
but his neck  and head  curvetted  a little occasionally.  He died
when about sixty years of age, without ever exhibiting any debility
of intellect.
   There is a singular form of this disease which has been called by
some writers malleatio, consisting in a convulsive action of one or
both hands which strike the  knee like a hammer.  In this case the
hands  are usually open,  but sometimes  clenched.   Morgagni* re-
lates a case in which it came on even in the sound  hand, if the fin-
 fer of the affected one  were extended.  If  the motion  be forci-
 ly slopped, the  convalsion becomes afteeward still more  violent
and general.
   Where the system is disposed to hysteria the paroxysm is  some-
times extremely vehement,  and partakes of the constitutional dia-
thesis, making an approach  to epilepsy, but distinguished from it
by a continuance of consciousness and sensibility.   Dr. White, of
York,  has given us a striking example of this mixed affection in a
lady forty-two years of age, who " had always a very weak  system
of nerves," and was rendered speechless for an hour or two  upon
any sudden surprize.   In November, he tells  us she was affected
with a fresh paroxysm, which, upon being sent for, he describes as
follows :—" She complains of a violent pain in the right side of her
face, and of universal erratic aches and soreness.  There is a scorch-
ing heat all over the skin, except  from  the feet up to the ancles,
which are as cold as marble.  Pulse not quickened but full; mouth
dry but no great thirst; body costive, which  is indeed her natural
habit, so as to oblige her to  the frequent use of magnesia.  She is
regular as to the  menses, the return of which she expects in five
or six days.  Appetite good, rather voracious ; but her spirits al-
ways low after a full  meal, especially dinner.   Has  a violent pain
in the loins, which often shifts from  hip  to hip : the leg of the ach-
ing side being so much affected with stupor and numbness, that she
drags it after her in walking.  She  falters in  her speech at times.
but this does not continue long.  All the  muscles of the body evince
convulsive motions; not  simultaneously but successively :  thus, her
face is first violently affected, then  her  nose,  eye-lids, and whole
head,  which is thrown forcibly backward, and often twitched  from
One side to the  other  with exquisite pain.   From  this quarter the-
convulsive action removes first into one arm, and then into the oth-
er :  after which  both legs  immediately  become convulsed with vio-
lent and incessant motions, and in this manner all the  external parts
* De Sc]ibus> x. 1G. 
GE. HI.-SP. II.]       NERVOUS  FUNCTION.                  29.3

of her body are affected  by turns.  She  is  all the  time perfectly
sensible, and knows  what  limb  is going to be attacked next, by a
sensation of something running  into it from  the  part already con-
vulsed, which she cannot describe in words: but the foretoken has
always been found to be  true, though the transition is surprisingly
quick.  She is easiest in a prone posture."  " Such," continues Dr.
White, " has been her situation  upwards of forty-eight hours with
scarce a moment's remission, by which she complains of great and
universal soreness.  No  words can convey an adequate idea of her
odd appearance : and I do not in the least wonder that in the times
of ignorance and  superstition, such diseases  were  ascribed to super-
natural causes and the agency of demons."*  Even Dr. White him-
self applies to it, perhaps in imitation of  Sauvages,  the  name  of
hieronosos.
   The  predisponent cause of this disease  is an irritability of the
nervous system, chiefly dependent upon debility, and particularly a
debility of the stomach and its collatitions organs.   Most of the dis-
eases of children are  seated in  this quarter; and it is from this
quarter therefore, that chorea commonly takes its  rise,  and shows
itself in an early period  of life ; the ordinary  occasional causes be-
ing bad nursing, innutritions diet, accumulated feces, worms, or some
other intestinal irritant.
   About the  age  of puberty there is  another kind of general irrita-
tion that pervades the system ; and where this change does not take
place kindly, which is frequently the case  in weakly habits, the ir-
ritation assumes a morbid character, and is exacerbated by a con-
gestive state of the vessels that  constitute its more immediate seat:
and chorea takes its rise from this cause.
   In effect where the predisponent cause of an irritable state of the
nervous system is very active and predominant, a  local or tempora-
ry excitement of any organ, and almost at  any period of life, by in-
creasing the  irregular flow or disturbed balance of the nervous fluid,
will give rise to  the convulsive  movements of chorea: and hence it
is that we find it so  frequently united with an hysteric diathesis.
On this account it has been produced by a  fright,! by a wound pe-
netrating the brain through the  orbit of the eye,J by an improper
use of lead, mercury, and some other metals,§ and by  suppressed
cutaneous  eruptions.||
   From this view of tho  general nature  and origin of the  disease,
we can  be  at no loss to account for the great benefit which has been
derived from a steady course of brisk purging in recent cases  or
those of early life: for this,  while  it carries off the causal acrimo-
* Edinb. Med. Comment. Vol. iv. p. 326.
t Stoll, Rat. Med. Part m, p. 405.
+ Geash, Phil. Ttans. Vol. liii. 1763.
$ De Haen. Rat. Med. Part. m. p. 202.
[[ Wcndt, Nachriclit von dem Krankeninswu? 7a\ Eiian^n, 1783. 
294
>,EUROTlCA.
[CL. IV.-OR. III.
ny, or unloads the infarcted viscera, seems at the same time to act
the part of a revellent, and to prohibit the return of the paroxysm
by a new excitement.  It may appear perhaps strange to those who
have not thought upon the subject, that where the disease  has pro-
ceeded from intestinal irritation, it should be carried off by intesti-
nal irritation also.  But the irritations are of very  different kinds:
and it is so far from following of necessity that, because  one kind of
irritation applied to a particular organ excites a particular effect in
a remote part, another will do the same, that the converse is more
commonly true, and that any other kind of irritation applied to the
same organ, by exciting a new action, will be the most effectual way
of taking off or preventing such  effect  And it is upon this ground
alone that we often endeavour to cure rabies, trismus, and tetanus,
by  laying open  the original wound  to a considerable extent,  or
the application  of some  new stimulus that may answer the same
purpose.
  The principle being a general one it does  not seem of much con-
sequence what purgative  is  employed, provided it be sufficiently
powerful: though, where worms are suspected,  the essential oil of
turpentine, from its being a good  anthelmintic,  as  well as a good
cathartic, will be found one of the best.   It seems, indeed,  to have
been occasionally serviceable where  worms have not been the cause,
for Dr.  Powell relates a case in which he completely effected a cure
in a girl of seventeen by a single dose of a fluidounce:* and hence
its antispasmodic power may at  times co-operate with its purgative
quality as well as its vermifuge power.
  Sydenham who recommended an alternation of bleeding and purg-
ing, probably derived far more advantage from the latter than, the
former part of his plan :  it has been found peculiarly advantageous
in the hands of Dr. Hamilton : and Dr. Parr,  who ascribes  to Syden-
ham the first hint he obtained upon this subject,  affirms that having
pursued the purgative plan with great  activity  through sixty cases
of the disease which occurred to him in a course of twenty years1
practice, he was successful in the whole of these cases except one;
and that in all but this one he found the disease yield, not only soon,
but with few instances of a relapse.
  There is, therefore, no  malady whatever, perhaps, that calls so
peremptorily for stimulating the abdominal  viscera into increased
action;  and as chorea  often precedes puberty or occurs about thin
period of life, we have another reason  for directing an augmented
stimulus to the  lower regions of the living frame, and rousing  into
energy the tardy developement of the sexual organs.
   But it is necessary to attend  to the stale of the system generally
as well as locally ; to take off the constitutional weakness and irrita-
bility, as well  as the topical acrimony, and especially where the
disorder has acquired a chronic character.  And hence  other reme-
* Transact. Medicc-Chir. Sec. Vol. v. p. 358. 
GE. 11I.-9P. II.]         NERV0U9  FUNCTION.               295

dies must  be had recourse to as well as purgatives.   The German
physicians have strongly recommended the use of antispasmodics
and sedatives, and especially musk, bella donna and fox-glove, with
a view of allaying the irregular action, and Dr. Cullen  speaks as
decidedly of the benefit of opium.*   But  the advantage ^derivable
from these seems to be merely palliative ;  and the stimulant tonics
and alterants promise a better success.
  The cuckoo-flower or lady's-smock, cardamine pratensis, so com-
mon to the meadows of our own country, was at one time supposed
to  be  of  essential  service in  the cure of  this  and various other
spasmodic affections.  Michaelis,  who  is  a great advocate for its
vise, employed it in the proportion of a drachm every six  hours.t
But it owed of  late its  reputation in this country chiefly to the
recommendation of Sir George Baker who published five cases of
spasmodic diseases, two of them instances of chorea,  in  which he
conceived a  most  decided benefit was obtained from the  use  of
these  flowers.  In  the hands of later practitioners, however,  they
have  not supported their credit,  and have  consequently sunk into
disuse.  The leaves  of  the  Spanish or Seville  orange-tree  as a
stimulant and tonic bitter, are far more  entitled to attention, not
only in this but in  various other cases of convulsive spasm.  They
were first recommeded to De Haen by Westerhoef, who as well  as
Werlhoff employed them with considerable success: and they were
afterwards introduced by Hoffman, as a valuable ingredient, into hLs
celebrated stomachic elixir ;  and for the same reason formed a part
in the composition  of Wbyt's stomachic tincture.  They were given
in the form  of  decoction,  and in that  of powder: in the last case
the dose is from half  a drachm to a drachm, three or four times a
day.
   The metallic  salts and oxydeshave been tried in every form, with
apparent  benefit in a few individual cases, but without any decided
or general success.  The most popular of these were at one time the
flowers of zinc.   Dr. Gaubius first  brought them into reputation,
and gave to the metal the name of cadmia ; and according to his
statement they worked wonders in all clonic affections  whatever,.
chorea,  hooping-cough, hysteria, convulsion,   and  epilepsy:  on
which account they were  afterwards employed  upon a still larger
 and more popular scale by the famous empiric Luddeman,  under
the name of luna fixata.J   This medicine has, however, by  no
 means been  able to maintain  its  high character; and even Stoll,
 who  once employed it  as a  favourite, at  length abandoned  it  as
good for nothing, and returned to the bella donna in its stead, which
 he employed in  the form of an extract from the juice of the root;
 giving it  from a  sixth to a quarter of a grain every quarter of an hour,
and, as he affirms, with very great advantage.

      * Mat. Med. Part n. Chap. vi. p. 246.
      t Richter Chiruig. Bibl. D. v. p. 120.
      t DWscrtatio Modirni nni-. dcZinco. Am. .' irnb. list. T "id. P.at.<ttfi, 
296
NEUROTICA.
[CL. IV.-OR. III.
  For  the information  of practitioners  in general, however,  it
should be noticed  that when the stomach has reached its full dose
of this medicine, it will still bear a full dose of ammoniatcd  copper
in conjunction with it, by which means the metallic power may be
very much increased.  Thus a delicate  stomach  will rarely bear
more than two grains of either of these without nausea; yet it has
been  found that the same stomach  will continue  at ease  under a
mixed powder of two grains of the former, and two and  a half of
the latter, at a dose*
  The preparations of iron have  for the  most part been found too
stimulant: but silver in the form  of its nitrate seems to have been
radically successful in various well established cases.  It has com-
monly  been given in the guise of pills, from one  to five or six grains
to a dose.  Yet the metal that  seems by far most  entitled to credit
in the present day, is arsenic;  for it is difficult to resist the evidence
from various quarters in which it  seems not only to have produced
benefit,  but to  have  established  a perfect cure.   It is  commonly
given in  the form of the solution of the London College, in doses of
ten drops to a youth of twelve or  fourteen  years of age three times
a-day, increasing the dose as there may be occasion.
  In this disease,  however, as in various others,  it will often be
found, and the remark is well worth attending to,  that different
remedies are required for different  individuals,  even where the
cause is obviously  the same ; and that what produces no benefit in
one case, is  highly advantageous  in another.   Camphor in  large
doses has succeeded, where turpentine or the nitrate of silver has
completely failed;  and a  brisk purgative plan has sometimes an-
swered where all  the preceding have proved of no use whatever.
It is hence, we are to reconcile Dr. Cullen's peculiar attachment to
the bark, which he tells us he has found  "• remarkably useful" and
prefers to any of the preparations of copper, zinc or iron :t while
 Dr. Powell informs us that in a  lady of  seventy years of age of a
very irritable habit, attacked for the first time with this complaint
severe paroxysms at night, he found musk, in doses often grains every
six hours, succeed and produce a cure,  when purging, blistering,
the ammoniated  spirit  of amber, nitrate  of silver, ammoniated
tincture  of valerian, castor, muriated tincture of iron, bark, and
opium had all failed.J
  I am inclined, however, to think that reports of a successful use
of  medicines under the circumstances here stated should be received
with some degree of caution: for first the very repose itself from
so  active a campaign of the Materia Medica may  have proved the
best means of cure ; and next, some mortal blow,  though  it did not
immediately show  itself, may have  been  given to the disease from
so  extensive an assault, before the plan of attack was changed, and
* Letter from Dr. Ocier to Dr. A. Duncan, Edin. Med. Coin. m. p. 191.
t Mat. Med. Part. n. ch. ii. p. 112.
t Medic. Transact. Vol. v. p. 132. 
UE. III.-SP. II.]          NERVOUS FUNCTION.              297

the general charge, so to speak, converted into an affair of outposts.
And hence the musk,  as  being the last medicine employed, may
have  run off with the  claim of victory, as  an empiric often does
when called in at the  lucky moment for him in which a disease is
on the point of yielding to the plan of a more skilful, though dis-
carded, practitioner.
  How far in this disease voltaism or electricity, as warmly recom-
mended by De Haen, may be depended upon it is difficult to determine.
Like the preceding remedies, either appears to have been service-
able in some cases, but they are far outbalanced by the instances in
which they have  failed.   It  is  very possible that in some cases a
long and punctual discipline of the affected limbs, where the disease
is  not very  severe, to regular and  measured movements, may
progressively recal them to  their wonted order and  firmness, as a
like discipline of the  vocal organs in stammering has not unfre-
quently been found to  restore them to a regularity of utterance :
and with  this view  the  gymnastic exercises  of  dancing,  whose
movements are all measured  with the greatest  nicety, and  which
was so much depended upon in former times, and asserted to have
been so successful, may be well worthy of attention in the present
flay, provided it  be kept  within due bounds, and be not carried  to
the ridiculous extreme we had occasion to notice a few pages  above.
                        SPECIES III.

              SYNCLONUS BALLISMUS.

                      SuaEiua=$3alsi).

PERMANENT AGITATION OF THE  HEAD  OR  LIMBS WITHOUT VOLUNTARV
  EXCITEMENT ; BODY BENT FORWARD, WITH  A  PROPENSITY TO  RUN AND
  FALL HEADLONG ;  USUALLY APPEARING AFTER MATURITY.

This is the scelotyrbe festinans of  Professor de Sauvages, and the
shaking palsy of Mr. Parkinson.*  The genus Tantarismus of Balig-
vi, seems to hold an equal point between ballismus and chorea,  and
the species usually arranged under it may be resolved into the one
or the other, and are done so under  the present arrangement.
  The term Ballismus (pxXXto-po?,) is not used in a medical sense by
the Greek writers, but occurs in Athenaeus and various other au-
thors, in the  literal sense of tripudiatio, or " tripping, capering,
curvetting on the toes ;" from paXXifr, " tripudio, pedibus plaudo,"
and is hence, well  designed to express the characteristic feature of
the patient's being thrown involuntarily, when he  attempts to walk
      *■' F. 'ny on the Shaking Palsy.
vol.  ur.                  ^8 
298                      NEUROTICA.         [CL. 1V.-OR. I If.

•' on the toes and fore-part of his feet,"  to employ the  language ol
Mr.  Parkinson,  "and impelled unwillingly, to  adopt a  running
pace:" or as Dr.  Cullen,  who has indiscriminately blended  this
species with the preceding, expresses it, to " various fits of leaping
and running."*
  Ballismus, however,  though not  found  in the writings  of the
Greek physicians, has been long established as a technical term in
the medical nomenclature of later times, in which it  has been used,
with little discrimination, to import almost  all or any of the species
that belong to the present genus.
  Sauvages  observes that while chorea, or scelotyrbe Sancti  Viti
attacks the young, ballismus, or scelotyrbe festinans, attacks those in
advanced lite; and the remark is  founded  on  a just distinction of
the characters of the two diseases;  though  there are other features
also of as striking a peculiarity, and  which  are  here introduced into
their respective definitions.   Shaking palsy as  it is  called by Mr.
Parkinson, who has adopted the colloquial  name, is  by no means a
correct designation; for  though in the disease before us there is a
weakness of muscular fibre, and a diminution of voluntary power in
the parts affected, there is none of that  diminution of sensation by
which palsy is peculiarly characterised.  Mr.  Parkinson's descrip-
tion of the disease, however, is the best we have hitherto had, and
is as follows:
  " So imperceptible is the approach of this malady, that the pre-
cise period of its commencement  is seldom recollected by the pa-
tient   A slight sense  of  weakness with  a  proneness to trembling,
sometimes in the head, but most commonly in  the hands  or arms,
are the first symptoms noticed.  These affections gradually increase,
and at the period, perhaps of twelvemonths, from  their first being
observed, the  patient,  particularly while walking, bends  him-
self forward.  Soon after this his legs suffer similar  agitations and
loss of power with the hands and arms.
  " As the disease  advances, the limbs become  less and less capable
of executing the dictates of the  willy while the unhappy sufferer
seldom experiences even a few minutes' suspension  of the  tremu-
lous agitation: and should it be stopped in one limb by  a  sudden
change of posture, it soon makes its appearance in another.  Walk-
ing, as it diverts his attention from unpleasant reflections, is a mode
of exercise to  which the  patient is in general very partial.   Of this
temporary mitigation  of  suffering, however,  he  is now  deprived.
When he attempts to  advance he  is  thrown on  the  toes  and fore
part of his feet, and impelled unwillingly to adopt a running pace,
in danger of falling on his face at every  step.  In  the  more ad-
vanced stage of the disease the tremulous   motions of the limbs oc-
cur during sleep, and  augment in  violence till  they awaken the
patient in much agitation and alarm.  The power of conveying the
food to the mouth  is impeded, so  that he must  submit to be fed by
* Pract. of Phys. Part n. Bookni. ch. iii. mcccliiu 
HiE. III.-SP.  III.]
NERVOUS  FUNCTION.
299
 others.  The torpid bowels require stimulating medicines to excite
 them into action.  Mechanical aid is often necessary to remove the
 feces from the rectum.  The trunk is permanently bowed;  muscu-
 lar power diminished ; mastication and deglutition difficult; and the
 saliva constantly dribbles from the  mouth.   The  agitation now be-
 comes more vehement and constant:  and when  exhausted  naturr
 seizes a small portion of sleep, its violence is such as to shake the
 whole room.  The chin is almost immoveably bent down upon the
 sternum ; the power of articulation^s lost; the urine and feces are
 discharged  involuntarily, and coma, with^slight delirium, closes the
 scene."
   The remote -cause is involved in some obscurity.   Long exposure
 to damp vapour, by lying from night to night on the bare earth, in
 a close unventilated prison, seems to have  produced it;  and  possi-
 bly other causes  of chronic  rheumatism:  and  hence  it has  fre-
 quently supervened on chronic rheumatism itself.   Long indulgence
 in  spiritous potation has often given rise to  it; and  probably  any
 thing that debilitates the nervous power.
   And  on this  account  miners, and  others  exposed to the daily
 exhalation of metallic vapours, and  especially those of mercury, are
 frequent and severe sufferers,  of which Hornung has adduced many
 interesting  examples  from the  quarrymen in Carniola.*  It  has
 also followed upon  worms in the intestines ;t  and in this  case,  has
 sometimes assumed a periodical type.|
  The part of the  nervous organ more  immediately affected has,
 also, afforded some  ground for controversy.   Bonet ascribes it to a
 diseased state of some portion of the cerebrum, and has  given  ex-
 amples of its being found, on dissection, to contain, in various quar-
 ters, proofs  of serum, sanies, and other morbid secretions.§  But the
 misfortune is here,  as we have already observed in similar appear-
 ances after mania, that it is impossible for us  to determine whether
 these diseased fluids give rise to the disease or the disease to them.
 And hence Mr. Parkinson seems  to  pay no  attention to them  at
 least as a cause, and fixes the seat of the affection in the cervical
 part of the spinal marrow, from which he supposes it to shoot up by
 degrees to the medulla oblongata.   We have already shown suffi-
 ciently in the Physiological Proem to the present Class, that  the
 nervous fibres which ramify over  the  extremities,  whether sensific
or motific, originate from the chain of the spinal  marrow; and  we
 have also shown, in discussing the diseases of trismus, tetanus, and
lyssa, how acutely one extremity  of a chain of any kind, and parti-
cularly of a continuous fibrous chain, sympathizes  with another:
 and there can be no difficulty, therefore, in conceiving that wherev-
er the  cutaneous ends of  the nerves of motion are torpitied  or

          * Cista, p. 280.
          t Commerc. Liter. Nor. 1743. p. 55,
          f: Act. Nat. Cur. Vol. ii. Obs. 143.
          i  Sppnl..I.ib. i. Sect. xiv. Obs. 7, P 
300
NEUROTICA.
[CL. IV.-OR. UT.
otherwise affected by any of the causes just adverted to, the verte-
bral column must itself very seriously participate  in the mischief,
and consequently the upper or cervical part of this column : and
that from this point the disease must ramify to the brain before the
general functions of the system become affected, as in its latter stages.
  The remedial process is not very plainly indicated.  Vesicatories,
and other stimulants applied to the neck or even  the dorsal verte-
brae, have appeared useful.   A seton or caustic, and especially the
actual cautery, as practised so generally in France, might possibly
be of more avail applied to different  parts of the spine.   Beyond
this an active  purgative system, as strongly recommended by Ried-
lin, has certainly been found efficacious ;* and the solution of arsenic
bids as fair for a favourable result here  as in  the preceding species.
Stark tried musk, and  carried it to very large  doses frequently re-
peated every  day :j but it does not seem to have  produced any de-
cisive success.
  Friction of  the affected extremities resolutely  persevered  in by
a skilful  rubber,  with stimulant  embrocations of camphor or am-
monia, should  also be tried  in an early stage of the  disease, and be
alternated  with the use of the voltaic trough.  Here, too^  we may
expect to derive advantage from a free use of diaphoretic and  alter-
ant apozems,  as the decoction of the woods, and  especially where
the disease is  suspected to be of a rheumatic origin:—to which may
be added a regular course of bathing in the Bath springs.
                        SPECIES  IV.

                        RAPHANIA.

                          Kapha ma.

r?PASTIG  contraction of  the joints;  with trembling  and periodi-
                            cal PAINS.

Of this species we  know little or nothing  in our  own country.   It
was first described  by Linneus, who  called  it Raphania, from  his
supposing it to be  produced  by  eating the  seeds of the raphania
Raphanistrum, a wild raddish orsharlock that grows indigenously in
our native  corn-fields  as well as in the corn-fields of most parts of
Europe.  By other  writers, as Hermann and Camerarius, it has been
ascribed to the use of darnel  or  ryej infested with the  spur, or
* Lin. Med. 4695. p. 101.
t Klinische und Anatomische Bemerkungen.
X Abhandlung von der Kriebelkrankheit, &c. Cassel, 1775-8.
  De Lall. Lolip. tcmulento.  Tubing. 1710. 
GE. III.-SP. IV.]      NERVOUS FUNCTION.                  301

ergot, or some  other parasitic plant, which, as we have already ob-
served, is a frequent cause of other very severe complaints, as mil-
dew mortification (gangra?na tistalagtnea)*  and erythematous plague
(pestis erythematica.)]   All these diseases,  however, are so distinct
from each other, that  though  there  can  be little doubt of theif
being severally produced by some  poisonous material contained  in
the patient's food, the poison must be of different kinds, and we do
not seem to be acquainted with the cause of this difference; and
hence the question has given rise  to much controversy, and been
discussed with  some warmth on the Continent; for, while the greater
number of writers refer the disease to the raphania, or spurred rye,
(secale cornutum)  many deny that it is produced  by  either of these,!
and Lentin ascribes it to the honey-dew of various plants,§ concern-
ing which we shall have to speak in  the fourth volume, under paruria
mellita.   That it is a vegetable poison, however,  seems to  be ad-
mitted by common consent, and it is possible that the  poison is not
confined to a single plant.
   That many poisonous plants have a direct tendency to affect the
nervous system and excite entastic  or clonic spasm, or a mixture  of
the two according to the peculiarity of the poison  itself, or of the
habit into which it is introduced we have  frequently had occasion
to notice  already, and particularly  under the head of eruptive sur-
feit (colica cibaria efflorescens.)||   This is  particularly the case
with several of the deleterious  agarics or funguses, some of which
seem to operate chiefly on the sensific nerves, and  produce a gene-
ral stupor; and others  on  the  motory, and produce palpitations,
cramps, or convulsions over the whole system.H  It is very probable,
therefore, that the ordinary cause  assigned for the  present  species
of disease is the true one.
   There is an  excellent paper upon this subject in the Amcenitates
Academical**  furnished by Dr.  Rothman, a pupil of Linneus, from
which  the disease seems to  be not unfrequently  epidemical, and
always to commence in the  autumn.   It is  found, however, only
among the lower  orders of people, and, in the  epidemic referred
to, is sufficiently traced to impure admixtures with their grain, and
the employment of this  vitiated grain in too new a state.   Dr. Roth-
man delineates the disease from actual observation, and does not
believe it to be a new malady, as generally supposed, but thinks he
has traced it in the writings of  various authors from the year 1596
to 1727 ; which would establish, moreover, that it has been common
to other parts of Europe as well as to Sweden.   And in confirmation
* Vol. n. p. 608.
t Id. p. 427.
X Wichmann, Beytrag. zur Geschichte der Kriebelkrankheit,  Leips. 1771-8.
§ Beobachtungen einiger Krankheiten, &c.
|| Vol. i. p. 141.
1 See Heberden, Med. Trans, n.218.
** Tom. vi. Art. cxxni. 1763. 
302
NEUROTICA.
[CL. 1V.-OR. III.
of this we may observe, that Dr. Mercard* describes a disease very
much resembling raphania that appeared at Stade in the winters of
1771, 1772, was evidently epidemic, and  accompanied with  symp-
toms of fatuity, or that narcotic effect which many deleterious plants
are sure to produce.
  Dr. Cullen who has generalized far  too much his  description of
chorea, in his Practice of Physic, seems to have embodied this species
as well  as the preceding in  the common  delineation, and hence,
when  he tells us that " there have been instances of this disease
(chorea) appearing as an epidemic in a certain corner of the coun-
try,"t there can  be little doubt that he alludes to the species before
us originating from the cause  now assigned, although without ^ome
such interpretation as the present the passage is not  very intelligi-
ble.
  The disease  commences with cold  chills  and lassitude, pain in
the head, and anxiety  about  the  prascordia.   These  symptoms are
followed by spasmodic  twitchings and afterwards rigid contractions
of the limbs or joints,  with excruciating pains, often  accompanied
with fever, coma or delirium, sense of suffocation, and  a difficulty
of articulating distinctly.   It continues from eleven days to three or
four weeks;  and those who die generally sink under a diarrhoea or
a paroxysm of convulsions.
  The warm antispasmodics,  as valerian, castor, and  camphor, ap-
pear to have  been employed with  decisive  success.   An emetic,
however, given  at the onset of the symptoms, as  recommended by
Henman, would probably cut short  the course of the disease, and
mitigate its violence.  This  writer advises also blistering or bath-
ing with Dippell's Animal oil.f  Camphorated vinegar,  as employ-
ed by other practitioners, would  probably be found a more  useful
embrocation.^
  Towards the close of the disease purple exanthems or vesications
are said to be sometimes thrown  out, which approximate it to mil-
dew-mortification,  and the erythematic pestis, both  which, as we
have already observed, have been traced to a similar cause.
* Medir»ische Versuche. Zwcyter Tbeilc, 3vo. Leipzig.
t Part II. Book in. Chap. iii. mccclih,
X Abhandl. von der Kriebelkrankheit.
* Nachricht von der Kriebelkrankheit. 
GE. III.-8P.  V.]       NERVOUS FUNCTION;                303
                        SPECIES V.

              SYNCLONUS  BERIBERIA.



SPASMOniC R!GIDITY OF THE LOWER LIMBS IMPEDING LOCOMOTION ;  OFTEN
   SHOOTI.VG TO THE CHEST, AND OBSTRUCTING THE RESPIRATION AND THE
   VOICE; TREMBLING AND PAINFUL STUPOR  OF THE EXTREMITIES; GENE-
   RAL EDEMATOUS INTUMESCENCE.

 Bo.NTirs seems first to have introduced the term beriberi or beribe-
im into  medical nomenclature,  and tells us it is of oriental origin:*
and Sauvages  has hence copied it into his list of" nomina barbara,
seu nee  Graeca, nee Latina."   Mangetus affirms that the disease
was known to  Erasistratus,  but certainly not under  this  name.
Eustathius,  however, has Ceg&g*  but in the sense  of " concha or
ostreum" " conch or shell,"—and tells us that it is a term of Indian.
origin.   He might have said,  with more  propriety, of  oriental
origin, for it is common both in its primary and its duplicate form,
"O or K"Q, p213 or Dm"D to  the  Hebrew, Chaldee, Syriac,
and Arabic,  in which last it is berabir,  and in  all of them is  a
nomadic term, importing tillage and its production  which is  grain,
or pasturage and its production which  is sheep, or other cattle;
and hence, probably the origin of brebis or sheep, in the French
tongue.  The  term is said to be applied to  this  disease in India
from the patient's  exhibiting, in walking, the  weak and tottering
step of a sheep that has  been over-driven.
  This disease, though common to various parts of India, is chiefly
met with on the Malabar coast and in  Ceylon: and seems  to be
produced  by sudden transitions  of the  atmosphere from dry to
damp, and from sultry calms to  freshening  breezes, by which the
nervous and absorbent systems  are peculiarly debilitated  and torpi-
fied.  In  this region it attacks both natives  and strangers, but par-
ticularly the latter, during  the  rainy  season  which commences in
November  and  terminates  in  March;  through  a  great  part of
which, also, the land-winds blow from the neighbouring  mountains
every morning about sun-rise with great coolness; and hence those
who sleep abroad,  or without sufficient shelter, are equally exposed
to the intluence of a penetrating chill and damp.
  Fresh  troops,  partly  from their being new to  the climate, but
chiefly from their want of a sufficient degree of caution, very fre-
quently sudor  severely from this complaint so  long as the  rainy
season continues.   Thus we learn from  Mr. Christie that the 72d
* He Mci-licina Inclnrurn. Cap. 1. 
304
NEUROTICA.
[CL. IV.-OR. III.
 regiment was severely attacked with it in the autumn of 1797, not
 many months after its arrival, and  continued to suffer from it till
 the ensuing spring;  and that the 80th regiment which relieved the
 72d  in March 1797, was equally attacked  with it in the  ensuing
 November.  It is, however, in all such cases most frequently to be
 found amongst those who have previously weakened their constitu-
 tions by sedentary habits or a life of debauchery : and particularly
 where  too free an indulgence in spirits has co-operated with seden-
 tary habits,  as among  the tailors and  shoemakers of a battalion,
 who, in order to give them time to work at their respective trades,
 are often excused  from  the duties of the field, and, by their double
 earnings, are enabled to procure a larger quantity  of spirits  than
 other men. And we may hence in some degree account for Mr. Chris-
 tie's remark that during his stay at Ceylon,  he never met  with an
 instance of this  complaint in a woman, an officer,  or a boy under
 twenty.
   The  disease commences with a lassitude and painful numbness of
 the whole bodj', the pain sometimes resembling that of formication.
 The legs and thighs become  stiff,  the knees are spasmodically re-
 tracted, so that the legs  are  straightened with  great difficulty and
 instantly relapse into the retracted  state, whence the patient is apt
 to fall if he attempt  to walk.  In some  cases, indeed, the  motory
 and sensific power, instead of flowing through the muscles of loco-
 motion  irregularly, does not flow at all, and the limbs become para-
 lytic.   And even where the spasmodic action exists, it often travels
 or extends to other parts of the body, and particularly to  the chest
 and the larynx, so  that speaking and respiration are conducted  with
 great difficulty.
   At the same time the  whole  of the absorbent system exhibits
 equal proofs  of torpitude, the legs  first, and  afterwards the  entire
 surface  of the body becomes  bloated  and edematous, and  all  the
 cavities, particularly those of the  chest, are progressively loaded
 with fluid : and hence towards the close of the disease, where it ter-
 minates fatally, the dyspnoea is extreme, and accompanied with an
 intolerable restlessness and anxiety, and constant  vomiting;   the
 muscles are convulsed generally; while  the  pulse  gradually sinks,
 the countenance becomes livid, and the extremities cold.
   Such is the course of the  disease  as it shows itself at Ceylon,
 where  it seems to  rage  more severely than on the Malabar coast,
 and where we are  told  by Mr.  Christie, inspector general of the
 hospitals at this station, whose account is confirmed by Mr. Colhoun,*
 that its  progress is so rapid that the patient is often  carried off in
 -ix, twelve, twenty-four, or thirty-six hours fiom its onset, though
it ordinarily runs on for several weeks.
   The curatif e  intention  is to re-excite the absorbent system  and
  *" Essiy on the Diseases incident to Indian seamen, or Lascars ou long Voyase6 :
jy W. Hunter, A.M. &c.
   Lord Valentia's Travels, Vol. I. p. 31?. 
 GE. in.-SP. V.]       NERVOUS FUNCTION.                  305

 the affected branches of the nerves to a discharge of their proper
 functions by a process of diaphoretics and  stimulants.   Squill pills
 and calomel  are chiefly  depended on  for the latter,  and James's
 powder for the  former, though  the-compound  powder of ipeca-
 cuan seems better calculated for the  purpose, as  containing a seda-
 tive admirably adapted for allaying nervous irregularities.
   On the Malabar coast, it is no uncommon practice  to excite pers-
 piration in this complaint by burying the patient in a sand bath : for
 which purpose a hole is  dug in the sandy soil, into  which he is
 plunged as  deep as to his neck, and confined there as long as he can
 bear the heat of the  sand that  surrounds  him.  The  strength,
 throughout the whole, is supported by cordials, and in many in-
 stances even by ardent  spirits diluted for the  purpose; punch  is  a
 common  drink on this occasion,  and the  refreshing  and sedative
 power of the acid'entitles it to a preference.  To remove the numbness
 and pricking  or formicative pain from the limbs, friction and stimu-
 lant liniments are applied locally,  and not unfrequently the legs are
 plunged  into  a pediluvium.  And where  the  disease assumes an
 alarming appearance, and the  spasmodic symptoms  are very  vio-
 lent, recourse is  had to a hot bath,  and the strongest  cordials and
 antispasmodics as brandy, sulphuric ether,-or its aromatic spirit, and
 laudanum, which  it is sometimes found necessary to  continue for
 several weeks.
   In convalescence the  patients should be removed as  soon  as may
 be to a drier  and more  equable temperature, and be put upon the
 ordinary plan of tonics, regular exercise,  and nutritive  diet.  In
 milder cases they generally  recover with the  shifting of the mon-
 soon, which carries off the remote cause of the disease, and brings
 a change of temperature home to  them.
   Beribery has not been hitherto described as existing in any other
 part of the world, and if it should be found  it will probably exhibit
 a modification of some of the symptoms according to  the quarter in
 which it appears.  I am induced to make this remark from observ-
 ing in the  Transactions of the  Medico-Chirurgical Society,* an
 account of a very singular spasmodic disease by Dr. Bostock, which
 evidently belongs to the present genus, and seems to be  a variety
 of the present species assuming a chronic form.   The patient, who
 was in the middle of life, was first  attacked with achings in the
 lower limb on one side, accompanied with  a difficulty  and irregu-
larity of motion, which soon spread to the other side, and then gra-
 dually to the throat, so  as to hinder deglutition except  with great
 pain and severe exertion: the larynx next  became affected so as to
 prevent speech, and afterwards the back of the neck, the muscles
 affected being the voluntary alone.  From the  spastic  rigidity of
 the limbs  they were both bent and  straightened with  a like difficul-
 ty.  The  pricking pain like that of pins, or of a limb awaking from
 stupor, common to the extremities in beribery, was present here
                    * Vol. ix. Art. i. p. 1.
vol.  m.               39 
306                       NEUROTICA.         [CL. IV.-OR.  III.

also, though apparently without  stupor or edematous  swellings
Yet the intellectual powers were at length affected and weakened;
the failure of understanding gradually  increasing  but principally
showing itself in paroxysms, during one  of which the patient died.
No cause  of the disease could be traced before death or by dissec-
tion afterwards. 
CLASS  IV.
NEUROTICA.
                        ORDER IV.

                     SYSTATICA.

Btseases  affectum  sebrral  or all the sensorial $ofoers
                     sfmultancouisls.

irritation or inertness of  the  mind extending to the corporeal
  senses or the muscles ; or of the corporeal senses or the muscles,
  extending to the mind.

The sensorial powers are  those which are dependent on the senso-
rium  or  brain as  their instrument or  origin; and  are three in
number,  the intellectual,  the  sensific, and the motory.  Thus far
we have only contemplated these as they are affected singly, or,
where more  are  affected than  one, as influencing the rest  only
secondarily or sympathetically.  The diseases of the present order
are of a  more complicated  origin and nature, and affect several or
all  the sensorial powers  conjointly from the first.  The order is
hence denominated systatica, a Greek  compound from o-iwcroj/iu,
" congredior, consocio."   Syncoptica might have been employed and
upon as large a scale, so as to denote increased*as well as diminished
action, impellentia as well  as concidentia;  but that this  term is
usually limited to express  maladies  of the latter kind, and, conse-
quently, might have  produced confusion, since the present order,
like all the  preceding, includes diseases evincing different and even
•pposite states of action. 
304J
NEUROTICA.
[CL. IV.-OR. IV..
                       GENUS  I.

                       AGRYPNIA.

                       Sleeplessness.

           DIFFICULTY OR  INABILITY  OF OBTAINING SLEEP.

Agrypnia («yg»?rwa) is a  Greek term significant  of  the  English
sleeplessness, by which  it is here rendered.  The affection is not
introduced  into  Dr. Cullen's  nosological arrangement, and has,
consequently, been  omitted by  most nosological writers since his
time ; but it occurs in the  greater number of those who preceded
him ; and its claim to be considered  as an idiopathic affection, is as.
clear as that of most diseases concerning which there is no dispute
  The two following species are embraced by this genus:

     1. AGRYPNIA EXCITATA.           IRRITATIVE WAKEFULNESS.
     1,-------PERTiESA.            CHRONIC WAKEFULNESS.
                         SPECIES I.

               AGRYPNIA  EXCITATA.

                 Xm'tattfce Wakefulness.

 SLEEP RETARDED BY MENTAL EXCITEMENT : LISTLESSNESS TO SURROUNDING
                            OBJECTS.

 On the physiology of sleep and dreaming, we briefly touched under
 the genus paroniria or sleep-disturbance in the first order of the
 present class,  but the subject is  of  great extent and complexity,
 and cannot be followed up into any detailed explanation in a work of
 pathology.  At present, therefore, I  can  only observe that natural
 sleep is a natural torpitude of the voluntary organs of the animal
 frame, produced  by a general exhaustion  of sensorial power in
 consequence of an exposure to the common  stimulants or exertions
 of the day. And hence, if such exhaustion do not take place, natural
 sleep cannot possibly ensue, though morbid sleep undoubtedly may
 as produced  by other causes.
  Now it often happens that,  from an energetic bent of the mind
 to a particular subject, the sensorial power continues to be secreted
not only in a more than  usual quantity, but for a more  than usual
term of time ; and, in consequence, of this additional supply, there 
OE, I.-SP. I.]
NERVOUS FUNCTION.
309
 is  no exhaustion at the ordinary period, and  therefore no  sleep.
 Severe  grief is often  a stimulus of this kind ;  during which  a
 morbid  redundancy  of sensorial  power  continues to be secreted,
 followed by a morbid excitement  of the system generally, from day
 to  day, and from night to night, till the frame  is worn out by the
 protracted watchfulness or sensorial erethism.   And it is astonishing
 to  witness in various instances how long the frame will support itself
 before it is worn out, or the irritation that prevents sleep sufficiently
 subsides for its  return,  and particularly where the mind is labouring
 under the influence of the  depressing passions,  or  of depressing
 pain. A hemicrania has kept a person awake for three months ;*
 and  a melancholy  or  gloom on  the spirits for  fourteen  months.
 Overwhelming  joy has often a similar effect though seldom  in an
 equal degree, or for so long a period of time.   The  mind may also
 be intensely directed  to  some peculiar  object of study;  and the
 energy  of the  will becomes in this  case  a like stimulus to the
 secretion of a fresh or protracted tide of sensorial power, so that
 the usual exhaustion of the  nervous system does not take  place at
 the accustomed period.  This is peculiarly the case  in a pursuit of
 the abstract sciences, or those of a more strictly intellectual nature.
 as  the higher branches  of the mathematics.
   Where the determination of the mind  to  a  particular subject is
 exquisitely intense, whether that subject be a passion or a problem^
 by  far the greater  part of the sensorial secretion is expended  at
 this particular outlet; and, consequently, the frame at large,  with
 the exception of those organs to which such outlet peculiarly apper-
 tains, is  so far drawn upon, as a common bank, for a contribution of
 sensorial power, that it labours under a certain degree of deficiency.
 and, hence, a certain degree of torpitude, so far as to  become insen-
 sible  to  the  world around it: making, in this respect, an approach
 to the state of mind we have already  described under the name ci
 aphelxia intenta, or mental abstraction.
  The cure of this species of sleeplessness  is  to be accomplished
 by  allaying the  mental  excitement by which it is produced.  This
 is  best done by recalling the mind from the pursuit that  leads is
 astray, and a free surrender of the will  to  listlessness and quiet
 The  perturbation will then subside; the sensorial organs  become
 tranquillized and inactive ; the secreted tide of sensorial-power will
 be at its ebb, and the habit of refreshing slumber resume its influence.
 But where this cannot be obtained by the mere exercise of the will.
 we  must  call opium or some other narcotic to our aid, which,  by its
 revellent stimulus, may  coincide with  the consent of the will and
 produce the exhaustion, and, consequently, the  quiet that is requi-
site for sleep.
* Bartholin. Hist. Anat. Cent. I. Hist. 64.
  Schenck Lib. I. Obs. 256. 
31tt
NEUROTICA.           [CL. IV.-OR.  IV.
                         SPECIES  II.

                AGRYPNIA  PERT.ESA.

                  <£nronfc Wakefulness.

SLEEP RETARDED BV BODILY DISQUIET; ATTENTION ALIVE  TO SURROUND-
                          ING  OBJECTS.

The exhaustion in which the very essence of natural  sleep consists
supposes a perfect quiescence and inactivity of the sensorial powers.
Uneasiness of any kind will become an obstacle ; and hence, an ach-
ing coldness of the extremities or of any other part will prevent it;
an uneasy sensation at the  stomach or  any other part will prevent
it;  an absence of the  common pleasurable feeling with which we
ordinarily prepare ourselves for  sleep will  prevent  it: " And, on
this account," as Darwin observes, " if those, who  are accustomed
to wine at night,  take tea instead  they cannot sleep.   And the same
evil happens from a want of solid food for supper to those who  are
accustomed  to use it; as, in these cases, there is an irksome or dis-
satisfied  feeling  in  the stomach."  And  hence, also, too great an
anxiety or desire to sleep, is another  cause of its  suspension ; for
this as a  mental  disquiet will  only add to the corporeal disquiet
which has produced it; and, as already observed, the emotions of
the mind must be as quiescent as  those of  the  body,  and the  will,
instead of commanding  or interfering, must  tranquilly resign itself
to the general intention.
   Where uneasiness  of this kind has been permitted to continue
for several nights in succession, the  sleeplessness is apt  to become
chronic and to be converted into a habit.   We  have hence had ex-
amples, as noticed with their appropriate  references  in the  volume
of Nosology, in which vigilance or sleeplessness has  continued for
a month without  intermission ;* for six months ;t and  even for three
years.J
   Mr. Gooch gives  us a singular case of a man who never slept and
yet enjoyed a very good state  of health  till his death which hap-
pened in the seventy-third year of his age.  He had a kind of doz-
ing for about a quarter of an hour once  a day, but even that was
not sound, though it was  all the  slumber he was ever known to
take.§
   The cure  of this  disease demands a particular attention to its
* Grilling, Cent. iv. Obs. 90.
t Panarol, Pentecost, v. Obs. 4.
X Pliuii Lib. v. vii. Cap. 51.
i Medical and Chirurgical Observations, ice. 8vo 
GE. I.-SP. II.]
NERVOUS FUNCTION.
311
 cause;  for if we can get rid of the organic disquiet on which it de-
 pends, we shall be pretty sure to succeed in obtaining  our object.
 All irksome chills, and especially those of the feet should be taken
 off by a sufficient warmth of clothing; and  the  habitual supper or
 other indulgence which has hitherto preceded and introduced sleep,
 should be freely allowed.
   The lulling sounds of soft and agreeable music, or agreeable read-
 ing, have been  tried  as concomitants, and  not unfrequently with
 success.  And narcotic aromas, especially the hop has at times been
 had recourse to, heaped into pillows;  but so far as I  have seen, and
 I have once  or twice witnessed the experiment,  with as  little effica-
 cy, as the pillows of the male fern in cases  of rickets, which were
 once, according  to Van Swieten, in  equal  estimation for this last
 complaint.   A pediluvium as recommended  by Lang,* will  often be
 found a much better prescription, or  any means which will  excite
 that breathing moisture, which is indicative of general ease.  Soft,
 gentle, and general friction, and especially where there is any chill
 or rigidity upon the limbs, will frequently produce the  "same effect
 in a very agreeable way :  and this too without  combining  it with
 the external  use of opiates as proposed by De la Prada,fand various
 other writers.J
  Mosch was the favourite medicine of Thilenius,§and hyoscyamus
 of Stoerck.||  But a free and exhilarating  glass of wine, as proposed
 by Fordyce, will often answer much better than  either of them.  In
 many cases of disquiet and particularly in the stomach and praecor-
 dia it might be well to try the  hypnotic powers of the nutmeg, as
 warmly  recommended  by  Dr. Cullen.  We have already noticed
 this reputed  effect  in the East  Indies which Bontius confirmed by
 his own experience, and which has since been confirmed by practi-
 tioners in Europe.  And when  taken in a  large  dose  there  can be
 little doubt of its somnolent virtue.  In  the case recited  by  Dr.
 Cullen in proof of this  the person had swallowed more  than  two
drachms by mistake, and the effect was a drowsiness commencing an
hour afterwards which gradually increased to a complete stupor and
insensibility.   After this he was delirious, and continued  to  be al-
ternately stupid  and delirious for several hours:  but in six hours
from the  attack he  was pretty well  recovered from every  symp-
tom.lf
  Where, however, the morbid habit  is  too rigidly  established to
give way to any of these means we  must  forcibly  break through it
* Epist. xlv.
t Journ. de Medicine, Tom. xxxvi.
X Ansert. Abhand). B. i. iv. St. 45.
§ Medinische und Chirugische Bemerkungen, &c.
|| Libellulus quo continuantur Experimenta, &c.
T Mat. Med. Part ir. Ch. v. 
312
NEUROTICA.
[CL. IV.-OR. IT.
by the use of opium, till the habit itself be overcome, when all nar-
cotics should be gradually omitted.
  The wakefulness so common to old people  is hardly a disease.
They use but little exertion, and hence require but little sleep; and
the internal inactivity is upon  a par with the external.  A  third
part of the vessels perhaps that took  a share in the general energy
of the middle of life, is obliterated and the wear and  tear of those
that remain are much less.  The pulse beats feebly; the muscles of
respiration are less forcibly distended ; the stomach digests a smal-
ler  portion of food, for only a  smaller portion is required; the in-
tellect is less active ; the corporeal senses less lively, and a minuter
quantity of nervous fluid secreted by the brain and its dependencies.
And hence, though there is far more  weakness  than in earlier life
there is a less proportionate demand  for exertion, and hence a far
smaller necessity for sleep.
  From such a line of reasoning  we may  see why sleeplessness
should be found as a symptom  in excessive fatigue, violent pain of
any kind, inflammation,  fevers, and various affections of the brain.
                     GENUS  II.


                       DYSPHORIA.

                        Restlessness.

TROUBLESOME  AND RESTLESS  UNEASINESS OF THE MUSCLES ; INCREASED
         SENSIBILITY ;  INABILITY OF FIXING THE ATTENTION.

This is the inquietudo of many authors, which  the Greeks  express-
ed by the  generic  term now  chosen, importing literally, " tole-
randi difficultas," "  a difficulty of enduring oneself"  It does not ex-
pressly enter into the classification of Sauvages or that of Cullen,
but is nearly synonymous with the anxietas of the former, which in
the present system becomes a species of  this genus.   Molesta sensor
tio, says Sauvages, quae  ad jectigationem  cogit, sed quomodo ab affi-
nibus morbis discrepet,  dicant qui exporti sunt.
  The genus embraces  two species as exhibiting restlessness or in-
quietude chiefly confined to the sensific or the irritable fibres;  or
as dependent upon the state of the mind.
         1. DYSPHORIA SIMPLEX.                FIDGETS.
         ?. ——------ANXIETA?.               ANXIETY. 
Ufci. ll.-SP. I.J         NERVOUS FUNCTION.                Ji«>


                         SPECIES I.

                DYSPHORIA  SIMPLEX.

                           iFfiW'ts.

RESTLESSNESS  GENERAL,  AND  ACCOMPANIED  WITH A PERPETUAL  DESIRE
                   OF CHANGING  THE POSITION.

This is what we mean by the English colloquial term Fidgets from fid-
gety, most probably a corruption  of fugitive, though the  lexicogra-
phers  have given us no origin of the term. Both import restless-
ness, unsteadiness and perpetual change of place.   The proper La-
tin term is titubatio ; and,  indeed, most languages have some pecu-
liar term to express this troublesome and irritable sensation, though
it has  been rarely introduced as a disease into the nosological ca-
talogue.  The actual cause seems to consist  in an undue  accumula-
tion of sensorial power, which seeks an outlet, so to speak, at eve-
ry pore, for want of a proper channel of expenditure.  Thus eve-
ry one becomes fidgety who is obliged to sit motionless  beneath a
long-drawn and tedious story of common place facts totally desti-
tute of interest: and still more so when he is eagerly waiting, and
fully bottled  up, as it were, to reply to an  argument loaded with
sophisms, absurdities, or untruths, and  over  which he feels to have
a  complete mastery.  So the high-mettled horse is fidgety that,
called  out, in full caparison, and  still  restrained in bis career,  is
panting for the race or the  battle.   " So the squirrel, when confin-
ed in a cage, feels," as Dr. Darwin has ingeniously observed  on
this disease which  he calls jactitatio, " a restless uneasiness from
the accumulation of irritative power in his muscles, which were
before in continual and violent exertion from his habit of life, and
in this  situation finds relief by perpetually jumping about his cage
to expend a part of his redundant  energy.  For  the same  reason
children  that are constrained to sit in the same place at school for
hours together, are liable  to acquire a habit  of  playing with some
of the muscles of their face, or hands, or feet, in irregular   move-
ments which  are called tricks, to exhaust a part of the accumulated
irritability by which they  are goaded."
  In the two last instances this  irritability is simply accumulated
for want  of a proper outlet, and pot from inordinate  secretion.  In
the two preceding cases, of the restrained horse and the  restrained
orator, there is added to this simple accumulation, for want of dis-
bursement, an accumulation  also  from inordinate excitement.
   It is  this last  source alone that can give the present affection any
thing of a morbid character: and in irritable temperaments  this is
often the case :  for there is a diseased excess of sensorial  power se-
creted  constitutionally, which is apt, on various occasions, to show
   VOL. III.                    10 
314                    NEUROTICA.           [CL. 1V.-OR. IV-

itself by a perpetual restlessness  or jactitation as troublesome  to
those who are of the company, as to those who are afflicted with it.
  Paulini* observes, that worms, and Lentint that atony alone, is a
cause ; and hundreds of other sources of irksome irritation may be
added to these ;  one of the most common of which is an obstinate
and unconquerable itching like that of prurigo senilis, and especially
in a part of the body that we cannot conveniently get at to scratch:
and hence ascarides in  the  rectum or  pudendum, into which last
organ they have sometimes been found to creep, is a most distressing,
and, in some cases, a maddening cause.
  A course of cooling purgatives, warm  bathing, or increased exer-
cise,  will probably  be found most serviceable in this harassing
complaint; with an attention to  the primary  disease  where it is
sympathetic.
                        SPECIES II.

              DYSPHORIA  ANXIETAS.

                          ^ntfetg.

THE RESTLESSNESS CHIEFLY AFFECTING THE PR.ECORDIA ;  WITH  DEPRES-
     SION OF SPIRITS AND A PERPETUAL  DESIRE OF LOCOMOTION.

This species, in persons of an irritable or highly nervous tempera-
ment, and especially among those inclined to hysteria or hypochon-
driac  symptoms, is occasionally to be  met with as an idiopathic
affection, to which such a temperament gives a peculiar predisposi-
tion.  But we see it more frequently as a feature in the first attack
of fevers, in nausea, in various affections of the praecordia, and most
powerfully and most  distressingly  in lyssa or  canine  madness.   It
has been ascribed to the want of a free passage for the blood through
the heart, in consequence of a polypous concretion  or  some other
obstruction ; to a similar difficulty of its passage through the lungs :
and to a constriction of the vena portae, producing a like impedi-
ment in the lower  belly ; and  the  anxiety has been  denominated
praecordial, pulmonary, or epigastric, according to the part affected,
which, however, we  cannot always trace out.  The complaint is
particularly noticed by Hippocrates  who distinguishes it  by the
name of alysmus (aXvaftos,) literally restlessness or inquietude.
  It has sometimes, and  especially in persons of an acutely irritable
habit, been accompanied with great excitement of the nervous sys-
tem generally, and spasmodic action of some or even all the muscles,
* Lanx. Sat. Dec. u. Ob*. 10.
t Beobacht. der Epidemischen Krankheiteu. p. 47. 
GE. II.-SP. II.]
NERVOUS  FUNCTION.
315
displaying, according to the idiosyncrasy, the symptoms of chorea,
hypochondrias, or lyssa; and has  occasionally, as I have reason to
believe, been mistaken for lyssa, where the morbid mind has pored
incessantly on  the  recollection of some  former scratch or bite of a
dog or cat: and like lyssa it has sometimes terminated fatally though
by no means with a like rapidity.
  Where  the  affection is idiopathic, an emetic will  be generally
found to produce the readiest assistance : after this, the  warmer
antispasmodics, and, if necessary,  narcotics may be successfully em-
ployed, with gentle exercise and a light diet.
                     GENUS III.


                      ANTIPATHIA.

                         ^ntfjjatns.

INTERNAL HORROR  AT THE PRESENCE OF PARTICULAR OBJECTS  OR SUB-
         JECTS ;  WITH GREAT RESTLESSNESS OR DELIQUIUM.

Antipathia  {xmirxhsi from xnmxiia, " naturalem repugnantiam ha-
beo,") does not occur in Dr. Cullen's classification, but enters into
his supplementary catalogue, " morborum a nobis omissorum quos
omisisse fortassis non oportebat;" or, as he expresses it, in  another
place, of diseases which were either forgotten when the arrangement
was settled, or for which no fit place could be found within its limits.
It occurs, however, in Sauvages,  Linneus, Vogel, and  Ploucquet:
and seems  to comprise two species :

    1. ANTIPATHIA SENSILIS.           SENSILE ANTIPATHY.
    2.----------INSENSILIS.         INSENSILE ANTIPATHY.
                         SPECIES  I.

              ANTIPATHIA  SENSILIS.

                    Senstle  &ntt>itng.

ANTIPATHY PRODUCED THROUGH THE MEDIUM OF THE EXTERNAL SENSES.

Very singular examples of both species belonging to this genus are
recorded by the collectors of medical curiosities;  while others are
of every day occurrence.  Some may be  accounted for from  early 
 316                    NEUROTICA.           [CL. IVw-OR. IV.

 fright, stories told in the nursery, or that incongruous association of
 ideas in early life, which we had occasion to notice in the Proem to
 the present class.*  But many are of difficult solution, and others '
 altogether inexplicable.
   Under  the  species before us, we may mention  an  antipathy
 produced by the smell of roses ; of strawberries ;  of mint and some
 other herbs : by the sound of music :  or the sight of a drawn sword,
 which is said to have existed  in King James I.; or the rattling of
 a  carriage  over  a bridge, which continued for  some years after
 mature  life in Peter the  Great of Russia,  who  was frightened,
 while an infant,  by a fall from  a bridge into  the  water; and who
 only overcame the antipathy by resolutely accustoming himself to
 the object of disgust.
   The sight of crabs and  lobsters,  and, still more frequently, of
 toads and vipers,  has produced the same effect.  And we have a few
 instances  of its being occasioned by what we  should much less
 expect as a cause, the  appearance of bread and cheese, or even
 bread alone.t   The object  itself, however, seems to be of  little or
 no importance ; the feeling in most  of these cases results from an
 association of such object, whatever  it may be, with some  painful
 occurrence in early life, of which it continues to be  as  much the
 symbol or expression as  letters are of ideas.  In many instances &4
 original occurrence  is forgotten, but the impression indelibly re-
 mains, and the object recalls the  mind to its influence.   There is
reason to believe, however, that the antipathy is often a result of
idiosyncrasy, or something peculiar in the frame-work of the indi-
 vidual constitution.
                         SPECIES  II.

             ANTIPATHIA  INSENSILIS.

                   Knsenslle  &ntt]rath£.

      THE ANTIPATHY PRODUCED THROUGH AN UNKNOWN MEDIUM.

In the preceding species the feeling of antipathy is excited through
the medium of one of the external senses, to which the object of
antipathy presents itself, or with  which it is associated on recollec-
tion ;  for it is the sight, or taste, or smell, or touch, or hearing of
such object or the idea of such sensible impression, that alone calls
the antipathy into action.
  * Vol. in. p. 37.
  t Ephera. Nat. Cur. Dec. I. Ann. i. Obs. 144. et in Schol. Dec. HI. Ann. m.
Obs. 149. 
CE.HI.-SP.H.]      NERVOUS FUNCTION.                  311

  There are some persons, however, that are struck with a pecu-
liar and indescribable kind of horror at the presence of an  object
which  is unperceived  by any  of these senses,  as soon as it  comes
within  the atmosphere  of some unknown influence.  The presence
of a cat has been  often known to produce this effect, under the
circumstances now adverted to, or when the animal though present
has been concealed, and not one of the senses has been alive to its
presence.  Instances of this kind are to  be found in most of the
collections of medical curiosities, as well as in various other works ;*
and I have met with several decided instances in the course  of my
own practice.   The affection, in this case,  depends  unquestionably
upon an extraordinary idiosyncrasy; but  by what means such an
idiosyncrasy is influenced we know not.  Sauvages inquires whether
the effluvium  thrown from the object of aversion into the  atmos-
phere  may not, in combining with the fluids of the affected person,
produce an irritating  and distressing tertium  quid, as  corrosive
sublimate is produced  by a combination of mercury with oxymu-
riatic  acid.   The fact, at present,  appears inexplicable  : but it is
not more singular than the wonderful power so well known  to be
possessed by the viverra noctula (common  or great bat,)  which
renders it conscious of the presence and position of objects,  when
all its senses are muffled, and which enables it, when flying in this
state, to avoid them.   This  extraordinary  faculty  to  which  we
adverted in the Proem to the present class,t has been called a sixth
sense by several naturalists.
  In all these  cases, whether of the preceding or of the present
species, the only means in our power of destroying  the anomalous
or morbid impression is by introducing a counter-habit; or, in other
words, by gradually inuring the sensorium  to the influence  of the
disgustful object.   By being familiarized with what at first we most
shrunk from, our courage becomes hardened and the painful impres-
sion blunted; and sights,  and sounds, and smells, and the most immi-
nent dangers that could not at one time be encountered, or even
contemplated without fainting, in process of time no  more affect us
than the roar of cannon affects  the  war-horse, or  the  mountain-
tempest the mariner.
* Eph. Nat. Cur. Dec. II. Ann. n. Obs. 50.
  Borelli, Cent. iv. Obs. 61.
  Emercetanus, Diactet. PoTyhistor. p. 82.
t Vol. III. p. 17. 
318
NEUROTICA.
[CL. IV.-OR. IV.
GENUS  IV.

 CEPHALiEA.

   3B?eau-=acne.
ACHING PAIN IN THE  HEAD ;  INTOLERANCE OF LIGHT  AND SOUND;  DIF-
       FICULTY OF  BENDING THE MIND  TO MENTAL OPERATIONS.

Cephauea, {xvpaXxtx  from  xiQxM, caput.) is employed by  Galen.
chiefly, in the sense of chronic head-ache; whence the term cepha-
lalgia has been  invented in  later times to express affections of
shorter duration.  Head-aches of all kinds, however, form a natural
group, and should be described under a common genus, which is
here named after the oldest and most authorised  term.  Sauvages
has particularly remarked the symptom of disability of the mental
powers in the first species we are about to notice, and the  remark
maybe applied  to all the others : "difficultas cogitandi, distincti
ratiocinandi, reminiscendi."  The species which may be enumerat-
ed under this genus are the following :
1.  CEPHAL.EA GRAVANS.
2.  —
3.  —
4.  —
5.  _
— INTENSA.
— HEMICRANIA.
— PULSATILIS.
— NAUSEOSA.
STUPID HEAD-ACHE.
CHRONIC HEAD-ACHE.
MEGRIM.
THROBBING HEAD-ACHE.
SICK HEAD-ACHE.
          SPECIES I.

CEPHAL.EA  GRAVANS.

     Stupftr ?|eaa=aene.
PAIN  OBTUSE J WITH A SENSE  OF HEAVINESS EXTENDING OVER THE WHOLF
                 HEAD ; SOMETIMES INTERMITTENT.
The remote causes of head-ache are so numerous, and so complica-
ted that it is difficult to catch or arrange them;  and many of them
are so completely^concealed from view, by a confinement to the
brain itself, thatwOT'ainly endeavour to discover and analyze them.
Repelled dischar^Hfrom the hemorrhoidal  vessels, repelled or re-.
tarded  catameni^repelled fluids  from-the  surface,  are very fre-
quent causes of one or other of the species of cephalaea now enu-
merated.  Whatever retards the current of the blood in the sinuses
 
 tiE. IV.-sP. I.]         NERVOUS FUNCTION.                 319

 of the brain, or the veins which convey the blood from the head,
 will produce it.  Of this kind are various tumours,  particularly of
 the conglobate glands, polypi, exostosis, or bony fragments separat-
 ed by some violence from the internal table of the scull, not pro-
 ducing irritation, perhaps, till the accident that gave  rise to them
 has long  passed by and been  forgotten.   Hence some part of the
 brain  has often, on  dissection, been found diseased in its structure,
 producing,  occasionally,  an abscess with  a considerable  lodgement
 of pus.  And, in some cases,  the disease has been cured by the pus
 making its  way through  the frontal sinuses,* or through the ears,t
 and escaping externally.  It has, at all times, been produced  by a
 decayed tooth,  and has  ceased on its removal;  a profusion of hair
 on the head has been also an occasional cause, in which case it has
 yielded to  shaving or  merely thinning the hair.., It has often fol-
 lowed upon a neglected catarrh or neglected rheumatism, and still
 oftener has resulted from some  morbid  irritation of the stomach,
 and especially from worms.J  So again,  whatever  prevents a free
 evacuation of the right auricle and ventricle of the heart, and con-
 tributes to retard  the motion of the blood in the veins  which dis-
 charge their  contents on  this side of the heart, has a tendency to
 lay a foundation for this complaint.
   Under these circumstances nothing is more difficult than to deter-
 mine,  in many  instances,  whether a head-ache of any kind be an
 idiopathic or a  symptomatic affection, and on this account Djr. Cul-
 len, deviating from the general opinion of the nosologists who pre-
 ceded him has regarded it as a symptom in every instance.  This,
 however, is to suppose that the  encephalon which, from its magni-
 tude and complexity, seems to open a theatre for more intrinsic dis-
 quietudes than all  other organs whatever, is exempted beyond any
 of them.
   The species immediately before us, emphatically distinguished by
 the name of stupid head-ache, seems, when idiopathic, to  be strictly
 a nervous affection of the organ, originating from. nervous debility
 or exhaustion;  or, in other  words, from the want of a proper sup-
 ply of that kind of sensorial  fluid on which the organic feeling of
 comfort and refreshment depends.  It  is hence peculiarly marked
by a general disquiet and confusion, rather than by acute pain;  by
 a  general  hebetude of  sensorial power  which  disqualifies  the
 person.labouring under it for a continuance of mental  labour;  and
in which the sight is dim, and the  hearing dull,  and the memory
vacant. On which account  it is  frequently experienced by hard
students, who have  sat up through the whole of the night in pursuit
of some abstruse and difficult subject, or  who have laboured upon the
* Nicolai, Decad. Observationuni illustr. anat.
  Schrader. Observ. Anat. Med.
  Lentilius, Miscell. I. 599.
t Gockel, Gallicin. Med. Pract.
  Trecourt, Mem. et Observ. de Chirurgie. A. 5.
X Walther, Thes. Obs. 17.
  Blumenbach, Mel. Bibl. B. ii. p. 434, 
320
NEUROTICA.
{CL. IV .-OR. IV.
 same from week* to week with too small an allowance of time for
 sleep or exercise.   In all  which cases it is often relieved by sur-  •
 rounding the temples with a bandage steeped in cold  water, which
 acts as a tonic  upon the spent and enfeebled brain, and once more
 excites it to a  little temporary  energy.  A sudden blow of severe
 grief often produces the  same l^ifNf of exhaustion, and is accompa--
 nied with the same symptoms, during which the  sufferer is equelljV
 incapable of thinking, sleeping, or attending to external objects.   W
   A similar effect  is produced by whatever else has a tendency to
 induce debility  and torpitude in  the nervous structure of the brain,
 as a profuse diarrhoea, repeated and immoderate  venesections, and
 particularly any sudden faintness, or debility of the stomach.   The
 last  acts, indeed,  in a double  way;  directly, as  withholding the
 means of sensorial recruit; and indirectly, from the close sympathy
 that, on all occasions, exists between the two organs.  And hence,
 wherever we meet with cephalaea gravans as a  sympathetic affec-
tion,  and are doubtful to what  particular orgatt^to ascribe„..it, we
shall, in most cases, find the stomach affected, and  may venture to
treat it accordingly.
  As much of the remedial gipcess,  however, whfeh  may be  ser-
viceable in any  one of the species q£ head-adjhe befjore us, may be
useful in  the rest, it will  be most expedient to reserve thfifc subject
for the close of the entire genus.-
      *  9                *?
i
                        SPECIES  II.

                CEPHAL^A  INTfi^SA.

                    (Kfivontc  ?^eatr=|lclie.                 *    a

PAIN VEHEMENT, WITH A SENSE OF TENSION.-pVER THE WHOLE HEAD:
                    PERIODIC ;  OFTEN CHRONIC.

This species is, perhaps, alwajB dependent  upon $ome local irrita-
tion ; and may be produced by manyj probably most, of the irritants
noticed at the  opening of the preceding species: and as not a few
of these have  a seat in the brain ^selfu and  must  remain concealed
till  disclosed to us by dissection, arid  would be still beyonl our reach
if we could ascertain them from  the first attack, fhere is no difficulty
in conceiving  why  this form > of head-ache should often defy all
medical aid whatever and run parallel with  the life itself.
  Among the external cause!, those  productive of rheumatism  are,
perhaps,  the most frequent, as  exposing the feet for a long time to
cojkl and dampfjjor lying in a  damp bed with a small quantity of
covering.   An^jas all  rheumatic affections,  when  they becojje    '
chronic, have  a tendency to intermit and return  periodically,  we   4
may easily see why the disease before us should do so in many
instances.                                         * 
    GE. 1V.-SP. II.]       NERVOUS FUNCTION.                  3"!

      This species may, therefore, be distinguished by its being rather
    limited to some particular part of the head than extending over the
    whole organ ;  by its remissions  or intermissions;  by the acuteness
    of the pain during the return of the paroxysm ; by an intolerance of
    all motion of the head, far more than of light  or  sound,  both of
*&  which, however, are sometimes highly irksome ; and by a peculiar
^  feeling of tenseness or contraction over the encephalon, as though
    its membranes were muscles and spasmodically contracted.
      This last symptom rarely takes place till the  disease  has  estab-
    lished itself for some time, and seems to indicate a thickening of
    one or more of the  tunics of the  brain from increased action, pro-
    duced by a long course of irritation ; a result which  has  frequently
    been  discovered on dissection.   Where  the  affection  is entirely
    rheumatic, the local pain in the head ceases as soon as a rheumatic
    pain takes place in any other part of the body.   There  is, indeed,
    no great  difficulty in accounting for a cessation of pain in this case
    upon the principle of a transfer of action.   But we find it  cease also,
    or very much remit, not unfrequently in other cases, in  which
    post-obit  examinations have proved the disease to be dependent on
    local irritation, as some bony protuberance from the interior of the
    skull,  ossification,'.or calcareous concretions  in  some part of the
    substance of the  brain, a tumour in a pineal gland, or some  other
    ganglion or commissure, or an aneurism of the carotid-artery ; the
    two last of which are particularly described by Sir Gilbert $lane, as
    having been detected after death, in persons who had been long and
    severely troubled with this modification of cephalaea.  To account
    for the intervals of ease that occur under these  circumstances  in
    which the cause  of  irritation is permanent and perpetually acting,
    we must  call to our recollection that most organs, when  they have
    been long exposed  to  a  more  than  ordinary  stimulus, become
    gradually exhausted  and blunted in their sensibility in consequence
    of such exposure.  And hence the pain they are occasionally sensible
    of, and which returns in irregular paroxysms, is produced by fresh
    causes of excitement, periodical or incidental, or a serious aggra-
    vation  of the  disease itself.
      In a  few instances, an  obstructing*material, forming the exciting
   cause, appears  to have been carried off, and in one or  two very rare
   cases, by channels, whose communication it is peculiarly difficult to
  ^account for.   A caries, or some other disease, affecting a small part
   of the bony substance of one of the sutures, is a cause  noticed by
   many pathologists; and this cause  has, in some instances, been so
   obvious, that  while  the  patient has been  able to  point out the
   precise spot  of pain  with his finger, the practitioner has been able
   to  discover a  considerable indentation  or  vacuity, proving that  a
   part of the suture had been absorbed or detached.*  In  a case of
       * Bonet, Sepulchr. Lib. i. Sect. I. Obs. 92.
        Morgagni, De Sed. et Caus. Morb. Epist. III. Art. 8„
        Stalpart van Her Wei), Cent. i. JV. I.
vor.. ill.                   4J 
1*1
NEUROTICA.          [CL. IV.-OR. IV.
this kind, related by Mr. Henry, of Manchester, the immediate seat
of distress was in the lower part of the coronal suture about an inch
above the sphenoides.  The pain was excessively acute and  lanci-
nating, the integuments directly over  it, to the extent of a half-
crown  piece,  were puffed up  like  an inflated  bladder,  and the
temporal artery appeared  tense like a chord on its full stretch.
Upon the subsidence of the tumour, a chasm of about an inch long, %1
and  a  sixth part of an inch  broad, was felt in  its late  course.
With the disappearance of the tumour the pain was transferred a
little lower to the processus condeloides, and afterwards to a situa-
tion  about an inch and a half below the angle of the lower jaw-bone.
Shortly after  this it ceased altogether; but the patient's breath,
from this time, evinced an earthy  and disagreeable  smell; and
within  a few  days, without any previous fit of coughing  or  retch-
ing,  he was suddenly seized with a feeling of suffocation from some-
thing that had  dropped into the  oesophagus  and stuck there; but
which he threw up  after great exertion, and found to be an angular
solid substance, about the size  of the  last  joint  of  the thumb,
consisting, as  he described it, for, unfortunately, he did not  preserve
it, of a hard,  brown and white matter, the latter of which on being
pressed fell into a dry powdejr. ' The whole was covered  with a
greenish mucus, and resembled exactly in smell the fetor which had
antecedently affected his breath and had now subsided.  About six
weeks  afterwards he had  a slight return of the pain in the same
part of the head,  which lasted about two minutes, when  he again  ^',
became sensible of  something  falling into his throat which he soon
hawked up, and which proved to be similar to what he  had brought  "*
up before, though in  smaller quantity,  and  broken into fragments.
This was examined by Mr. Henry, and was found to be calcareous
matter covered with  a  layer of brown tenacious mucus.  The
vacuity in the cranium filled up from this period, and the patient
could bear the integuments to  be pressed upon without pain.*
   That the calcareous substance thus  ejected from the oesophagus
had  travelled  there  from the coronal suture,  where, before its
separation, probably in the form  of a  caries, it  had for so long  a
time been the cause  of cephalaea,  is  sufficiently  clear  fropi  the
course it seems to have taken, "and the  symptoms that accompanied
that course;  and a passage having been once  formed,  probably
through the nasal sinus, we can readily account for the more easy
and  rapid descent of the second separation  than of the  first,  and
particularly as it was  so much smaller in quantity.  And although
the  nature of the passage it thus opened for itself cannot but be a
matter of astonishment, it is  not  more mysterious than the migra-
tion of  needles, and  even small bullets,  which have sometimes
(ravelled almost over the whole  body  with  little inconvenience to
any part.  Thus, a fish-bone  after  having long fixed itself in  the.
oesophagus, has worked its  way  into its substance,  and been, at
* Mem. Med. Soc. Lond. Vol. i. 
GE. 1V.-SP. II.]        NERVOUS FUNCTION.                3L.'i

length, thrown  out  at the skin:* and the  point of a sword,buried
thirty years  before, in the eye, has at last been  ejected by th<
palate.t   Why, under this slow course of migration, inflammation i<
not produced has been  ingeniously shown by Mr.  J. Hunter ;| but
the general progress is still wonderful and unaccountable.
   For the few  remarks we shall have to  make under the head  of
medical treatment, it will be most convenient, as already observed
under the preceding species, to refer the reader to the close  of the
genus, in order that the  plan  proper to be pursued under one
species may be compared with that under another.  At present it
is only necessary to add further, that the irritating causes of chronic
head-ache we have thus noticed, excite, occasionally, other  symp-
toms  than acute  pain,  and particularly  clonic agitations of the
muscular fibres adjoining  the  seat  of pain, not  unlike those  of
neuralgia ; and severe and irremediable hemiplegia.
                        SPECIES  III.

             CEPHAL.EA  HEMICRANIA.



 TAIN VEHEMENT : CONFINED TO THE FOREHEAD, OR ONE SIDE OF THE HEAD i
                        OFTEN PERIODICAL.

 This is, in most  cases, a disease  of far less importance than  the
 preceding.  Its seat seems to be chiefly in the  integuments of the
 head, and  its principal symptoms are tenderness  on pressure, an
 obscure redness of the skin, and a suffusion of the eyes.   And with
 these there is frequently a  nauseating uneasiness at the stomach,
 but whether as a  cause or a consequence of hemicrania, it is not
 easy to determine ; it is most probable, indeed, that in some instances
it is the one, and in others the other.
  The disease is  most common to persons of delicate  health or
relaxed habits and an  irritable temperament, and particularly when
subject to dyspepsy and hypochondrism.  In such persons all the
causes of catarrh and  rheumatism are sufficient for its production,
 as is any thing that disturbs the  balance  of the circulation.  And
hence, it is often a result of cold feet, or the chill that follows on a
dinner not  comfortably digested.
  Hemicrania frequently assumes a periodical character, in which
* Articulari, Practica.
t Hoechstetter, Observ. Medic. Dec. vi. Car. 0. Francf. 187Q.
t On Blood and Inflammation, p. 239. 
824
NEUROTICA.
[CL. IV.-OR. IV.
  case  the pain  mostly fixes  itself on  the  same side,  or the same
  part of the head, in some cases being limited to a small disk of the
  integuments, with little affection of the encephalon, and in others
  striking deeply into the interior of the head, and down towards the
  eye, which  cannot endure the  least  glimmer  of  light.  In  many
  instances, its intermissions are perfectly regular, and the paroxysm
  returns daily at the hour of noon :*  but more commonly its attacks
  are produced by some  incidental excitement, and are consequently
  of uncertain recurrence.  Yet  it is more frequently found in  the
  afternoon than in the morning.   So far as  1 have observed, indeed,
  it usually takes place in  the evening during,  or  soon after,  the
  digestion of the  dinner, and  in  persons  of  the  middle age  of
  fife who live temperately.  In one instance, in which the  disease
 is still very obstinate, it returns at this hour  after an interval of two
 or three  weeks, continues through the whole of the night  and the
 ensuing day, and subsides towards the  evening;  the paroxysm thus
  lasting about twenty-four hours. In a very active and otherwise
  healthy man, however, about thirty years of age, who has no apparent
 disorder  of the stomach or bowels, it  commences uniformly before
 breakfast, continues with great violence about six hours, and then
  subsides; leaving intervals of about six weeks or a month.
              V



                        SPECIES IV.

             HEMICRANIA PULSATILIS.

                   Earofjlu'ttfl f£eafc=acfie.

 PAIN PULSATORY, CHIEFLY AT THE  TEMPLES; OFTEN  WITH SLEEPLESSNESS
              AND A SENSE OF DRUMMING IN  THE EARS.

 In discussing the genus palpitation (clonus palpitatio) we entered
 into an explanation of the very  curious phenomenon of the throb-
bing or beating of the heart, or of a particular artery, or part of an
artery,  which frequently takes place without any connexion with
the regular systole of -the circulation,  often, indeed discordantly
with it  both  in  time and  moment:  and we  endeavoured to show
that these anomalies, for the  most part, depend  upon a peculiarly
nervous irritability, and spastic  tendency of the  muscular fibres of
the arterial fabric, sometimes  limited to the artery, or portion of an
artery, in which  the palpitation  occurs, and sometimes common to
the whole arterial system.
  Whenever any of the preceding species of the  present genus are
* Schenck, Libr. Obs. 78, 79.
  Zeccini, Consult. Med. 90, 98.  Franc. 16J0- 
 GE. IV.-SP. IV.]       NERVOUS FUNCTION.                 325

 grafted upon a constitution of this, kind, or at least upon an idiosyncra-
 sy in which one or both the temporal arteries are possessed of this
 spastic tendency,  and are consequently disposed to run into  this
 anomalous contraction and relaxation, we  shall have an instance of
 the species before us which commonly originates in  this manner.
 The  consequence of which is, that  a regular arterial stroke, as
 though influenced by the systole and  diastole of the heart, is often
 feigned, which has no existence ; and a pulsation is produced which
 is in no respect synchronous with the movements of the  heart, and
 is often half as rapid again.   It occurs, not unfrequently, however,
 that the morbid beat is in perfect accordance with that of the heart;
 but it is  not less  a spasmpdic action  on  this account, for  in  the
 discussion already adverted to, as well as in the Proem to the third
 class, we have  observed tha,tthe arteries, when in a state of health,
 suffer  no  alteration in  their  diameter during the passage of the
 blood  through them, and that their ordinary pulsation  is only pro-
 duced  by the pressure of the finger or of some other hard substance
 against their sides.
  The species of head-ache before us, therefore, is to be regarded
 as something of a  more compound  kind than  the rest, in  conse-
 quence of the peculiarity  of the constitution in which it occurs :
with the exception of which its causes, and history, and, as we shall
presently show, mode of treatment do not essentially differ
                         SPECIES V.

                CEPHALiEA NAUSEOSA.

                      Sfcfc  ?fceatr=atfie.

 This is the spasmodic affection of Dr. Fothergill, who has described
 it at great  length  and with  much accuracy.   As the last  species
 consists of almost any of the preceding set down upon a constitution
 peculiarly predisposed to irregularity of arterial action, the present
 consists of the same set down upon a constitution peculiarly  predis-
 posed to irregular  action of the intestinal  canal.   In its  general
 symptoms, however, it  is chiefly related  to the stupid  head-ache,
and the hemicrania, particularly to the last, only that while  proper
hemicrania most frequently makes its attack in the afternoon, sick-
head-ache usually shows itself in the morning; though  the latter,,
like  the former, occasionally  varies  its hour, as  it  does also its
length  of intermission.
  The patient, observes Dr. Fothergill^* commonly  awakes  early
in the morning with a head-ache that rarely affects the whole head
* Folhergill's Works, p. 597, 4to.
  Medical Observ. and Inrjuir. Vol, vj. p. 103. 
326
NEUROTICA.
[CL. IV.-OR. IV.
 but only some particular part of it, most  frequently the forehead,
 extending over one or both eyes.   Sometimes it is fixed about the
 upper part of the parietal bone of one side only ; sometimes the oc-
 cuput is the part affected ;  or it darts from one  place  to another ;
 and equally varies during its continuance in its degree of intensity.
 There is some degree of sickness  usually connected with it, mostly
 limited to nausea, but occasionally amounting to vomiting.   If the
 pain commence in the  morning before any meal is taken,  phlegm
 only is thrown up, unless the.straining be  severe, in which case bile
 is intermixed with it.   Afte'r  this the pain  soon  begins to abate
 leaving a soreness about the head, a sqijeamishness at  the stomach,
 and a general uneasiness which induces the patient to wish  for re-
 pose.  Perhaps after a short sleep he recovers perfectly,  only  a
 little weakened by his sufferings.   The duration of this species of
 head-ache differs, however,, in different persons : in some it subsides
in two or three hours;  in others it extends to twenty-four hour;s or
 longer, and with a  violence scarcely to be endured, the smallest light
or noise  rendering the pain intolerable.   In young persons  the pa-
roxysm goes off soon;  but after the disease has been  a companion
 for years, it is of longer duration, and the system becomes extremely
 debilitated.  Its returns are very  irregular:  some persons suffer
from it every two or three days;  some every two  or three weeks;
and others have still longer intervals.  Those who use but little ex-
ercise, and  are inattentive to their diet, are  afflicted most severely:
costiveness when habitual  is  a frequent  predisposing cause ; and
hence a protracted laxity of the bowels,  supervening on habitual
constipation, has removed thetcomplaint altogether.
  Dr. P. Warren, in a  very valuable paper  on  this subject, seems
to think that a line of distinction may be drawn between the  disease
as produced by a morbid state  of the stomach,  and of the  collati-
 tious viscera, or, in other words,  as it makes an approach  to the
 first or to the third species before us.  "Upon the  whole," says Dr.
 Warren, " that  form of head-ache, which is attended more  with»
 confusion than pain,  and in  which there  is  a  temporary  dim-
ness  of sight, appears  to depend chiefly upon a defective action or
secretion of the  stomach ;  the other (that  in  which  the  pain is
acute or  exceeds the confusion) which is  the most prevalent form, ^
more particularly upon inactivity of the upper bowels, from what-
ever cause  it may be produced, and an imperfection of that part of
digestion in which the  bile is concerned.1'*
  The connexion between all these species of head-ache is so close,
 and several of them are so apt to  run into the others, that  the au-
thor  has reserved the few remarks he will have to  make upon
 the remedial treatment till the whole have,  as  now, passed under
 review, and have furnished us  with an opportunity of concluding
 how  far any thing like a common plan of  treatment may be advan-
 tageous and upon what points it ought to vary.
  * On Head-aches which arise from a defective action of the Digestive Organ?.
Metf. Tran$. i\\ Art. xtiii. 
 QE. 1V.-SP- V.]          NERVOUS  FUNCTION.               327

    A very slight recurrence to the  preceding history will show us
 that the chief causes of head-ache are local irritations,  suddenly
 checked perspirat.on, or exposure to cold  and damp ; a peculiar ir-
 ritability  of the nervous system, and particularly a  spastic ldiosyn,
 crasy of the temporal arteries, and a morbid condition of the cnylo-
 poetic viscera.                                           ,
    The last  is, perhaps,  the most  common  cause:  and  hence,
 wherever there is any doubt as to  the specific character  of the
 disease, we can never do better than  treat it as chiefly appertain-
 ing to the fifth  species, and implicated with a diseased  action of
 the stomach or its .collatitious organs.
    It is on this account that emetics, with  an anodyne given after-
  wards, have been so generally  found serviceable,  and  have  often
  effected a cure in a few hours.  And  hence  also the great advantage
  of keeping the bowels not only free from costiveness, but with some
  kind of warm irritant slightly, though constantly, acting upon them,
  of which one of the best is aloes, where  there is  no  tendency to
  piles ;  and copaiba, or the extracts of rhubarb and colocynth, where
  there is.   Piles, however, are not an affection to be much regarded
  in ce,phal#H, for it is probable that they may often become a useful
  revellent: and Dr. Arbuthnot was so  firmly of this opinion that he
  was in the constant habit of employing suppositories of  aloes,  rock-
  salt, and honey, and asserted that-nothing relieves the head so much
 as piles.
    When the disease is evidently of a  rheumatic character, an  open
 state of the bowels should  be combined with mild sudorifics, and, if
 necessary, narcotics.  And hence the benefit that is so  often  found
 from adding four or five grains of antimonial powder to an aloetic
 pill given at night,  which rarely disturbs  the  patient before  the
  morning: and, where this does not answer  alone,  or we  have rea-
  son to fear from a constitutional debility of the bowels that the ape-
  rient may act in the night, we should unite a grain of  opium  with
fthe other ingredients, or employ Dover's  powder instead.
    Such a plan will, indeed, often be  found to succeed   even in the
 pulsatory head-ache orhemicrania; though here we may often employ
  such sedatives as hyoscyamus, conium, aconite, and flammula Jovis,
  or the antispasmodics  of musk, camphor,  valerian, and  ammonia,
  with somewhat more  benefit during  the paroxysms; and epithems
  of cold  salt water, or a diluted solution  of acetate  of ammo-
  nia, applied round the head every morning.  In some cases thinning
  the hair, where it is profuse, has also been  found  serviceable; bat
  in others it has failed, and the  following remarks  of  the author's
  late  valued friend, Dr. Parr, upon the subject of shaving, are  well
  entitled  to  attention.   "  This  practice,"  says he, "  has not the
  sanction of long experience, nor is it supported by reason.   Each
  hair is a vegetable, nourished by a bulbous root, supplied by nume-
  rous blood-vessels.  These,  though small  from their number, con-
  vey no inconsiderable quantity of fluids;  and  as the external and
  internal carotid* an^e  from  a common  trunk, and anastomose in 
 328                      NEUROTICA.           [CL. IV.-OR. IV.

 some of their branches, whatever cause increases the circulation in
 the former, must lessen it in the latter."  He adds that he himself
 was for many years a sufferer from an irregularly returning parox-
 ysm of head-ache for which he could assign  no cause, but at  last
 discovered that it frequently returned after  shaving the head:  he,
 consequently, suffered his hair to grow, and  from that  time the dis-
 ease gradually lessened in violence, in duration,  and in frequency
 of its return.  " From being a complaint," says he, " highly serious,
 and beginning to affect the memory, its  returns are  now rare, and
 never so violent as to unfit the  frame for any  exertion of  body or
 mind."
   Temporary relief has also, in many  cases, been obtained by the
 external application of  volatiles and aromatics,  as  ammonia,  cam-
 phor, oil of cajeput, and ether; and where  the  disease has  been
 produced by cold or  rheumatism, from  blisters, burning moxa,* or
 the actual cautery,t an issue or  a  seton.J   In the Transaction^ of
 Natural Curiosities, is a case of ten years duration completely cured
 by the last application.§   So the use of errhines has also been found
 useful, and particularly in chronic hemicrania, by  stimulating  the
 mucous membrane of the  nostrils, and exciting a considerable-, dis-
 charge : but as we have already observed  that taking snuff ;is  in-
 jurious in cases of indigestion, where head-ache  is connected with
 the chylopoetic organs, sternutatories should be avoided.
   In the interval of most  of the cases thus  far adverted to, tonics,
 and especially the metallic,  should  be employed with steadiness.
 It is here  the nitrate of silver  has  been found  eminently useful,
 when every  other remedy has antecedently failed,   A tonic  regi-
 men,  however,  of exercise,  and early hours should  combine, or
Jittle advantage will be gained by any plan.   Linneus is said to haye
 cured himself of a severe  and obstinate Jh^emicrania, which  returned
 at the  interval of a week,  and continued for twenty-four hours, by
 merely drinking a draught of cold water, early in the morning, and^
 then walking  himself into a glowing heat: and  in  many  cases no £J
 plan can offer a better promise.
   The verticillated stimulant  plants have,  in many instances, also  %
 been  found serviceable in most of the species thus far considered,
 whether the disease originate in the  head or in the stomach, and of  A
 these  the  most  active,  as well as the most'  pleasant, are lavender,
 rosemary, and marjoram.  How far the  arum may answer the same
 purpose, the author cannot say from his  own practice, but it is very
 strongly recommended by Bergius, who  tells us, that when  taken in
 doses  of half a scruple of the compound powder,  he never knew it
 fail of giving relief,  even after the most celebrated remedies had
 proved useless, or even add&d to the  distress.  It is certainly a very
* Wepfer, Observ. p. 81.
t Velschius, Episagm. 11.
X Ruysch, Observ. 40.
4 Vol. ix, Obs, PI. 
GE. 1V.-SP. V.]
NERVOUS FUNCTION.
329
    acrid stimulant,  and seems to have been dropped from the Materia
    Medica too precipitately.
      There is one species of head-ache, however,  to which but little
    of. what we have thus far recommended will in all cases apply,  and
    that is the second or chronic cephalaea: and on this account  it is of
    great importance  that we endeavour to distinguish  it from  the
    rest:  or rather  that we  endeavour to distinguish  those causes of
    it under the operation of which it is necessary to pursue a different
    plan : for in many instances even here the cause of irritation  may
    be palliated, or even destroyed, by some part of the process already
    recommended.   But. we have stated that this form of the disease is
    often dependent upon  some structural irritation within the cavity of
    the skull, such as  a node or toph, or caries of the interior table of
    the cranium, a  scirrhous or other  tumour  in  some  part  of  the
    brain, or a thickening of the membranes that surround it.
      And here, in conjunction with the aperient plan, or even a brisker
    plan of this kind than  has yet been recommended, local bleeding by
    cupping or leeches should be had recourse to without delay.   Free
    venesection, indeed, has  often been of great service in diminishing
    theJLnflammatory action,  and taking off the topical irritability for
    many weeks or even months.   And hence, the temporal artery  has
    often been opened on  the continent, and with very good effect:  and
    we may see why a vicarious hemorrhage from the nose, the  mouth,
    the liver, or some  other orgau,  has been followed, in various cases,
    by a perfect cure.*  And, where some other obstruction has been
    the cause, it has occasionally yielded to a severe fright,! or a fortu-
    nate concussion of the brain,! or a wound on the head.§  Hildanus
    refers to several inveterate cases effectually overcome by accidents
    of this kind.||
      Here,  also, if any where,jwe may possibly expect advantage from
    a long continued use of mercury as an alterant and absorbent, in
   ^connexion with  apozems  of sarsa, bardana,  or  some other warm
    "diluent.   In organic enlargements and obstructions in other parts of
    the boa^y such a planjias often  answered,  and analogy will  fhere-
ttt  fore lead us to expect Tome benefit in the present  disease.  Velschius
    describes a case of a most obstinate cephalaea in which it completely
    succeeded.1T           f-
     ^ But where every other mean has failed,  and the symptoms  are
    violent,  and the painful  spot is clearly defineable,  and we have
    strong reason to apprehend some local organic irritation, it may be-
    come a question how far the use of the trepan has a chance of being

          * Heister, Wabrnemungen, i. p. 70.
            Abhandl.  der Konigl. Schwed. Acad, der Wifsenchaft. xiii. 39.
          t Riedlin,  Cent. II. Obs. 55.
          X Ephem. Nat. Cur. Cent. IX. Obs. 6.
          J Desgranges, Journ. de Med.  Tom. lxii. p. 360.
          || Cent. n. Obs. 8.
          1 Hecatost. n. 67.
      vol. m.             40 
330
Neurotica.
[cl. iv.-or. iv
serviceable.   Vogel gives a ca*e in which the pain was hereby
considerably  mitigated ;*  and Baglivi another, in  which  a radical
cure was effected.t   But in this instance, a portion of the brain was
found in a state of suppuration, and the confined pus hereby obtained
away of escape   Marchetti gives an example of a temporary curer
the head-ache being suspended so long as the wound  was open,  but
returning after it was healed.|  And hence, even  where no struc-
tural cause of irritation has been reached, this operation has some-
times proved serviceable as a revellent.   It must, however, be ad-
mitted,  that it has often been performed without any benefit  what-
ever.
   It is hardly needful to observe that where  cephalaea is evidently
a secondary disease, as in plethora,  chlorosis,  gout, or  neuralgia,
our attention  must be chiefly directed to the malady on which it is
dependent.   Where it appears as a sequel upon any suppressed and
habitual evacuation, or repelled eruption, the best means of obtain-
ing relief will always be found in restoring the system to its former
state ; and where this cannot be done we must furnish the best sub-
stitute we can by some temporary irritation or drain.
   As a general  palliative, strong coffee has often  proved service-
able ; and,  where  its own sedative  virtue is not sufficient, it forms
one of the best vehicles for the administration of laudanum in doses
of eighteen or twenty  drops.   It diminishes, in some  degreeT the
hypnotic power of the latter,  but it counteracts its distressing se-
condary effects.   When laudanum is intermixed with strong coffee
for the cure of many  modifications  of head-ache, tranquillity and
 ease are produced, though there may be no sleep: when laudanum,
 on the contrary, is taken alone, sleep will, perhaps, follow, but is
 mostly succeeded by nausea and a return of the pain.  Hence, the
 Turks and Arabians make strong coffee their common vehicle for
 opium, from its tendency to counteract the  narcotic principle of the
 latter.§.



                        GENUS  V.

                            DIMJS.



 ILLtSORY GYRATION OF  THE  PERSOX  WHILE Al'  KCST, OR  OE OBJEC."?
    AROUND THE PERSON, WITH HEBETUDE OF  THE HJNSOr.IAL  TOWERS.

 The distressing sensation of dim;.-, a strictly Greek  term, occus in
* Chirurgische und Medic. Beobachtungen, p. 410.
t Speciin. Quatuor Lib;oruin de fibia motrice et inorbosrt.
X Observ. 36, 38.
: Phil. Med., and Experimental E-?nys. By Thomas Percival, M.D. Vol. in. 
GE. V.-SP. I.]         NERVOUS FUNCTION                 J3*

different persons and different circumstances,  under very different
modifications, or is connected with very  different  symptoms.  It
is  often united  with cephalaea, and  hence, by  some  nosologists,
it  is made a mere  species of this  last genus, but there are  few
practitioners who  have not  witnessed instances of both that have
commenced, continued, and  terminated  their career without  any
interference with  each  other:  and hence, Linneus  has not only
separated them  from  each  other  and regarded them  as distinct
genera, but has even made  scotoma,  or dizziness with  blindness
and a tendency to swoon, a distinct genus also.
   In the  author's volume  of Nosology,  scotoma, with  two  other
 forms of  dinus, were regarded as  separate species.  But as, on a
 fuller  consideration of the subject, I am induced to think that all
 these diversities originate from the particular habit or temperament
 of the individual  or the nature of the exciting cause, it will be more
 correct to reduce them  to a  single  species, and to contemplate the
 diversities of symptoms and sensations they produce as varieties or
 modifications alone : and hence, adopting the common name for this
 purpose, we shall denominate this species

          \.  DINTS VERTIGO.                       VERTIGO.
                         SPECIES I.

                   DINUS VERTIGO,

                           Wtvtiqo.

               DIZZINESS,  WITH A FEAR  OF FALLING.

Common as this complaint  is I have not hitherto met with any satis-
factory  explanation of its cause.  Sauvages,* indeed,  has  entered
upon  the  subject  pretty fully, as has Darwinj since his time, and
Crichton| since the time of  Darwin;  while on the continent it has
been  investigated  with  much patience and ingenuity by Dr. Herz
of Berlin.§  For the most  part it has been ascribed  to a morbid ex-
citement,  or  increased action in  the organ of vision, which is the
view  taken of it by Sauvages and Darwin, or to " a state of mental
confusion  arising  from  too  rapid a succession of representations,"
which is the  explanation of Herz and Crichton.
  That  there is, in all instances, some degree of mental confusion,
* Nosol. Method. Class vm. vesaniae.
t Zoonom. Class iv. n. i. 10.
X Of Mental Derangement. Vol. r. p. 324.
' Versuch Qber der Schv/indcl. Berlin, 1791. 
332                     NEUROTICA.            |_CL. IV.-OR.
may, perhaps, be allowed, and that  there is often  too rapid a suc-
cession of representations, with a morbid  increase of sensorial ac-
tion, may be  allowed as  readily: but if the  following remarks be
found entitled  to  attention,  and succeed  in  delineating the  real
nature of vertigo, it will appear  that the external  senses are only
indirectly, if at all, the seat of the morbid action; that  this action
is far more frequently in a state of diseased diminution than of dis-
eased increase;  and that even a rapid succession of representations
is not essential to the sensation.
  We have had frequent occasions of showing  that the nervous
power which supplies the  muscular fibres is  communicated,  not,
strictly speaking, in a continuous tenour, but in minute and succes- *
sive jets, so  that the course of this delicate fluid  is  alternately
broken and renewed  by a series of  fine and  imperceptible  oscilla-
tions.  In a  state of health and vigour this succession of" influx and
pause is  perfectly regular and uniform, and hence, whatever move-
ments result  from it  will partake of the same  uniformity,  and ap-
pear to be one continued line of action insfead of a successive series.
But as soon as ever the harmonious  alternation through  which the
nervous power is thus supplied, is interfered with, the  oscillations
become manifest;  the apparently uniform  current is converted into
a tremulous undulation,  and the muscular exertion to which  it gives
rise, instead of being seemingly one and undivided, is sensibly  mul-
tiplied into hundreds : of  which any person  may convince  himself
on observing a strong and  healthy arm  extended for  a few  minutes
with a small weight at the end of the fingers, and  an arm reduced
in strength by a fever,  or any previous labour;  for while the first
maintains an even and uniform line, in the second this line is broken
into perpetual tremours and undulations.
  That the  nervous  power which  supplies  the  muscular  fibres is
communicated in this way there is  no  doubt; and, as it is higbijy
probable that all the different kinds of nervous fibres are fed by a
like process,  there can be  little  doubt, also, that  those which main-
tain an intercourse between  the  brain and the  external  senses, and
even those which belong to the external senses themselves are sup-
plied by the same kind of alternating  pause  and  flow. And con-
sequently that, as a perfect regularity and uniformity in this alter-
nation is the means of conveying from the  organ of vision to the
sensorium one undivided perception of  every single object present-
ed to it,  so, an irregularity and want of unformity in the alternating
series, must  confuse  and  complicate the perceptions, and multiply
them into as  manj' as the series of jets themselves consist of, though
each perception may, perhaps, be less distinct and perfect than the
single perception conveyed in the ordinary course.   Thus,  in look-
ing through a window, or an e3'e-glass,  the objects  that pass before
us in regular order,  pass singly  and  without confusion;  but if this
order be interrupted by movements we are not  accustomed  to, or
the objects jerked about, as in a magic Ianthorn, they  make us dizzy
with their  motion,  and  we see them  confusedly and  in delusive
numbers. 
 GE. V.-SP. I.]         NERVOUS  FUNCTION.                 333

   In this manner then it  appears to me  that the increased motion,
 aod apparently rapid  succession of representations is produced in
 the affection we call vertigo :  which under this explanation is a
 clonic action of the nervous fibres subservient to perception, in the
 same manner as the rapid and tumultuous agitation of the muscles
 in tremor, shaking  palsy, or  epilepsy, are a clonic  action of the
 fibres subservient to voluntary  motion.  In the last of these affec-
 tions we find a  considerable difference in the nature and intervals
 of the clonic movements;  for these must depend upon the greater
 or less degree of interruption, which the nervous power sustains in
 its flow, or upon the peculiarly relaxed  or spastic state of the ner-
 vous fibres themselves, and probably, at times, upon some other cause
 of which we are totally ignorant.  And  we have, hence, reason to
 expect,  and  do in fact perceive, an equal diversity in the clonic and
 illusory  motions of vertigo; for the objects or their representations
 presented to the perception appear sometimes to circumvolve hori-
 zontally from right to left, or  perpendicularly from  above  down-
 wards, or from below upwards,  or  to be very whimsically changed
 in their form.  And not unfrequently  the patient himself seems to
 be moving as well; and commonly in a contrary direction to the ap-
 parent motion of the objects.  And as the intermediate  nerves be-
 tween the other external senses  and the  brain seem occasionally to
 coincide in the same morbid agitation, we can  easily conceive how
 that very common  modification  of  the disease may be produced in
 which the dizziness is combined with illusory sounds, as of whisper-
 ing or murmuring, the ringing of bells, or beating of drums, or even
 the roar of cannon: for, as single objects may, under the influence
 we are now  contemplating, be prodigiously multiplied  or magnified,
 so may  single,  and otherwise  almost imperceptible  sounds:  and
 especially where the auditory nerve is itself in a state of high mor-
 bid acuteness,  during  which we have already had occasion  to re-
 mark that the gentlest and lightest tones, even the whisperings of a
 mere current of air in a room, or the breathing of persons present
 is intolerable, while sounds before  unperceived become highly dis-
 tressing.*  And in like manner by an equal irregularity in the flow
 of  the nervous fluids subservient to  the perceptions of smell and
 taste, we may account for similar illusions upon these faculties.
  In many instances, we find  the vertigo equally present whether
 the patient be in^he dark or  light, whether the eyes be closed or
 open;  and we have hence a full proof that  it is not dependent, as
 Dr. Darwin  conceives, upon an  increased energy in the irritative
 motions of the organs of vision.   In some cases the representations
 of objects are very numerous  and rapid, but in others far less so,
and particularly  where the affection is severe from the first, or the
patient is in a state of constitutional debility ; under  which circum-
stances we may conceive the pauses in the flow of the nervous fluid to
be more  irregular or of longer duration than they otherwise would
* Pi»e Paracusis an is. Vol. in. p. 1£4. 
 334                    NEUROTICA.           [CL. IV.-OR IV,

be.  In miny cases, indeed, the only sensation is that of  a buoyant
uniulation or swimning without any succession of representations
whatever;  affording us a proof that  the rapid succession of repre-
sentations described by Dr. Herz, is not more essential to  vertigo
than the increased energy of Dr. Dirwin.
   But as the disease advances, or,  in other  words, as the flow or
secretion of the nervous fluid becomes still more interrupted,  the
representations  are  confused,  indistinct, and rapid in succession,
often conjoined with a sense of dimness or darkness, existing equally
whether the eyes be shut or open, forming a state  by Hippocrates
and the Greek writers gane rally called scotoma or scotodinus :  and
as the  disease makes a further progress  by a further interruption
in the  flow  of the sensorial fluid,  every power of body and mind
augments in languor, till at  length sensation both  external  and
internal  fails altogether,  the  action of the  heart, and  the  other
involuntary  organs is enfeebled, and the patient swoons away, or
sinks into a fainting fit, constituting the morbid condition we shall
have to describe under the next genus.
   The  great predisponent  cause  in all  these cases, whether of
muscular agitation or of vertigo, is nervou3 debility or exhaustion:
the  exciting causes  are whatever  has a  tendency to disturb  the
uniformity with  which  the nervous  power is supplied through the
whole of its fibres, an:l from one fibre to another.  And hence those
persons are  most subject to  both kinds of affection  whose  nervous
system is constitutionally weak and mobile, or has become debilitated
by disease or accident.   Hence dyspeptic  patients  are  peculiarly
subject  to both these affections; as  are those who  are  faint from
sudden  and violent evacuations, want of food, or a  long course of
labour.   Hence  we  maet  with it   as a  frequent  and  distressing
attendant upon those who have too freely  indulged in the plea-
sures of the table, in  those  of sexual  intercourse, and  particu-
larly the gross gratification of self-pollution.   And, hence,  we  may
see why it is so  often an accompaniment of cephalaei, as the nervous
fibres subservient to the  organs of perception are here  influenced
from contiguous, in some cases from continuous, sympathy.
   The  exciting causes we have stated to be whatever has a tendency
to disturb the uniformity with which the  nervous power is supplied
through the whole line  of its fibres.  Of these the chief are motion
or exertion to which the strength is not equal, motion to which the
system  has not been accustomed, or hurried motion whether  external
 or internal.
   In a state of great weakness, whether  from hunger, hard labour,
 hemorrhage, or a protracted fever, even the ordinary motion of
gentle  walking is more  than the  little  remaining strength can
 support: and the man  who tries  it trembles in every limb and
 becomes immediately  vertiginous.   In  like manner whatever be
 his degree of strength he will feel  vertiginous by exchanging the
 motion to which he has  been uniformly accustomed for one  of a 
\J,E. V.-SP. I.]
NERVOUS  FUNCTION.
335
 different kind, and which he has seldom or never engaged in ;  and
 hence, the reason of the vertigo that accompanies swinging, sailing
 in a slip, walking in  a circle, sitting backward in a carriage, or
 standing on one's head ; for the uniformity of the external habit has
 by length of time associated itself with the uniform flow or secretion
 of the sensorial fluid, and the one cannot be interfered with without
"interfering with  the  other.  And  that this is  the  cause of the
 dizziness hereby produced is obvious, since as socn as the old habit
 is overpowered by a  new  one, or, in other words, as  soon as the
 man has accustomed himself to the new action, it may be persevered
 in without any  vertiginous  sensation whatever.   In  some persons
 this sympathy of association is not so strong as in others, and hence,
 they are  not so soon affected : in infants and young children such a
 kind of sympathy has rarely commenced, for while their age has
 not given time  for it, they  have had so little walking in a straight
 line, and been accustomed to so much swinging and tossing about in
 the arms, in every direction, that they are equally prepared  for
 all; and hence can run round a circle, or even circumvolve on their
 feet, without any  feeling of giddiness whatever.
   For the same reason hurried, tumultuous, or confused, motion of
 any kind, whether external or internal, has a tendency to produce
 the same effect; for the Current of the  nervous supply will partake
 of the agitation, and  dizziness be a necessary result.   Hence the
 vertigo that accompanies intoxication, in which, from the inordinate
 excitement that prevails  throughout the system, the  regular and
 uniform stream of the sensorial fluid is quickened into a confused
 and disorderly rush.  And  hence the same effect from  congestion,
 or compression of any kind, as also from a sudden influence of mental
 emotion, and particularly of the depressing passions: though in such
 cases  the uniformity of the sensorial stream is interfered with by a
 check, instead  of by a rapidity of action :  and where the check is
 considerable,  as in cases of sudden fright or apprehension, a fainting-
 fit is at once produced without the preceding stages.
   It is to this cause, exercised indeed in a less degree,  that we are
 to ascribe the dizziness which is felt on looking clown a precipice,
 climbing a tall ladder, or walking over a very narrow bridge, with a
 roaring torrent below;  for in all these cases  we are conscious of
 danger, and lose our firmness in our  fear.   And that such is the  real
 cause  is quite obvious from the fact that those who possess their
 firmness,  and  have no apprehension or trembling whatever, have no
 dizziness : and that we ourselves are able to endure an  exposure to
 the same  scenes and the same motion with as great a freedom from
 it, when habit has given us calmness, and we have no longer  any
 apprehension.   So the sleep-walker has been known to tread firmly
 and fearlessly over planks  and precipices the  sight  of  which  ha<-
 whirled all his brains when awake.
   Vertigo, then, as thus  explained, consists in a clonic action of the
 nervous fibres subservient  to the faculty  of perception : tmd lavs
 open to us the three following varieties: 
336
NEUROTICA.
[CL. IV.-OR. IV.
x Undulans.                  Dizziness with a sense of swimming
  Swimming of the head.         or undulatory motion.
g Illusoria.                   Dizziness with dimness  of sight, and
  Illusory Vertigo.              imaginary  objects before the ex-
                               ternal senses.
y Scotoma.                   Dizziness with blindness and tenden-
  Blind head-ache.              cy to swoon ;  often succeeded by4
  Nervous fainting-fit.          head-ache.
  Vertigo, is not generally an alarming affection, but it  is only to be
remedied by a particular attention to its cause, and especially the
predisposition of the system to a  relapse.
  If we have reason  to  suspect congestion or extravasation in the
head, bleeding, and especially from the temporal artery, will  often
afford effectual relief.   I  have seen a very severe attack of vertigo
cease instantly, as by magic, on  opening this artery, although not
more than a tea-cup-full  of blood was  drawn from it.   Where the
stomach has been gorged, an emetic and afterwards a purgative will
prove most  effectual; where the cause, on the contrary, is debility
or exhaustion, it is best relieved by cordials and  a generous  diet:
and where it is an idiopathic affection of the  nervous system the
warm antispasmodics  and tonics,  with a ionic  regimen, will bid
fairest to  succepd.   Such persons  will derive great  benefit  by  a
change of air, of scene, and of company ; by visiting the most  quiet
of our watering-places,  cold bathing, and  a cold ablution  of the
head, or of the whole  body every morning.   Here also a particular
attention shouid be paid to the state of the bowels, as costiveness is
always an exciting cause.   During the paroxysm perfect rest and a
reclined position will  be always found necessary ; and,  where there
is  a  tendency to fainting, stimulant odours  may be applied to the
nostrils, and ether,  ammonia, and the volatile fetids to the stomach
in draughts of cold spring water.
                     GENUS  VI.

                         SYNCOPE.

                          Sgncoye.

MOTION OF  THE HEART AND LUNGS  FEEBLE  OR IMPERFECT .  DIMINISHED
              SENSIBILITY : INABILITY OF  UTTERANCE.

Syncope, from <r»yxoitxa  " concido,?' " to fell  or cut down,"' is a
neoteric rather than an antique term.   It occurs, indeed, among the
Greek writers, but  rather in the description  of  battles than of
diseases.   I cannot find  who  first introduced  it into  the medical 
GE. VI.-SP. I.]      NERVOUS FUNCTION.                 3o7

nomenclature.   In Hippocrates the common synonym is leipopsychia,
and in Galen apopsychia : but it answers its purpose, and is, in the
present day,  so generally  established, that there  is no  kind  of
necessity for exchanging it.
  Dr. Cullen's definition of the genus is " motus  cordis imminutus
vel aliquamdiu quiescens."   But this  is  by no  means sufficient:
for  the heart  has  been sometimes totally void of motion  without
syncope, as in acrotismus, and especially in the well-known case of
Mr.  John Hunter, which we have  noticed under that  division.
The leipothymia of Sauvages and other nosologists is, only syncope
in its first attack or mildest degree.  Its character is " subitanea et
brevis virium dejectio, superstite pulsus vigore,  et  cognoscendi
facultate." The  pulse  is, perhaps, always affected in some mea-
sure ; but in slight cases it  still retains a certain degree of power :
ihe  perception rarely fails  altogether: but the voice seems to  be
uniformly lost.
   The species in some systems of nosology are very numerous, and
unnecessarily multiplied.  Out of deference to high and established
authorities, the author was induced, in his volume of Nosology to
offer five: but as several of these differ only in cause or some acci-
dental symptom, they may be reduced to the two  following, and the
accidental differences be  regarded  as constituting varieties  or
modifications alone :

           1. SYNCOPE SIMPLEX.              SWOONING.
           2. RECURRENS.                   FAINTING-FIT.
                         SPECIES  I.

                  SYNCOPE  SIMPLEX.

                         Sfooom'ng.

OCCURRING SUDDENLY  AND ACCIDENTALLY,  AND CEASING  WITHOUT  ANY
                  TENDENCY  TO  A RECURRENCE.

In vertigo the defective or irregular action is chiefly confined to
the nerves, and particularly to those of perception: in swooning it
is sometimes a result of nervous exhaustion as in cases of exquisite
pain or torture, whether of body or of mind, but it more commonly
originates in the sanguific or  digestive organs, though the sentient
participate in the affection.  Vertigo, as we have already observed,
occasionally terminates in swooning;  and in like manner swooning
is not unfrequently succeeded  by vertigo.
  To maintain  the  faculty of perception  clear  and  true  to  the
impressions that  are  made on  the external senses, we  endeavoured
  v©l. in                 43 
338
NEUROTICA.
[CL. IV.-OR. IV,
to show, under the preceding genus, that the motion of the nervous
power  which connects it with those senses must be equable  and
uniform ;  and to  maintain  the action  of the  heart in  a firm  and
regular order, it is necessary that the blood should flow into it in an
equal and uniform stream :  for if its volume be altered from  any
cause, whether of obstruction, surcharge, or deficiency, its motion
will be checked and  enfeebled:  the brain  and respiratory organs
will participate in the  debility, and syncope be a frequent result.
And hence, we may account for the fainting that frequently takes
place on the  commencement and sometimes on the close of vene-
section.  On  tying the arm for this  purpose, a  considerable stream
of supply is cut off, and ten ounces  of blood flows, in perhaps five
minutes, into a bason, which would otherwise have flowed into the
heart in the same period of time.   The  volume  of blood is hence
diminished and the heart must collapse or contract itself in propor-
tion.  In many habits  this is done with  great facility -. but in others,
and particularly where there is a feeble  supply of motific or  irri-
tative  power, the contraction takes place  slowly and  irregularly
and with a considerable degree of flutter, or, as we have already
explained it,  clonic  spasm ;  and fainting  or  a  temporary failure of
sensation, is  the necessary consequence : during which the alter-
nating  systole is very feeble,  and  the  blood ceases to flow at  the
puncture.   This  effect  is  ordinarily  ascribed to a  loss  of  the
stimulus of distention  ; and there may  be some degree  of truth in
such an explanation.   But that there is a something beyond this is
certrun, because on removing the ligature from the arm this stimulus
is once  more  obtained ; for the blood,  instead  of flowing  away at
the venous orifice, now takes its proper course  and flows back to
the heart.  Yet we see almost as often a syncope produced at this
moment, and consequently by a renewal  of the distension, as  well
as by an interruption  of it.   The fact is that  the heart, which by
this time has accommodated itself to the diminished volume of the
returning current, has now once more to change its diameter, and to
expend itself in proportion to the increased  measure and momentum
of the  inflowing tide.   And  as a  change in its diameter  produced a
syboope in the former case, a change in its diameter in like manner
pro.luces it m the latter.
  For the same reason we may see  swooning takes place when any
extensive range of blood-vessels  that have  been  pressed upon by
any other means, suddenly acquire a power of dilatation, as when "a
large cavity is formed in the  abdomen by  the  process  of tapping
for an ascites, or  on  opening an extensive  abscess in  any other
quarter.*
  But the flow of sensorial power from the  brain may also be  sud-
denly exhausted,  or checked, or perhaps  its  secretion impaired;
and syncope may ensue from this source, the action of the heart
* Meckel, Epist. a-l Hallen. Script. Vol. m.
  Kph. Nat. Cur. Dec. u. Ann. v. Ob?. 53. 
QE. VI.-6P. I.]          NERVOUS  FUNCTION.                33^

being diminished not  primarily, but secondarily,  or by sympathy
with the state of the  sensorium.  In fainting, from entonic passions
or  emotions as a sudden  shock  of vehement joy, the sensorial
power is perhaps abruptly expended, as also in severe  pain.   In
fainting, under the influence of the atonic passions, as fear, or heart-
sick grief, this power is unquestionably checked in its regular flow,
and  probably checked also  in its secretion : as we have reason to
believe it is where fainting occurs from a repulsion or retrocession
of gout, exanthems,  or various other diseases.  And to the  same
cause  may be referred those cases of swooning,  which, in  some
idiosyncrasies,  or indispositions of  body, are  well  known to take
place on exposure to particular odours, as those of cheese,  apples,
or, as we have already  had occasion  to  observe,  of roses,  lilies,
and  other fragrant plants.  Where it has  followed  instantly  upon
acrid poisons,  there can be no doubt that these  have  induced a
rigid or entastic spasm upon the muscular fibres of the heart; and,
where  the poisons are purely narcotic, the  living or  instinctive
stimulus is suddenly extinguished  or carried off*, and  the nervous
system becomes an exhausted receiver.
   Syncope then, in its simple state, as unconnected with any struc-
tural disease of the heart or its adjoining  vessels, seems to appear
under the following modified forms  or varieties:

x Inanitionis.           #        The swooning produced by  fa-
  Swooning from inanition.         tigue, long-fasting, or a sudden
                                  and excessive discharge of any
                                  fluid whether natural  or mor-
                                  bid, accompanied  with a sense
                                  of inanition, and great prostra-
                                  tion of strength.
£ Doloris.                      Preceded by severe pain or irri-
  Swooning from acute pain.       tation  of body, internal, as from
                                  poisons, flatulency, or worms;
                                  or external, as from wounds or
                                  other injuries.
y Pathematica.                  Preceded by  an exercise of some
  Swooning from mental emo-      sudden and overwhelming pas-
     tion.                          sion or emotion.
S Metastatica                    Accompanied with a retrocession
                                  or repulsion of gout, exanthems
                                  or other diseases.

  The degree and duration of the paroxysm depend upon the pe-
culiarity or the violence of the cause, the  extent  of the sensorial
exhaustion, or the nature of the constitution, and hence must great-
ly differ in different individuals.  In some cases it  ceases in a few
minutes, and the  patient, though  incapable  of speaking,  retains
* Amat. Lusitan. Cent. n. Cur
  Hater, Observ. II. p. 431. 
340
NEUROTICA.
[CL. IV.-OR. IV.
enough of perception and sensation, to be conscious of his own dis-
order, and to understand what is passing around him.   The pressure
and irritation of flatulency in dyspeptic and hypochondriacal habits
are often sufficient of themselves to produce a fainting of this kind.
In other cases the general feeding and understanding fail totally, and
the pulse is scarcely perceptible.    Occasionally  the  sensorial
power has been totally as well as suddenly exhausted,  and the syn-
cope has run into asphyxy, and even proved fatal.
  When not assisted by medicine the system recovers itself by the
gradual accumulation of sensorial energy that must necessarily take
place,  so long as the living principle continues, during such a state
of quietism;  aided, unquestionably, by the continued  action of the
instinctive, or remedial power of nature, which is always  aiming to
repair what is amiss.  The process of recovery, however, varies
almost as much as that of sinking. Some revive  almost immediate-
ly without  any inconvenience  or sense of weakness whatever:
while others improve slowly and almost imperceptibly, and require
many hours before they fully regain their self-possession.  In vari-
ous case? the head becomes clear as  soon as the  pulse becomes re-
gular : while, not unfrequently, the recovery is accompanied with
a confusion of ideas, vertigo, and head-ache.
  As this disease is always attended with an irregularity in the flow
of nervous power, and some degree of spasmodic action, entastic
or clonic,  about the heart, the best remedies we  can have recourse
to, during the paroxysm, are antispasmodics and stimulants; and those
that are the most volatile are the most useful.  Hence the advantage
of admitting a free current of cold air, sprinkling cold water over the
face, and pouring a little of it, if possible, down the throat. And hence,
also, the advantage of holding ammonia, the strongest vinegar, or any
other pungent odours to the nostrils.   A  recumbent position is  al-
ways adviseable, as most favourable to an equable circulation of the
blood; and irritating and warming the  extremities by  the  friction
of the hand or the application  of rubefacients will commonly be
found to expedite the recovery upon the principle  we often had occa-
sion to advert to,  that, in a chain of organs united by  sympathy or
continuity, an impression produced on the one extremity is sure to
operate on the  other.  As soon as the patient is capable of swallow-
ing, some  spirituous cordial, as a glass  of wine, brandy and water,
fetid tincture, or the aromatic spirit of ammonia,  or of ether should
be administered;  and the  occasional  cause should  be  sedulously
avoided in future. 
 GE. VI.-SP. II.]      NERVOUS FUNCTION.                 341


                         SPECIES  II.

               SYNCOPE RECURRENT

                       iFaCntinjfclFft

 RECURRING AT PERIODS MORE  OR LESS REGULAR;  OCCASIONAL PALPITA-
   TION OF THE HEART DURING THE INTERVALS: AND UNQUIET RESPIRA-
   TION DURING THE PAROXYSM.

 This is, in most cases, a far more serious form of syncope than the
 preceding, and is commonly  ascribed to some structural disease  of
 the heart or the lar^e arteries that immediately issue from it, as  an
 ossification of the valves,  polypous concretions, an enlargement  or
 thickening of the substance of the heart, an accumulation of water
 in  the pericardium, or an aneurism.
   Each of these may possibly be a cause in some instance or other;
 and where, during the paroxysm, the  breathing, though  feeble,  is
 anxious and obstructed, the  face livid, and the patient in the midst
 of  the swoon  shows a tendency to  jactitation,  or an uneasiness   on
 one side or on the other; and, more especially still, where no ordina-
 ry  exciting cause can be  assigned, and  it has commonly followed
 upon  some unusual  exertion,  or hurry  of the blood through the
 lungs, it would be imprudent not to suspect some such lurking mis-
 chief.
   But there are causes of a different and much slighter kind that I
 cannot avoid believing, frequently operate in the  production of re-
 current syncope, and that  too, with many of  the peculiar symptoms
 just enumerated.  And I now allude to any of the ordinary causes  of
 syncope, as set down under the first species, or any other incidental
 irritation whatever, occurring  in a constitution of great mobility
 and excitability, or where the heart  alone,  or in conjunction with
 the whole arterial system, is peculiarly disposed to that irregular
 and clonic action which we have noticed under the species palpita-
 tion,  and particularly under  the first and second varieties.
  In  such a frame of body any sudden  alarm, a longer abstinence
 than  usual,  a  fuller  dinner  than usual,  unwonted exercise, and a
 thousand minute excitements of daily occurrence will often succeed
 in producing a fainting-fit: and especially where a morbid habit of
 recurrence has been once  established,  and  there is a predisposition
 to return.   Atonic plethora is another frequent cause in  the peculiar
 constitution we are now considering, and a cause far too liable itself
 to establish a circle of recurrence, and consequently to  give recur-
rence to  the  form of syncope before us.   There is a singular ex-
ample of periodic swooning in the  Ephemera of Natural Curiosi-
ties,*  which seems to have been dependent upon this state of body:
* Dec. it. Ann. I. Obs. 10. 
342                    NEUROTICA.             [CL. IV.-OR. IT.

and another  example  in  which  it was  evidently produced by  a
return of the term of menstruation, and became its regular harbin-
ger.*
  In all cases of this kind, therefore, it is of the utmost importance
to study minutely  the  character of the patient's idiosyncrasy and
habit, and not to excite any alarm concerning organic mischief, and
thus add another excitement to  those  which  already exist,  while
there is  a probability that the affection may be owing to  one or
other of these lighter and  more manageable causes.
  In the latter  case tonics, cold bathing, equitation,  regular hours
and  light  meals will form  the  best  prescription  we can  lay
down.   Where  we are compelled to suspect some organic impedi-
ment or other mischief about the heart,  small bleedings  that may
anticipate the usual time of the return, camphor, nitre, hyoscyamus,
and whatever other sedative  may be found best to agree with the
patient and diminish the rapidity of the circulation, will  form the
most rational medical plan we can devise ; while tranquillity of body
and mind, an  abstinence from all stimulant foods, and a regular &U
tention to the state of the bowels should form a standard rule for
the whole tenour of his life.
                     GENUS  VII.

                        SYSPASIA.

                     Comatose Spasm.

   clonic spasm ; DIMINISHED sensibility ; INABILITY of UTTERANCE,

Syspasia, or syspasis from ovo-xxu, " contraho, convello"—literally
imports convulsion in the  popular sense of the term, or, in other
words, clonus or agitatory spasm, in combination with  a greater or
less degree of failure of the sensation and the understanding.   The
term seems wanted as a generic name for the three following dis-
eases, whose  symptoms, and, for the most part, mode of treatment,
are so accordant as to establish the propriety of linking them under
a common division:

       1. SYSPASIA CONVULSIO.                    CONVULSION.
       2. ------- HYSTERIA.                     HYSTERICS.
       3. ------- EPILEPSIA.                     EPILEPSY.

  The author has  entered so fully into the nature and principle of
clonic or agitatory spasm under  the  genus clonus, that a  very few
* Id. Dec. n. Aun. v. Obs. 53. 
GE.VII.]                NERVOUS  FUNCTION.               343

remarks  will  be necessary in explaining the pathology of these
three species.   They are  all of them clonic spasms, as expressed
in the definition, but complicated with other morbid  affections, and
particularly with those of the two preceding genera:  forif we com-
bine clonic or synclonic spasm with  different modifications of  ver-
tigo or syncope we shall produce the three  species that are now
before us.
   In explaining the nature of clonic spasm, we noticed the tendency
there frequently exists when the uniformity of the flow or secretion
of the sensorial power is once interfered with, to alternations of a
hurried and excessive, as well as of a restrained and  deficient sup-
ply, and  consequently to an intermixture of constrictive or entastic
spasm with  clonic or agitatory, of  which palpitation, and various
other affections of this kind afford perspicuous examples.  In the
diseases  immediately before us the  proofs of such an intermixture
are still  more striking; for there is not one of them  but evinces an
union of both  descriptions of spasmodic action  in a  high,  though
not an equal degree of vehemence.  In convulsion-fit the two kinds
of spasm are nearly upon a balance, commonly with a retention of
some share of both sentient and percipient power.   In hysteria the
spastic or entastic  action, in its sudden and transient irruptions, is
more violent than  the clonic, the  force  exercised  at this  time is
enormous,  and there is also, in many cases, a small retention of sen-
sation and understanding.   In epilepsy the  clonic action is  most
conspicuous, and the failure  of the mental and sentient faculties
generally complete.
   Of the essence of the nervous power we have repeatedly stated
that we  know nothing, for  we can trace  it only by  its effects: but
we are compelled to  conceive of  it as a fine volatile and energetic
fluid, not existing out of the animal system, and, therefore, formed,
and consequently secreted by some particular organ within it: which
organ there can be  no difficulty  in contemplating as  the  brain
singly, or the brain and nerves jointly, which constitute only differ-
ent parts of one common apparatus.   Admitting, then, the nervous
power to be a secreted  fluid, like all other secretions, this  may be
produced in excess or  in deficiency, or be imperfectly elaborated,
and, however produced, it may  be irregularly communicated  in its
flow, as well by precipitation as  by interruption.   The means by
which these  diseased actions take place,  we have already touched
upon; and have shown that the common causes are sometimes men-
tal, sometimes  mechanical, sometimes sympathetic,  and  sometimes
chemical,  as narcotics and other poisons, and particularly those of
repelled  eruptions.
   Now it is in persons  of relaxed or debilitated fibres that  we find
these  exciting causes chiefly operative.   For in  those of high
health, full vessels, and a firm constitution, however  the circulation
may be accelerated, or  the nervous  power excited, it is rarely thai
we meet with clonic spasms, or indeed, spasms of any kind: or, at
least, we meet with a far lets  tendency to such abnormities,  than in 
 344                     NEUROTICA.           [CL. IV.-OR. IV.

 persons  of lax and debilitated fibres, possessing, necessarily, more
 mobility, or facility of being put into new  actions from the very
 quality of debility itself.
   The common  predisponent, then, is weakness,  particularly  of
 the nervous system; and the common excitement irritation.  The
 peculiar effect must, however, be modified by the  idiosyncrasy  or
 peculiarity of the  constitution, or of collateral  circumstances, by
 which it may  be influenced  at  the time.  And hence, the very
 exciting cause that in one  individual  may produce hysteria,  in
 another may produce epilepsy, and in a third the more fugitive and
 less impressive attack of syspasia or convulsion.
  ^The nature of the idiosyncrasy, or particularity of the individual
 constitution, is rarely within our  control; but the collateral circum-
 stances are often  before us: they constitute the occasional cause  of
 the disease, and  should form a prominent  point in our attention  to
 its progress.
   There are, perhaps, few more common causes of weakness than
 over-distended vessels ; and hence plethora is a frequent occasional
 cause of each of the diseases  belonging to the  genus before us, the
 species actually  produced depending as just  observed,  upon the
 influence of other  circumstances.   Thus, if  such  plethora take
 place in  a young  woman of eighteen or nineteen, whose menstrual
 flux  has  been accidentally  suppressed, or retarded, it is  most
 probable, if an  irregularity  in  the  nervous system  be  hereby
 excited,  that  such an irregularity will lead to  a fit of hysterics
 rather than to one of convulsion  or epilepsy, since we  shall find  as
 we proceed, that this species of spasm is peculiarly  connected with
 an irritable and especially  an orgastic state of the genital organs.
   On the contrary, if the  plethora produce  chiefly a distention  of
 the vessels of the  brain,  epilepsy is more likely to  be the result;
 in other  words that form of spasmodic action in which the sensation
 and the intellect suffer more severely than in either of the others.
 While if the plethora  be general, we  have reason to  expect that
 the spasmodic effect will be general also,  or, in  other  words, take
 the form of convulsion in which no single organ  is tried more than
 another.   Yet plethora,  in a firm and  vigorous frame, is seldom
found to  produce  either of  these affections, for the resistance of the
 coats of the blood-vessels  is here sufficient to counter-balance the
impetus of the sanguineous fluid, and, consequently, to prevent  an
over-distension.   And hence, again, we see in what manner debility
 becomes a remote or predisponent cause of the diseases under our
 consideration.
   Plethora thus  acting by over-distension may  be regarded as a
 mechanical  stimulus, upon the  removal  of which, as  upon the
 removal  of other  mechanical stimuli, the disease will cease.   Vene-
 section is the  most direct  means of such  removal; but it  labours
 under  the inconvenience  of being only a temporary remedy.   It
 takes off the occasional cause, but by adding to  the general debility
it gives strength to the predisposing  cause. 
GE. VII.-SP. I.]        NERVOUS FUNCTION.                345

  The more direct mechanical  stimulants  are sharp-pointed  ossifi-
cations formed in the membranes  of the brain, or arising from  the
internal surface of the  cranium; splinters of a fractured cranium,
or the introduction of some wounding instrument.   1 he  occasional
causes resulting  from  mental  emotions,  we have already been
called to notice more than once ; as  also to <how  that while some
of these appear to act by instantaneously exhausting the sensorial
organ of its living principle, others operate by giving a check  to the
sensorial secretion.  These  modes of action  are  indeed opposite,
but the result, which is a depletion of the nervous apparatus, is the
same.  And as in weakly or relaxed habits there is in every  organ
a greater mobility, or facility of passing from one  stale of action to
another, than in the firm and robust, we see also why the former
should be  not only more subject to spasmodic actions from men al
emotion, but to sudden changes of mental emotion, and, consequently,
to caprice and fickleness of temper.
                        SPECIES I.

               SYSPASIA CONVULSIO.

                        ftonfoulsion.

MUSCULAR. AGITATION VIOLENT ; TEETH GNASHING : HANDS FORCIBLY CLENCH
                        ED : TRANSIENT.

In defining convulsion, most of the nosologists represent the faculties
of the  mind and the external senses as still sound  and unaffected.
Sauvages says,  " superstite in paroxysmis animae functionem exer-,
citio."   Vogel distinguishes it, " cum integritate sensuum."   Dr.
Cullen  is more exact than either of these.  His words are, " mus-
culorum contractio clonica abnormis, citra soporem ;" " an irregular
clonic contraction of the muscles, bordering on but short of lethargy."
The influence of the disease on the sensation and perception vary
considerably in different cases,  but so  far as 1 have  seen, the
sensibility is always  in  some degree diminished, and I hence
ventured to  introduce this feature into the generic definition as a
pathognomic symptom.
  There are also some other differences that occur in the character
of the disease in its different attacks, and which have been laid hold
of as the  ground-work  of very numerous subdivisions by many
nosolofists.  For these differences we cannot always account: but
in general they will  be found to depend  upon the idiosyncrasy,
habit, or stage of life in which the disease makes  its appearance.,
and to  give rise to the following  varieties:
  vol.  in.                       4-1 
                         NEUROTICA.            [CL. IV.—OR. IV.

                              The convulsion shifting irregularly
                                 from one part to another.
                              The  convulsion  attacking  every
                                 part"simultaneously; occasionally
                                 protracted in its stay.
                              The convulsive paroxysm  return-
                                 ing after intervals more  or less
                                 regular.
                              The convulsion accompanied with
                                 shrieks or yells, but without pain.
                              Occurring during pregnancy or la-
                                bour, usually with coma, and ster-
                                torous breathing.
                              Occurring duriug infancy ; preceded
                                by twitchings or  startings,  and
                                accompanied with a blueness about
                                the eyes and upper lip.

  In the first or  migratory variety, the convulsion travels, in
some  instances, so completely from organ to  organ,  and  from one
set of muscles to another, as to make an entire circle.
  In the second or universal varietv, the convulsion is often accom-
panied  with  a peculiar kind of percussion or hammering of one
limb against  another,  or against  some  other part  of  the body,
resembling the malleation we have already had occasion to describe,
and constituting the malleatio of some  authors.
  In the recurrent variety, the intervals are often very irregular;
but the  ordinary return, where any thing  like a regular period is
established, is menstrual or lunary.  To this, as also to the preceding,
many writers have applied the name of hieronosus or morbus sacer;
which by others, as we have observed above, has  been  limited to
some modifications of chorea.
  In the fourth  or shrieking variety,  the muscles of respiration,
and especially those of the larynx, appear to be  chiefly affected:
and the shrill sounds  or yelling  to which it gives rise, proceed
rather from an involuntary  motion of these organs than  from any
greater degree of pain that is suffered under this  form than under
any Other.
  In puerperal convulsion,  the irritation is supposed by Dr. Bland
to derive no  peculiar  character from  the state of the body at the
time.  But it is impossible to shut our eyes to the close and active
sympathy which exists  between the sexual organs and the sensorium,
and which is  peculiarly striking in hysteria; nor to  the dintinctive
symptoms which take place  in convulsion from this cause ; in which
there is a greater tendency to oppression  in the head than in any
other modification whatever, the breathing is stertorous, and the spas-
tic action peculiarly violent ;  insomuch that were it not that the head
seemed  first  affected,  we  might resolve  the  oppression  into the
vehemence and duration of the entastic struggle.  Convulsions of
this kind occur during  pregnancy, in the midst of  labour  or imme-

                                                              f
346

x Erratica.
  Migratory convulsion.
S Universalis.
  General convulsion.

y Recurrens.
  Recurrent convulsion.

3 Ejulans.
  Shrieking convulsion.
i  Puerperalis.
  Puerperal convulsion.

£ Infantilis.
  Infantile convulsion. 
CE. VII.-SP. I.]         NERVOUS FUNCTION.                347

diately afterwards:  they rarely, however, take place before the
sixth  month.  Yet, if  the  irritation were  not of a particular kind,
we might rather expect it on the first  turgescence of the uterus.
But we shall  have occasion to recur to this subject under the en-
suing class.                                       .  .       .   .
   In infantile convulsion, the mobility  of the frame is impressively
conspicuous.  The clonic  motions are exquisitely rapid, and  the
fingers work and the eye-lids nictitate with a quiver that it is often
difficult to follow up.  This constitutes  the ecclampsia of Sauvages.
In the subsequent stage of teething, as the irritative fibre is somewhat
firmer, the clonic vibration is rarely so  rapid.  Antecedently to the
time  of teething the usual causes of excitement are  retained me-
conium,  flatulency, and acrimonious food.
   The ordinary excitements of convulsion, however,  operate at
 all periods of'life.  They are often concealed, but are those of
 clonic spasm generally. They consist not unfrequently, as we have
 already observed, in pressure or  other irritation, from a deformity
 or some spicular node within the cranium ; and are said by Desses-
 sarts* to occur  most frequently in those whose sculls are peculiarly
 large, or,  in the language of Morgagni,! are nearly cubical  in the
 occipital region.   Pressure, however, or congestion in the brain
 from  whatever cause, is  an occasional source  of this  complaint.
 And  hence convulsion  is a frequent result of severe fright, or any
 other violent  agitation of the mind.  And,  like several  of the.
 species we have just noticed, it is a frequent result of some suddenly
 suppressed natural or  morbid discharge, or  suddenly repelled com-
 plaint affecting a  remote  organ.  It has  hence  appeared on sup-
 pressed menstruation, suppressed flow of milk, leucorrhoea or lochia ;
 on suppressed  dysentery,f or  the suppressed discharge from  an
 old ulcer.§  And it has followed, in like  manner, on repelled gout,
 exanthems, and cutaneous eruptions ; even on a sudden  cure  of the
 itch  where it has been of  long standing, and has formed a chronic
irritation.  The visual  causes  in  pregnancy and  infancy we have
 noticed above.
   Convulsions are  also frequently produced  by many of the narcotic
 poisons in a certain degree of strength or  activity, and a  certain
 state  of  the constitution.   For if the  dose be  very large, or  the
 system much debilitated at the  time, the irritability will be entirely
 destroyed, and  death will often ensue  instantaneously, without any
 struggle  whatever.  Tnus  the distilled  water  of the leaves or
 kernels of the prunus Lauro-cerasus, under different circumstances,
 will  produce  both these effects;  as will also the distilled water ot
 the kernels of various other fruits possessing  prussic acid,as those
 of the black cherry and bitter almond  tree ; and hence the prussic

      * Jouni.de  Med. xi.vii. 111.
      t Dj Sed. et Caus. Morb. Ep. ix. 9.
      ■}: Hoefner, Baldinger K.  Mag.  B. vi. p. 323.
      iv Grucllmann, Diss. Observ. de usu cicutoe Goett. 1782.
       Ephein. Nat. Cur. Dec. in. Ann. ii. Obs. 71. 
m
NEUROTICA.
[CL. 1V.-OR. IV.
 acid itself.   And  we  may  hereby  understand  the remark of >ir
 Hercules Langrishe,  that one  ounce of laurel-water  will occasion
 more violent and stronger convulsions than five or six ounces.   The
 dose  of this water given,  by way of  poison,  to  Sir Theodosius
 Boughton, was a  draught  phial  full,  and  consequently,  about an
 ounce and a-half.  The struggling fit in this case began in a minute
 and a-half, or two minutes, after it was swallowed ;* it continued for
 about ten minutes, when he expired
   The spasmodic action produced by  these plants  is chiefly clonic,
 which in effect is the ordinary action with which life ceases: but
 there are others that  render it of a mixed character, the- entastic
 alternating with the clonic; and some in which  the rigid or entastic
 power  considerably predominates, as in the poisonous juice of the
 upas tiente  which, though with  occasional  relaxations,  fixes the
muscles  as rigidly as  in tetanus, and continues the rigidity till the
 patient dies.
   In ordinary cases, however, the mode of attack and  the progress
of the paroxysm  exhibit a considerable variation.   Sometimes the
assault is sudden and without any warning, but more generally there
are few p recursive indications, and especially in  patients who are
subject to returns of  it; such as a coldness in the  extremities with
a dizziness in the head and floating spectra  before the  eyes, or a
flatulent uneasiness in the bowels, and a tenseness  in the  left hypo-
chondrium.   In other  cases the patient complains of tremours in
different muscles, and a cold aura creeping up the back which makes
him shiver.
  The  struggle  itself I  have already  said,  varies equally in its
extent and violence,  and I may add in its duration.   The  muscles
are alternately rigid and relaxed, the teeth gnash and often bite the
tongue, the mouth foams, the  eye-lids open and shut in  perpetual
motion, or are stretched upon a  full  stare, while  the protuberant
balls roll  rapidly in  every direction:  the whole face  is  hideously
distorted. The force exerted is enormous so as frequently to shake
the entire room, and overpower the  strength of  six or eight attend-
ants.   In  some instances it has been so violent  as to break a tooth,
and even fracture a  bone.f   When the lungs are  much  oppressed
in the course of the contest, the lips, cheeks, and indeed the entire
surface, is dyed with a dark or purple hue.
  The paroxysm will sometimes cease in a few minutes, but occa-
sionally lasts for  hours,  and, after a short and uncertain  period of
rest, returns again with as  much violence  as before;  a fact pecu-
liarly common to puerperal and infantile convulsions.  Great languor
commonly succeeds; sometimes head-ache, vertigo, and  vomiting,
occasionalIjlg delirium : but not  unfrequently,  and  especially  in
infants,  there are no secondary symptoms whatever.
  The treatment of convulsion must  apply  to the paroxysm itself,
  * Gumey's  Tiialof John Donnellan, Esq. for the wilful Murder of T. E. A.
Boughton, Bart, folio, pp. 18, 19.
  t Eph. Nat. Cur. Dec. n. Ann. 7 
 UE. VII.-SP. I.]        NERVOUS FUNCTION.

 and to the state of the constitution which gives  a tendency to its
 recurrence.                                             .   .   .
   As there is danger from congestion in the brain, venesection is, in
 most cases, a good measure of caution, and, in many instances, is
 absolutely necessary : and hence, where plethora has preceded, and
 has threatened  to  become  a cause, the disease has often  been
 prevented, and sometimes  effectually  cured, by  a spontaneous
 hemorrhage from the nose, the ears, or some other organ.  But we
 have often had  occasion to observe that,  in weak and relaxed habits,
 bleeding, if frequently repeated, increases the tendency to plethora;
 and, on this account, how necessary soever at the time, it should be
 employed with  caution, and persevered in with reluctance.^
   Brisk cathartics  introduced into the  stomach, if possible, and
 where this cannot  be accomplished, in the form of an  injection,
 lower  the morbid  distension almost as  effectually,  and  in  some
 instances directly remove from the system the principal fomes of
 the complaint.  Emetics are of more doubtful effect: they also may,
 occasionally, carry off the actual cause of irritation, and by power-
 fully determining to the  surface, make  a favourable diversion of
 action.  But in  many cases of debility they have evidently increased
 the violence and prolonged the  duration of the fit.   The authori-
 ties, however, in their favour, are numerous and highly respectable.
 Le Preux* strongly  recommends them in early infancy :  and Hoeff-
 ner asserts that he  has  found them highly serviceable  where the
 irritation proceeded from dysentery.t   Schenck  tells  us that he
 employed them  generally  with considerable success, and preferred
 the preparations of copper,  and particularly the  verdigris, to any
 other  emetic from  their  rapidity of action.f   Antispasmodics are
 certainly entitled to our attention, and often succeed in allaying the
 irregular commotion.  Those  most commonly resorted  to are am-
 monia, ether, musk, camphor, and  valerian.   The  empyreumatic
 oils, both animal and vegetable, seem to  have fallen  as much below
 their proper value  in the present  day as they were once prized
 above it.  And  the same  may be observed of the  volatile fetids
 generally,  as fuligo, assafoetida and chenopodium vulvaria or stinking
 arach :  the last  of which, however, under the older name of atriplex
foetida seems  to  have been a favourite with Dr. Cullen.
   It is not very  easy to explain the operation  of  antispasmodics of
 this kind.  Dr.  Cullen refers it to their  volatility alone, and hence
 concludes that they are useful in proportion as they are volatile:
 which is, in  fact, to regard them in the light  of stimulants.   But
 beyond this they seem to possess a sedative power which  probably
 resides in their fetor.  Where flatulency or some other misaffection
 of the stomach  is the exciting cause, as is frequently the case in
 infancy,  after opening the bowels,  the warmer carminatives  of
* Diss. An. Convulsionibus recens nntorum Vomitoria ? Paris. 1765.
t Balding. N. Mag. B. vi. 323.
t Lib. i. Obs. 244.
349 
350
NEUROTICA.
[CL. 1V.-OR. IV.
 anise, mint, ginger, and cardamoms will often be found sufficient;
 and where these fail recourse has  been had to opium, hyoscyamus,
 bella donna, and sometimes St. Ignatius's bean, or M. Wedenberg's
 favourite medicine in this disease, the extract of stramonium.*
   Cold and heat  have also been  very frequently resorted  to as
 powerful antispasmodics,  and, in  many cases,  with considerable
 success.   Heat appears to act by a  double power, and especially
 when combined with moisture, with which it is always most effectual.
 It both relaxes and stimulates: and is hence admirably calculated to
 harmonize the two alternating and contending states of a morbid
 rigidity and a morbid mobility on which the disease depends, and con-
 sequently to restore a healthy equipoise  of action.   On this account
 we find  warm bathing, and especially in  infantile convulsions, of
 great benefit.   It ought  not to be  forgotten, however, that both
 effects, as well the stimulating as  the relaxing, have a considerable
 tendency to exhaust and debilitate, and hence the warm-bath must
 not be frequently repeated.
   The immediate  effect of a sudden application of cold, whether
 by a blast of air, or by an affusion of water, is a general  shuddering,
 a spasmodic contraction of the entire skin.   And hence, where cold,
 applied in this manner, takes off  either clonic or entastic spasm, it
 is by a revulsive power ; by a transfer of the spasmodic action from
 a particular organ or set of organs, to the surface of the body gene-
 rally ; in  the same way as blistering the neighbourhood of an inflam-
 ed organ takes off the primary inflammation by a transfer of the in-
 flammatory action to the part where the blister is  applied.   If the
 cold excite a general reaction, and the shuddering be succeeded by
 a glow, it becomes a direct and very powerful tonic: and on both these
 accounts is a remedy highly worth trying in hysterics, convulsions, and
 even those cases of epilepsy in which a suspicion of some structural
 cause of irritation within the cranium does not form a bar, by prohi-
 biting every thing that may increase the impetus of the blood.
   In the  convulsion-fit of infancy, the effusion of cold-water, so far
 as 1 have seen, may be much oftener resorted to with perfect safe-
 ty than the fears of mothers will  allow;  and be found  much more
 successful in a hot close unventilated nursery than the  more popu-
 lar prescription of a warm bath.   And  where I have not been able
to proceed thus far, and the warm bath  has been tried repeatedly
in vain, I have frequently succeeded by taking  the little infant in
 my arms  and exposing him naked, or nearly naked,  for a few  mo-
 ments to  the air of the window,  thrown open  to allow it to blow
 upon him.   The great diminution of sensibility which  prevails at
 such a time prevents all danger of catching cold ; while,  on the
 contrary, the little patient is usually revived by the sudden  rush of
the external air, and the fit, in many cases, ceases instantly.
   Cold-bathing, when not prohibited by any other complaint, will
 also be found a useful tonic in the intervals of the attacks, and may
 conveniently be employed in conjunction with  internal medicines
* Di=sevtatio Medica dc Ptramonii usfi in morbis convnlsivis.4to. Unsalisn. 
CE. VH.-SP. I.]       NERVOUS  FUNCTION.                 ^D1

of the same character.  Of these the metallic salts  and oxydes are
chiefly to be depended upon, and  especially  those of iron, copper,
arsenic, silver, and zinc.  Zinc has had by far the greatest number
of advocates, and is generally supposed to have succeeded best in
the form  of its  white oxyde  or flowers,  ten  or twelve  grains
of which are usually given to an adult in the course of twenty-four
hours.  Mr  Dugaud increased the proportion to fifteen grains ;* and
Mr. Bell, at length, prescribed not less than ten grains at a time, repeat-
ed three times a-day.t  In the hands of the present author it has prov-
ed more salutary in the form of its sulphate, which has not unfre-
quently succeeded where the oxyde has failed ; the usual propor-
tion he has employed being a grain three  times  a-day given in the
emulsion of bitter almonds.  Where silver has been made choice of,
the usual preparation  has been its nitrate, and the dose has begun
with a grain given four or  five  times a day in the  shape of a pill,
and gradually increased to eight or  ten grains,  or  as  much as the
patient's stomach will bear.
   The virtue of all these,  however, seem  considerably improved
by a combination with camphor which has often  been found advan-
tageous even alone.   " In spasmodic, or convulsive affections," says
Dr. Cullen, " it has been of service, and even  in  epilepsy it has
been useful.   I have not, indeed, known  an epilepsy entirely cur-
ed by camphor alone ; but I have had several instances of a parox-
ysm, which was expected in the course of a night,  prevented by a
dose of camphor exhibited at bed time; and  even this when the
camphor was  given alone ;  but it has been  especially useful when
given with a  dose of cuprum ammoniacum,  or  white  vitriol,  or of
the flowers of zinc."^
   The vegetable tonics are little to be depended upon.  The bark,
recommended by Dr. Home, Sumeire, and  many other distinguish-
ed writers, is rarely of use except where the paroxysm is periodi-
cal : and the cardamine pratensis (ladies-smock,) sempervivum tec-
torum (house-leek.) and  viscus quernus (missletoe) are hardly wor-
thy of notice in the  present  day, notwithstanding  the specific vir-
tues they were supposed to possess formerly.  The cardamine, the
o-iwftfyov sripov of Dioscorides, is of ancient celebrity, and in moderq
times has been warmly extolled  by the  commending  authorities of
Mr. Ray, Sir  George Baker, and Dr. Home; the second of whom,
as was noticed under the head of Chorea, declares himself to have
succeeded  in its use not only in cases of convulsion but of all clonic
spasms whatever, and this  too, when almost every other medicine
had failed.§
   The house-leek was employed in the form of an expressed juice
intermixed with an equal quantity of spirit of wine, which gives a
* Edin. Med. Comment. V. 89.
t Id. i. 120.
X Medical Transactions. Vol. I. Art. xix.
I Auserl. Abhandlunulung. fur Pract. Aerzte. B. x. 13. 
352
NEUROTlCAt
[CL. IV.-OR. IT.
white coagulam resembling creme of fine pomatum, that has a weak
but penetrating taste, and was supposed, from its ready evaporation,
to contain a considerable portion of volatile alkaline  salt.   Pere-
boom* applauds its tonic and antispasmodic virtues in this state, and
for further instances of its fancied power the reader may consult the
German Journals of Natural Curiosities.  The missletoe has rarely
been employed in our own country, except by Dr. Home,  who
thought he found it serviceable ;  though it is chiefly indebted for
its fame as a specific in convulsions, to  the practice and writings of
Colbatch.t  It has been given in powder, infusion,  and extract.
                         SPECIES II.

                SYSPASIA HYSTERIA,


                          Hgstertcs.

 CONVULSIVE STRUGGLING, ALTERNATELY  REMITTING, AND  EXACERBATING ;
   RUMBLING  IN  THE  BOWELS ;  SENSE  OF SUFFOCATION ;  DROWSINESS ;
   URINE COPIOUS AND LIMPID ; TEMPER FICKLE.

 Hysteria, from hffrtfx " the uterus or vulva," or more correctly
 " viscus posterius vel inferius," evidently imported in an early pe-
 riod of medical science, some misaffection of  the  womb or  other
 sexual organ :  and hence hysteria, among  the  Greeks and Romans,
 was also a term by which female midwives  were denominated, or
 those who especially attended to affections of the hysteria or womb.
 The Latin term uterus, although it approaches it in sense and sound,
 is  altogether of a different origin.  For this has a direct reference
 to the use and figure of the  uterus as a single  organ, and is an im-
 mediate derivation from uter a bag or bottle.
   With a  morbid condition of  this organ, indeed, hysteria is in ma-
ny instances very closely connected, though it  is going too far to
say that it is always dependent upon  such condition : for we  meet
with instances  occasionally in \which no possible  connexion  can be
traced between the disease and the organ ;  and sometimes  witness
it  in males as decidedly  as in  females.  It has been contended by
various writers, that in this last case, the disease ought to be called
hypochondrism, the hypochondrias of the  present work; and that
hysteria and hypochondrias are merely modifications  of a common
complaint.  Nothing however, can be more erroneous.   These two
diseases have often a few similar symptoms, and  more  particularly
those of dyspepsy; but they are strictly distinct maladies,  and are
characterised by signs that  are peculiarly their own.  The con-
  * N. Act. Cur. vii. Obs. 4.
  t See also Diss, sur la Gui de Cbene, rcmede specifique pour les maladies Con-
■rulsives.  Paris, 1719. 
GE. Vll.-SP. II.]         NERVOUS FUNCTION.               «*3J

vulsive struggling paroxysms, the sense of a suffocating ball in  the
throat, the fickleness of temper, and the  copious and limpid urine,
which are pathognomic to hysteria, have no necessary connexion
with hypochondrias, and are never found in this disease when strictly
simple and idiopathic.  While, on the  contrary, the sad and sullen
countenance, the dejected spirits, and gloomy ideas that character-
istically mark hypochondrias,  have as little necessary connexion
with  hysteria, and are in direct  opposition to its  ordinary course.
Hysteria is strictly  a corporeal  disease,  hypochondrias a mental,
though it commonly originates in corporeal organs, but organs that
have a peculiar influence upon the mental faculties, and  has not es-
tablished itself till these participate in the morbid action.   Hysteria
is a disease of the irritative fibres, hypochondrias  of the  sentient:
Hysteria is a disease of early life, hypochondrias of a later period.
Both, however, are  diseases of a highly nervous or excitable tem-
perament, and, as such, may co-exist in the same individual: but so
also may vertigo or  cephalaea  with either of them; which would
nevertheless continue to be  regarded  as distinct diseases,  notwith-
standing such an  incidental conjunction.  And  hence  Mieg,*  and
various other established writers! upon the subject, have not incor-
rectly, though perhaps unnecessarily, treated of the disorder before
us under the two divisions of male and female hysteria, hysteria vi-
rorum, or masculina, and hysteria focminina.
   Hysteria, like  all  other  clonic  affections, shows  itself most  fre^
quently in mobile and irritable temperaments, and  particularly  dur-
ing that period of life in which irritability is at its  highest tide, as
from  the age of puberty to that of thirty-five years, seldom appear-
ing before  the former, and rarely after the latter  of these terms.
The  common occasional causes of convulsion,  which we have al-
ready described, are also those of hysteria; and hence,  acrimonies
of the stomach,  or other  abdominal organs, mental emotions,  ple-
thora, and particularly turgescence of the sexual  region are among
the most frequent; on which account, we are told by Forestus,^ and
Zacutus Lusitanus,§ that one of the most common causes of hysteria
in males is a retention of semen, as one of its surest cures is an ex-
cretion.
   As  every thing, moreover, that disturbs  the  uniform current of
the nervous fluid, or the ordinary diameter of the  blood-vessels or
cavity of the heart becomes a powerful irritant, we may  also see
why this disease  should occur on debilitating, and especially sudden
evacuations, and be at no loss to account for its appearing on excessive
as well as on suppressed menstruation, and consequently in  leucor-
nhoea. And as the sexual organs lose much of  their orgasm during

      * Epistolae ad Hallerum scripts, No. v.
      t Eph. Nat. Cur.  Dec. H. Ann iv. Obs. 18, 61.
       Truite Nouveau de Medicine, &c. Lions, 1684.
      X Observ. et Curat. Medic. Libr. xxvm. Obs. 29, 33.
      i De Praxi Adiniranda, Libr. ii. Obs. 85.
   vol. irr.                   45 
 354                     .NEUROTICA.           [CL. 1V.-OR. IT.

 the period of parturition, we may also see why the disease should at-
 tack barren rather than breeding women, particularly young widows,
 who are cut off from the means of exhaustion  they formerly enjoy-
 ed; and, more especially still,  those who are constitutionally inclin-
 ed to that morbid salacity, which has often been called nymphoma-
 nia, and, in the present work, will be  found under  the  genus lag-
 nesis.
   I have already endeavoured to show by what means, in a habit of
 great nervous irritability, both clonic and entastic  or  rigid spasms
 are produced ; and the disposition there  frequently exists  for them
 to pass into each other or to alternate in  rapid succession.   And we
 have also seen that the former is  most predominant in  laxer, and
 more mobile, and the  latter in  firmer and more vigorous  constitu-
 tions.   There is no frame, however, that may not become a prey to
 spasmodic action of some kind or other, and hence, there is no frame
 that may not become a prey, under particular circumstances, to the
 species of spasmodic action we are now describing.  These circum-
 stances are  very generally concealed from us ; but we uniformly per-
 ceive that the rule we have now adverted to holds true ; and that the
 hysteric spasm will assume more or less of a clonic, or of  a spastic
 character, in  proportion as  the individual is  of a more relaxed or a
 more vigorous make.   And hence  the most violent, though  the least
 common, instances of hysteric struggle that occur to us, are in young
 women of the most robust and masculine constitution.
   The  paroxysm often takes place  without any previous  warning or
 manifest excitement whatever, and especially   where it has  esta-
 blished itself by a frequency of recurrence.  Occasionally, however,
 we have a few precursive signs which  rarely  show themselves in
 vain: as a sense of nausea or sickness, flatulency, palpitation of the
 heart, depression of spirits, and sudden  bursts of tears without any
 assignable cause, showing a disturbance in the  secretion, or  distri-
 bution of the nervous  power.   The fit soon succeeds  with a  cold-
 ness and shivering over the whole body, a  quick  fluttering puke,
 and an acute feeling of pain in  the  head as though a nail were dri-
 ven into it.   The flatulency from the stomach or colon rises in the
 sensation  of a suffocating ball  into the throat, and forms what is
 known by the name of globus hystericus.  The convulsive struggle
 now commences, which in women  of very  mobile  fibres  is some-
 times very feeble, the  relaxant alternations prevailing over the con-
 tractile : but in other cases i9  prodigiously violent, evincing during
 the contractions a  rigidity as firm  as in  tetanus, and  a  force  that
 overcomes all opposition.  The trunk of the body is  twisted back-
 ward and forward, the limbs are variously agitated, and the fists are
 closed so firmly that it is difficult,  if not impossible, to open the  fin-
 gers ; and the  breast  is violently  and spasmodically beaten.  An
 equal spasm takes place in the sphincter ani;  so  that  it  is  often
 found impracticable to introduce a clyster pipe; and  the urine dis-
charged, though copious, is  colourless.  The muscles  of the  chest
and trachea are agitated in every way, and hence, there  is an invo-
luntary utterance of shrieks, ssreams, laughing, and crying, a«cord- 
GE. VH.-SP.  II.]       NERVOUS  FUNCTION.                *•*'*

ing to the direction the spasm takes, sometimes accompanied with,
or succeeded by a most  obstinate and distressing fit of niccougn.
When the fit ceases the patient appears to be  quite spent, and  lies
stupid and apparently lifeless.  Yet in an hour or two, or often mucD
less, she perfectly recovers her strength, and has  no other  feeling
than that of  a general soreness, and perhaps  some  degree of pain
in the head,   ft is rarely, indeed, that an hysteric fit becomes dan-
gerous ; thought has in a few instances terminated in epilepsy or
insanity.                                                    ,
   The definition asserts that the  temper is fickle  : this is not to be
 wondered at; for, in the hysteric temperament,  the irregular and
 clonic flow of the irritative fluid  is communicated, by sympathy, to
 all the  sensorial fluids :  and in consequence the mind is as unsteady
 as the muscles: " and from hence," observes the  sagacious  Burton,
 who has painted strongly, but from the life, " proceed a brutish kind
 of dotage,  troublesome sleep,  terrible dreams, a foolish  kind of
 bashfulness in some,  perverse conceits and  opinions, dejection of
 mind, much discontent, preposterous judgment.  They are apt to
 loathe,  dislike, disdain, to be weary of every object.   Each thing
 almost  is tedious to them.   They  pine  away, void of counsel,  apt
 to weep, and tremble, timorous, fearful, «ad, and out of all hopes of
 better fortunes.   They take delight in doing  nothing  for the time,
 but love to be alone and solitary, though that does them more harm.
 And thus they are affected so long as  this vapour  lasteth ; but by
 and by  they  are as pleasant and merry as ever they were in their
 lives;  they sing, discourse, and laugh in any  good company, upon
-Call occasions.  And so by fits it takes them now  and then, except
 the malady be inveterate, and then it is more frequent,  vehement,
 and continuate.   Many of them  cannot  tell how to express them-
 selves in words, how  it holds them, what ails them.   You cannot
 understand them, or well tell what to make of .their sayings."*
   The  mode of treatment  bears so close a resemblance to that for
 the preceding species that it will be unnecessary  to enlarge  upon it.
 Pungent applications may be applied to the nostrils, or round  the
 temples, or  the  face and  neck  may be sprinkled or dashed with
 cold water during the paroxysm,  and warmth and the friction of the
 hand be applied to the feet.  The peristaltic action of the bowels
 should  be increased,  which can  only be done by stimulant  and ca-
 thartic  injections, if the contraction of the sphincter ani will allow
 them to pass.
   Our chief attention, however, should be directed to the intervals.
 And here the first recommendation is, sedulously to avoid every
 remote or exciting cause.  If the menstruation be in a morbid state,
 this must be corrected as soon as may be, concerning  which,  how-
 ever, we shall have to speak in the ensuing order.  If plethora be
 a striking symptom, the lancet should be applied  to.  In robust and
 vigorous habits, we may bleed freely and have nothing to fear, but
Anat. of Melanckoly, Part i. Sec. in. 2. 4, 
 356                     NEUROTICA.           [CL. IV.-OR. IV.

 in loose and relaxed constitutions far more caution is necessary, as
 lias been already explained under convulsio.
   In this last state of body tonics should also be had recourse to, and
 many  of the  warmer  sedatives and antispasmodics as assafoedita,
 c;imphor, most of the verticillate plants, and cajeput, which was a
•favourite remedy with Mieg.*  Valerian has often proved service-
 able, but is rarely  prescribed in sufficient  quantity .to produce any
 good effect.  " It seems,"  says Dr. Cullen, "to beimost  useful when
 given in substance and in  larger doses.   I have never  found much
 benefit from the infusion in water."t   The  ammoniated  tincture  of
 the London College, however, is an excellent form : but even here
 the  quantity of the root employed should be double  what is pre-
 scribed.  The cinchona may be usefully united with valerian^ bat
 $oes not seem to be of much benefit in this disease by itself.
   Opium is a doubtful remedy :  where the procursive signs are
 clear it will often allay  the irritation, and thus prove of great value.
 But it so frequently produces head-ache, and adds to the constipa-
 tion, that it is rarely trusted to in the present day.  When resorted
 to it is best combined with camphor.
   Where the disease occurs in the bloom of life,  and there is rea-
 son to apprehend the ordinary orgasm of this age to be in evrp«.
 Ihe surest remedy i< a  happy marriage.
                        SPECIES III.

                SYSPASIA  EPILEPSIA.

              25julra)sj>.  iFallfnfi=«Stcutiim

SPASMODIC AGITATION AND DISTORTION, CHIEFLY OF THE MUSCLES OP THE
  FACE, WITHOUT SENSATION OR  CONSCIOUSNESS ; RECURRING AT PERIODS
  MORE OR  LESS REGULAR.

The Greek physicians gave the name of epilepsy, from t7riXxuZu»(t»ty
to the present disease, from its "sudden seizure or invasion,"  which
is its direct import: and as the violence of passion or mental emotion,
to which the Roman people were accustomed to be worked up in
their  comitia, or popular assemblies,  from the  harangues of their
demagogues, was one of the most common exciting causes, it was
among the  latter denominated morbus comitialis ; in the popular
language of our own day " Electioneering  disease," in reference to
the time and occasion in which it most frequently occurred.
  The general  pathology of the  two preceding species, and  which
* Epist. ad. Haller. ut supra No. v.
+ Mat. Med.  Part. n. Ch. vm. 
 GE. VILH5P. III.J       NERVOUS FUNCTION.                357

 has been gi?en at some length,  under the genus clonus, will apply
 to the present: but it is obvious from the symptoms that the muscu-
 lar power,  commonly speaking, though not always,  is affected to a
 less extent, and  the sentient and intellectual to  a  much greater;
 and consequently that the irritative fibres suffer in a smaller degree
 than the sensific and percipient.
   Before we  epter  upon the history of the disease it  will be con-
 venient to remark that, from the different modifications under which
 it shows ltsefl^it has been subdivided by many nosologists into very
 numerous  varieties, but that the whole may be reduced to the fol-
 lowing :

 « Cerebralis.                Attacking  abruptly  without  any evi-
   Cerebral Epilepsy.          dent excitement,  except, in a few
                              instances, a slight giddiness.  In thjs
                              case the predisposing cause is ex-
                               ternal violence or some internal in-
                              jury,  misformation or disease of the
                              head.
 C Comitata.                Catenating with  some  morbid  action
   Catenating  Epilepsy.        of a remote  part,  with  a sense of a
                              cold vapour ascending from it to the
                              head, or some other precursive sign.
■y Complicata.              The limbs  fixed and  rigid  with  clonic
   Complicate  Epilepsy.        agitation of particular organs.

   The causes of epilepsy, like  those of the two preceding species
 may be mental or corporeal: but to produce this father than either
 of the others there must be a peculiar diathesis, which  seems  to
 depend upon  the state of the nervous  organ.  Where this exists
 almost any of the passions or mental emotions, when violently agi-
 tated,  have been found sufficient to occasion a paroxysm, as anger,
 grief, fright, consternation; of all which the records of medicine
 afford abundant examples.  In a like diathesis  any  kind of corporeal
 irritability will often  become an exciting cause, whether more  or
 less remote from  the head itself.   Thus an irritability in the ear
from an inflammation,  abscess, or some  insect or other foreign sub-
stance  that has accidentally  entered into it, or the sudden  suppres-
sion of a discharge to which it has been subject,  has in various in-
stances produced epilepsy.*   Hildanust mentions a case  in which
it followed upon a considerable  degree  of irritation  excited in the
same organ by the accidental introduction of a small piece of glass.
 In like manner, an irritable state of the stomach  from chronic in-
 flammation,  debility,  worms, or the presence of substances that do
not naturally belong to it, has proved a frequent origin.  Bartholine
gives an instance in which it supervened upon swallowing pieces

    * Hornung, Cista. p. 394.
     Demerebene, De la Con6eillere in Diss, de Auditfi. Ultraj. 1710.
    t Fabr. Hildan. Cent. I. Obs. 4. 
358                     NEUROTICA.            [CL. IV.-OR. IV.

of glass ;* and Widenfield another upon swallowing a needle.t  Con-
firmed drunkards are peculiarly subject to this complaint.
   Particular affections of the uterus are, in like  manner, an occa-
sional source of epilepsy, is well as of  hysteria: and sometimes the
latter has  run into the form* r, where  the  epileptic  diathesis has
predominated; examples of which occur very numerously in all the
medical collections of cases.J  Menostation or a suppression or re-
tention  of the menstrual flux is, perhaps,  the  most, common of this
cla s of causes :  and  we may hence see, why it should occasion-
ally be  excited by a suppression  of the lochial discharge.   A sud-
den suppression, indeed, of discharges of almost every kind natural
or morbid, of long continuance in  an irritable habit, has occasionally
proved  a sufficient source of excitement.  And  hence,  it has follow-
ed upon restraining too abruptly a chronic diarrhoea,§  or an habitu-
al hemorrhage from the nostrils,|| or the hemorrhoidal vessels.1I
   Hence, also repelled gout has been a cause, and still more gene-
rally repelled eruptions, and  exanthems, as  itch, various species of
ecpyesis, small-pox, and in  one instance miliaria.**
   Yet the  most frequent cause of epilepsy is  seated  in the  head
itself;   and has been found on post-obit  examinations to consist in
some  morbid structure or  secretion, in  the  bones, tunics, or sub-
stance of this organ, as tubercles, exostoses, caries,  apostems, natu-
ral misconstruction of the  whole, or of  particular parts,  injuries
from external violence, hydatids, pus, ichor, and  other diseased
fluids.   Of these some  are predisponent,  others occasional causes;
the former of which will often continue inactive  for a long-period
of time, and, as-we have already  observed, appertain  chiefly  to the
first or  cerebral variety.  It has  been observed,  also, that in this
modification the disease often makes its attack suddenly, and with-
out any manifest exciting cause.   Yet there can be little doubt that
in every instance some occasional cause does exist, though from its
acting upon a morbid part of an organ that lies beyond our research
it entirely  eludes all notice.
   The  paroxysm, indeed, in most  cases  occurs suddenly,  and  the
patient  is, so to speak,  cut down at  once, and loses all  sense of per-
ception and power of  motion: so that if  he  be standing  he falls to
the ground with a greater or less degree of convulsion.  There are
a few rare instances of some degree of consciousness and perception
 * Hist. Anat. Cent. v. Hist. 66.
 t Diss. Obs. Med. Triga. Goett. 1768.
 X Moranus, Apologia de Epilepsia hysterica, Orthes. 1626. 4to.
   Schulze, Diss, casus hysterico-epileptici Kesolutio. Hal. 1736.
   Eickmeyer Diss, de Epilepsia uterina. Ultraj. 1638.
 J Eph. Nat. Cur. Dec. I. Ann. I. Obs. 88.
 || Hagendorn, Cent. i. Obs. 20.
 IT Riedlin, Lin. Med. 1695. p. 454.
■** Baraillon, Hist, de l'Acad. Royale de Med. ad 1776. p. 220, 
GE. VI1.-SP. III.]         NERVOUS  FUNCTION.                359

throughout the paroxysm ;* but the exceptions are few, and by no
means enough to disturb  the general rule.  Commonly the limbs on
one side are more agitated  than those  on the other.   The  muscles
of the face and eyes are  always much affected, and throw the coun-
tenance into various and violent distortions.  The tongue is thrust
out of the  mouth, which discharges a  frothy saliva : the lower  jaw
is strongly convulsed ;  the  teeth gnash violently upon each other;
and, as this occurs while  the tongue is protruded, the tongue is often
wounded most grievously.
   During the continuance of the fit there is generally an alternate
remission and exacerbation of the symptoms; though the whole does
not usually last long, and is often of shorter duration  than hysteria.
On the cessation of the paroxysm the  patient remains  for some time
motionless, quite  insensible, and  apparently in  a  profound sleep or
lethargy.  He recovers  from  this  attack sometimes  suddenly but
more generally by degrees, yet without any recollection of the suf-
ferings he has  undergone.
   Under the first or cerebral varietv, or where there is little or
no appearance of an occasional  cause, and the  predisponent cause
is supposed to exist in the head, the comatose symptoms, and indeed
the general mischief to the external as well as to the internal senses
is most striking.  Yet the  effect is even  here very different in dif-
ferent individuals.   The optic nerve  affords severe proofs of this.
Sometimes from a diseased accumulation of sensorial  power in this
organ, surrounding  objects appear  brighter or  larger than natural,
or both,t   Yet in many cases irritability of  the nerve or its adjoin-
ing muscles has been destroyed,  and a paresis, more or less general,
has been  the result.   Hence a perpetual nictitation,  strabismus, or
blindness, are no unfrequent consequences.   Vet the stimulant influx
of accumulated power  appears in one instance to have had a most
fortunate and directly opposite effect;  for an habitual blindness was
hereby removed.^   Where  the muscles of speech have suffered in
an equal degree, speechlessness  has in like manner followed ;§ and
for the same  reason where the joints have  been violently aflected
with a predominancy of rigid over clonic action they have sunk into
an  insuperable contraction.||  It is hence, not to be  wondered  at
that the  whole system should occasionally be  nearly exhausted  of
its entire  stock of sensorial power, and  that the  paroxysm should
terminate in mania, idiotcy, or even death itself;  sometimes instan-
taneously, and  at other times through the medium of a fit of  apo-
plexy.
  The warning or precursive symptoms, by which epilepsy is some-

       * Bresl. Sammlung. 1724. Band i. p.  436.
       t Bartholin. Hist. Anat. Cent. m. Hist. 45.
        N. Sanil. Med. Wahrnem. B. iv. p. 229.
       X Ephem. Nat. Cur. Cent. i. n. Obs. 130.
       * Hagendorn, Cent. I. Obs. 14. Act. Nat. Cur. Vol. I. Obs. 71.
       I| Horstius, ii. p. 90. 
360
NEUROTICA.
[CL. IV.-OR.  IV.
     times ushered,  have been most common to the second or catenat-
     ing variety.   The most  usual sensation is that of the ascent of a
     cold creeping vapour from some particular part of the body, of the
     nature and cause of which we know nothing, but  which has often
'     been called an  aura epileptica.  This halitus usually ascends from
     the extremities, but there is  no organ from which  it has not issued
     in different individuals, according to examples accumulated by the
     collectors of medical curiosities;  as  the feet, the hands, the fingers,
     the thumb, the great toe, the  legs, the arms, the hypochondria, the
     crown of the head.  And in  various instances spots on the  face or
     fieet have preceded, and at other times  accompanied the paroxysm.
       We sometimes meet, however,  with other harbingers of quite as
     singular a character, in  the other varieties ;  as a  heaviness of the
     eyes, pain, heat, and  sparkling, which, by Sir Clifton Wintringham
     were regarded  as signs that  peculiarly distinguish the idiopathic
     from the symptomatic disease.*   Sometimes there  has been a wild
     play of  phantasms or illusive objects before the  sight :t and Portius
     relates a case of a woman, who was  always warned of an approach-
     ing fit, by the appearance, as it were, of her own image  in a mir-
     ror.J  On many occasions indeed, as Paulini has rightly observed,
     there  is  a peculiar overflow of spirits, and a tendency to merriment,
     as though the mind were entirely thrown off its balance.^   Some-
 '   times  the patient  exhibits sudden starts of running,|| or dancing ;H
     occasionally he is strangely talkative ;** and in one instance exhibit-
     ed a new and peculiar talent for singing.tt
       Under the third or complicated  variety, while many of the limbs
     are rigidly fixed, almost  without  relaxation, the  muscles of other
     parts are thrown into the most grotesque and ludicrous gesticulations
     of chorea: and, if the muscles of the chest be affected in this way,
     the patient appears in some  cases to burst into involuntary fits of
     laughter from  their irregular and  clonic  action.JJ  At the same
     time that such has been the force  of the spastic muscles as to break
     one or more teeth, to rupture an artery, or render a vein varicose;
     and in one case at least to burst the left  ventricle of the  heart it-
     self.^
  * Ricardi Mead Monita et Prascepta, permultis notationibus et observationibus
illustrata. Tom. i. 8vo.
  t Bartholin. Hist. Anat. Cent. i. Hist. 81. Cent. II. Hist. 72.
   Hagedorn, Cent. m. Obs. 49.
  X Medics Considerations variae.
  4 Cent. ii. Observ. 13.  Bresl. Samml. 1724. Band. H. p. 434.
  || Boot. De Affectionibus omissis. Cap. vi.
   Schenck, Obs. i. Lib. ii. p. 202.
  If Chesneau,  Lib. I. Cap.  iv. Obs. 4. Eph. Nat. Cur. passim.
  **  Eph. Nat. Cur. Dec. n. Ann. vi. Obs. 229.
  tt Act. Nat.  Cur. Vol.  v.
  XX Eph. Nat. Cur. Dec. i. Ann. III. Obs. 304.
  H Johnston, Med. Remark?, &c. Vol. n. 
GE. VII.-SP. m.]      NERVOUS FUNCTION.                ^vl

  It has been observed that the epileptic paroxysm occurs chiefly at
irregular periods, and is for the most part of short duration.  There
are, however, some instances on record of a singular exception to
this rule in both cases.  For  it  has occasionally lasted for two  or
three days  with little  or  no remission.  It has also returned  at
stated times, and with great frequency ; with the revolution of" the
morn, or even of the night;  in  one instance six  times in a single
day ;* and in another, on the revolution  of the  birth-day of each
of the patient's  parents.!  In a  highly nervous  temperament it is
not difficult to account for such returns; since the dread  of its re-
turn alone, when it has once established a  circle of action, will form
a sufficient cause of irritatfon.  In a few instances it seems to have
been hereditary  ; and perhaps in an equal number congenital, appear-
ing soon after birth, and mostly produced by a fright of the mother
during pregnancy.  Hildanus gives an example in which  a fright of
this kind was occasioned by the presence of an epileptic  patient
when suddenly  attacked with a  paroxysm :|  and other  medical
records narrate  examples  of a like effect on a  sudden  rush  of a
hare, or some other animal, against a pregnant woman.
   Many persons habitually disposed to epilepsy  are  attacked immer-
diately on waking in the morning from a sound sleep, when we may
be  inclined  to think they would  be least liable to such a surprize.
Dr. Cullen admits that he finds a difficulty in explaining this curious
fact.  But  when we reflect that epilepsy is a disease of irregular
action, chiefly in a  debilitated system,  depending, where there is a
confirmed diathesis, upon  whatever may disturb  the balance  of
perhaps any of the circulating fluids—and that this  balance may  be
disturbed either by too much as well as  too little excitement;—
when we reflect, moreover, that during sound sleep there is always
taking place a  considerable accumulation of sensorial power, and
may at times be an  excess of it—we shall no longer, 1 think, be at
a  loss  to  account  for  an  adequate  cause  of this very  singular
phenomenon.
  The general mode of treatment proposed for the last two diseases
will apply to the present.  The two-fold intention is to remove, as
far as we are able, the exciting  cause, and to  allay the  habitual
irritation of the  nervous system.
  Where  plethora  manifestly exists, we may use venesection  with
great hopes of success, and, generally speaking, more freely than
in  hysteria.   But here also cathartics will be of considerable avail,
and in the hands of Dr. Hamilton have been found sufficient alone
to  produce a cure.  To effect this they should be  used  freely and
maintained steadily, so as to keep up a perpetual counter-irritation
in  the  bowels which may act as  a revellent against the  morbid
        * Tulpius, Lib. I. cap. xi.
        t Eph. Nat. Cur. Dec. m. Ann. iv. App. 193.
        t Cent. in. Obs. C.
vol.  w.                  4G 
 362                     NEUROTICA.            [CL. IV.-OR. IV.

 irritation in  any other  part, and  directly carry off whatever acri-
 mony may exist in the bowels themselves.
   Provided this be accomplished, the particular medicine employed
 does not appear to be a matter  of great  moment.    Colocynth,
 gamboge, sulphate of magnesia, and calomel, seem to  have been
 used with almost equally good effects ; though in visceral congestion
 the last should never  be omitted.  If worms be  suspected, and
 especially the vermicular acaris, the rectified oil of turpentine should
 undoubtedly be allowed a preference.   Even where worms are not
found to exist this has often proved highly successful, apparently by
the revulsive  action it excites.  As a purgative it should be given
in ounce or ounce and half doses to an adult: but as an alterant in
 smaller doses repeated daily.*
   It was probably from its stimulant and cathartic effects alone, that
 the muscus agaricus was ever in a high  degree of  popularity.
It is a reddish mushroom, with a white, thick, and hollow pillar, and
 a reddish or crimson cup, nearly flat, about six inches  in diameter.
 The dose was from ten to thirty grains of the powder to be taken
 in vinegar.   Its effects, however, are sudorific as well  as purgative,
 and, as  the last are not wanted, it has been judiciously relinquished
 for other medicines of the same  class.  It may be useful, never-
 theless,  to observe, whilst  upon  this article, that  it  is employed
 successfully in destroying both flies and bugs,  on which last account
 it has been called bug-agaric.  The former are killed instantly on
 their sipping  milk  in which the plant has  been infused;  and the
 latter by rubbing  the  juice  over the  holes and  other places  to
 which they retreat in the.day-time.
   De Haen often employed emetics,  and chiefly for the purpose of
 exciting and  maintaining a new action, for which purpose he conti-
 nued them daily for a week or two.  His example  was followed at
 one time,  but has  long been  relinquished  as highly  inconvenient,
 and in some cases injurious.!
   Externally  stimulants have  also been tried, and in  various in-
 stances  seem to have been attended with good success.  The spine
 has been rubbed night  and  morning  with different preparations of
 ammonia, camphor, or cantharides ; and setons and issues have been
 applied to different parts of the body,  as have also both the actual
 and potential cautery .J   Where the cause of the disease has  been
 suspected to  be seated in the head, they have been chiefly  confined
 to this  organ, but where, there has been a manifest aura epileptica,
 to the limb or other part of the  body from  which the vapour has
 seemed to ascend.  And there can be no question that these also
  *  See Dr. Latham, Med. Trans. Vol. v. Art. xxm. and compare with his
Treatise on Diabetes.
  t  Rat. Med. Part v. Cap. iv. * 1.
    Eph. Nat. Cur. Cent. vi. Obs. 58.
  X  Ab. Heers, Observ. var.
    Locher, Observ. pract.
    Roekard, Journ. de Med. Tom. xxv. p. 46. 
 GE. VII.-SP. III.]      NERVOUS FUNCTION.                  363

 have frequently proved serviceable, especially  in preventing the
 recurrence  of subsequent  fits, where  a habit of return has  been
 established.   Schenck has  examined  at  considerable  length the
 successful and unsuccessful cases which, in his day, had been  pub-
 lished upon the use of cauteries.*  In several instances an accidental
 burn has answered the purpose »of a surgical escharotic, and fortu-
 nately proved a radical cure.f  Professor Loeffler of Altona, instead
 of cauterizing the limb from which the epileptic hahtus  seems to
 ascend, has ingeniously tied a tight ligature above the part whence
 the vapour issues, probably upon the  ground of the  success  with
 which it is often attended in the bite of the rattle-snake, and other
 venomous animals  and in one or two cases the ligature  seems to
 have proved  quite as favourable in the present disease.
   The general irritability  of the nervous system has been attempted
 to be  overcome by sedatives and tonics.  Of the former the chief
 have been camphor, cajeput, valerian, hyoscyamus, stramonium, and
 opium.  The peculiar powers of all  these we have  so often had
 occasion  to examine, and  particularly under the preceding   two
 species, that it is only necessary to offer a  few  words on the  datura
 Stramonium.  This  medicine,  like  many others, has had a strange
 alternation  of fortune.  About a century ago it was esteemed every
 thing, half a  century  ago it declined greatly in its reputation,  and
 has of late been once  more rising into esteem.  Fourteen  epileptic
 patients in the royal hospital at Stockholm, were, many years since,
 treated with pills of stramonium.^  Of  these,  eight are declared by
 Dr. Odhelius, in the official report  upon this  subject to have  been
 entirely cured, five had their  symptoms  mitigated,  and only  one
 received no relief.  The greater number on first using this remedy
 were affected with confusion in their heads, dimness in their  eyes
 and thirst;  but these symptoms gradually diminished.
   Where hyoscyamus has been given it has been employed both in
 the leaves  and seeds: Dr. Parr preferred the latter, and usually
 combined the  seeds with some aromatics, commencing  with doses of
 a grain, and advancing them to four  or  five grains.
   The  tonics employed have been both  vegetable and  metallic.
 Among the former the missletoe of the  oak stood at one time at the
 head of the  remedies for epilepsy    It was  regarded as a specific by
 Colbatsch,§  and most warmly recommended  by Haller and De Haen.||
 It appears, however, of no importance from what tree it is  taken,
 for, as a parasite, it flourishes equally on  many, and preserves its

  * Observ. Lib. I. No. 233.
  t Eph. Nat. Cur, Dec. I. Ann. ii. Obs. 9.
  | Mem. de l'Acad. Royale des Sciences de Stockholme traduit par M. Keralio.
 Tom. m.                                                       '
    Razoux, Diss. Epist. de Stramonio, &c.
  i  See also Abhandlung von dem Missel,  und dessen Kraft wieder die Epilensie,
Alteub. 1776.                                                 4
  || Rat. Med. Pract. Part vi. p.  317. 
364                      NEUROTICA.          [CL. IV--OR. IV.

own peculiarities on all; and from every tree, so far as late experi-
ments  have been made, it is equally inefficacious and futile.  It is
difficult, indeed, to conceive  what property could ever recommend
this plant to therapeutic notice, for  its sensible qualities are few
and slight, both the leaves and roots  having little  smell, and only a
weak bitterish, nauseating taste.
  Bark, and the leaves of the orange-tree, both of which have  been
very strongly recommended  by many writers as powerful remedies
for epilepsy, are almost as  little worth a trial.  The  leaves of the
orange,  popular as  they were at  one time  for the cure of this
disease,* have less sensible virtues than the peel;  while it  is only
in a very few instances that  we can indulge a reasonablel hope of
any degree  of benefit from cinchona.  In plethoric habits  it will
generally do mischief, in the cerebral variety it can do little or no
good;  and it is only in  a relaxed and  mobile state  of the  animal
frame  in which we can expect the slightest success
  The metallic tonics, however, offer a  very different and more
cheering prospect:  and all of them  seem to  have given proofs of
a salutary result.  The metals chiefly trusted to have been mercury,
arsenic, zinc, silver, and copper.
  Mercury has been tried in almost every form and to almost every
extent; sometimes, indeed, to that of salivation, in which state some
practitioners pretend to have found it highly useful.   As a general
plan, however, this can never be advisable :  and Muralt admits that
in most cases where it has seemed to answer, it has only restrained
the disease,  or prolonged the interval, but not  effected a  radical
cure.t
   Of the preparations of zinc we took notice under convulsion, and
the  remarks  there  offered  are  equally applicable to  epilepsy.
Such, however, has been the state of exhausted irritability produced
by  this disease in some instances, that the patient would bear almost
any quantity of them.   Mr. Johnson of Lancaster gave the sulphate
of zinc in doses of five grains twice a-day at first, and increased the
dose gradually to twelve grains.  Thelenius had previously given
eight grains  of the same daily .J  Arsenic  has of  late been  chiefly
employed in the form of the common solution, and, as  united with
nickel, in the compound of an arseniate.§  But the preparations  of
copper and  silver,  have  met with  more success than any of the
preceding.   The best form of the first is that of the cuprum ammo-
niatum ; and the Edinburgh  Medical  Commentaries are full of cases
that afford proof of its remedial power.  The simplest mode of
  * Hannes (Christ. Rud.) Epist. de puero epileptico foliis aurantiorum recentibus
servato. Leips. 1766.
    Gesner, Bcobachtungen. i. No. 19.  The epilepsy was here an effect of terror.
  + Hippocr. Helvet. p. 247.
  X Mediciniche und Chirurgische'Bemerkungen. Franc. 1789.
  $ See a valuable article on this and similar medicines  in the Edinb. Med. and
'Surg. Journ. No. xix. p. 374. 
w
fcE. VII.-SP. III.]     NERVOUS  FUNCTION.                  3£5

exhibiting this medicine is that of pills, as the piluloz carulem of the
Edinburgh Pharmacopoeia, which is nothing more than ammoniated
copper made into a pilular consistence by means of crumbs of bread.
The  patient  should  begin with half a-graiu  of the metallic salt
every night, and increase  it to  double the quantity if his stomach
will bear it.
   The best, and indeed the common preparation of silver for the
purpose before us is its nitrate.   Under a more operose and unsci-
entific form, it was employed as early as the beginning of the seven-
teenth century by  Angelus Sala,  and  afterwards  by Boyle and
Geoffrey,  though for other complaints  rather  than  the  present.
Dr. Badeley has observed that the  use of this medicine, if perse-
vered in, gives a peculiar darkness  to the colour  of the skin, which
 remains for many months after its discontinuance, in some cases for
 upwards of two years.*
   Dr. Powell  has tried the  nitrate  of silver in  St. Bartholomew's
Hospital upon a large scale, and in  two forms, that of pills and that
of solution, the solvent being mint-water which seems best to cover
its unpleasant taste.   Many of the cases seem to have been strongly
 marked, and  they are given in  a  communication to the  London
College.!  They relate chiefly to young  persons of both sexes from
nine to fifteen years  of age ; in  all of whom the medicine proved
sucocessful, and is said to have operated  a perfect cure.  The dose
at first consisted of not more than  half  a-grain or a grain  of the
metallic salt whether in the form of pill or of solution, given usually
every four hours, but this was gradually increased to doses of three
or four grains taken at the same distance of time : and the increase
was still continued till sickness or some other inconvenience forbad.
It is singular that while the earlier  writers complain very generally
Of  the purgative powers  of this  medicine,  and the  griping  it
produces, the  modern preparation excites no such effects; not even
when it has been carried, as it has occasionally been, to the amount
of fifteen grains to a single dose in the shape of pills; though it
should be remembered that few stomachs will bear more than five
grains in a dissolved state.
  All these tonics seem to  act by*taking off the tendency to irregu-
lar nervous action, and, consequently, the  tendency to a return  of
the paroxysm,  where a habit of recurrence has once been estab-
lished : for in many  instances such  habit alone appears to  be  as
much an  adequate stimulus as  a similar habit in intermittents:
and hence, whatever has a tendency to break through such a habit
must have a beneficial  effect:  fevers themselves of various kinds
have often done this;{ and especially quartans, the most obstinate
* On the effect of Nitrate of Silver, Trans. Medico-Chir. Soc. Vol. ix. p. 234.
t Med. Trans. Vol. iv. Art. vm.
X Hornung, Cista Medica Norib. 1625. 4to.
  Augziige aus dem Tagebuche eines ausubenden arztes, &c.  1 Srunml. Berl. 
"V
366                      NEUROTICA.           [CL. IV.-OR. IV.

of the whole tribe of fevers; and the above remark explains their
mode of operation in this respect: it is that of introducing a new
circle of actions.
  But the exciting causes of epilepsy are so numerous, and  the
disease itself so complicated, that it would be in vain to expect suc-
cess in every instance from metallic tonics, or any one description
of medicines whatever.   The  remedies  must often be varied to
meet the varying case.   And on this account  it is by no means un-
common  to  find epilepsy removed by  oil of turpentine  or some
other purgative that had obstinately resisted the most powerful
doses of  the metallic salts: while in some instances  the disease is
altogether irremediable.
                     GENUS  VIII.

                          CARUS.

                           STorpor.

  MUSCULAR IMMOBILITY ; MENTAL  OB CORPOREAL TORPITUOE OR BOTH.

Carus or xxfog.  "sopor cum gravedine," is derived from xxfx, " the
head,"'being the organ in  which the disease is chiefly seated.   As
employed in  the present arrangement, the  genus signified  by this
term will  readily include the following species:—

1. CARUS ASPHYXIA.                 ASPHVXY.  SUSPENDED ANIMATION.
2.-----ECSTASIS.                  ECSTACY.
3.-----CATALEPSIA.                CATALEPSY.
4.-----LETHARGUS.                LETHARGY.
5.-----APOPLEXIA.                APOPLEXY.
6. ----- PARALYSIS.                 PALSY.

  Carus, therefore, will be found to embrace under the present ar-
rangement, a field somewhat more extensive than that allotted to it
by most other writers, so as to  include several of the  species ar-
ranged by Sauvages under his two orders Leipopsychiae, and Comata,
to be  nearly  synonymous with the Defectivi and Soporosi of Lin-
neus, and still more so with the Adynamiae of Macbride
  As a generic sign  the  author has preferred  the term  torpor or
torpitude to stupor or sopor, which have hitherto been chiefly made
use of for the same  purpose ;  and this on two accounts.  First, as
being of  wider signification,  since  it  includes  the  general  idea
furnished  by  both the others; and, secondly, because neither stupor
nor sopor  have been uniformly employed  in a determinate sense of
any kind.  Thus stupor is often, perhaps usually, restrained to 
GE. VIII.-SP. I.]       NERVOUS FUNCTION.                OVf

mental insensibility or morbid sleep; while Sauvages has explained
Si meaning hebetude of the sense of touch, «mo estia qua> sensum
tactus obscurat;"  and Linneus  "transient sleep of any part  with a
sense  of formication:  "sopor transitorius partis ahcujus  cum sensu
formicationis."   In this place, and, indeed, generally, Linneus makes
sopor  combine the two ideas of a cessation of mot.vity and of feel-
ing or of irritability and sensibility; while Cullen objects, and  cor-
rectly to  this strained extent  of the term, and  limits it  to  the or-
dinary signification of « sleep, or  a sleep-like  state."   Torpor or
torpitude, in the definition of carus now offered, imports insensibili-
ty mental or corporeal,  in a frame still alive, and  actuated, though
often imperceptibly, by the vital principle.   The term insensibility f»
would not so well answer the  purpose;  it is of too wide a range,
and too loose a meaning, being often predicated of insentient, un-
organized matter, that never possessed the principle of life.
   Carus or torpor  thus  explained, will  equally apply  to  all  the
 species we have just enumerated, some of which are very uncom-
 mon,  and a few of which  have been supposed doubtful;  though,
 upon the  whole, the authorities are in their favour, and  they ought
 neither to be omitted nor merged, as they seem to be by  Cullen, in
 the sweeping name of apoplexy; constituting in his  hands a genus
 that includes a variety of distinct, and in some instances, very differ-
 ent diseases; but which, under his own classification,  Dr. Cullen
found it difficult to distinguish, or place separately.
                         SPECIES I.

                  CARUS  ASPHYXIA.

            asjrfisrg.  Susjtfntati  animation.

  TOTAL SUSPENSION OF ALL THE  MENTAL AND CORPOREAL FUNCTIONS-
                                          at
Asphyxy, from x privative, and  e^vfe, pulsus, is here used in the
general sense of the term, though it has occasionally been employ-
ed to  import mere failure or cessation of the  action of the  heart
and arteries, which, in the present classification, is made a species
of entasia under the name of acrotismus ; and has already passed in
review as belonging to the second order of the present class.
  Asphyxy offers us several varieties from a difference of occasional
cause, which produces a like diversity in a  few of its  symptoms.
Sauvages, who has made the  disease a genus,  gives us no fewer
than seventeen species or subdivisions; Dr. Goodwin contents him-
self with three, and,  denominating the disease melancema from the
black colour which the blood ordinarily assumes under its influence, 
 368                        NEUROTICA.           [CL. 1V.-OR. IV.

 distinguishes them by the names of melanaema from hanging;  from
 drowning; and from inspiration of fixed air.
  Of these the first arrangement is  unnecessarily  diffuse  and com-
 plicated ; and the second too limited, and not quite correct, since it
 will presently appear that the direct  cause of asphyxy in hanging
 and drowning is one and the same.
  The* author  has, in  consequence,  been  induced  to divide  the
 species into the following table of varieties, forming a middle line
between  the  two  preceding  arrangements,  and including, as he
 hopes, every modification with which  it is of importance to become
 acquainted :

x Suffocationis.                   Produced by hanging or drown-
  Asphyxy, from suffocation.         ing: countenance turgid and
                                     livid.
£ Mephytica.                       Produced by inhaling  carbonic
  Choke-damp.                       acid or some other irrespira-
                                     ble  exhalation:  countenance
                                      pallid.
y Electrica.                       Produced by a stroke  of light-
  Electrical asphyxy.                ning or  electricity.  Limbs
                                     flexible ;  countenance pale ;
                                     blood  uncoagulable.
3 Algida.                         Produced by intense cold. Limbs
  Frost-bitten asphyxy.               rigid:  countenance  pale and
                                     shrivelled.

  In the first variety or asphyxy from  hanging or drowning, the im-
 mediate cause is  suffocation,  or a total  obstruction to the respira-
tion and is so  explained by Bonet, Haller, Lancisi, Pettit,  and De
 Haen.
  The  face, as we have just noticed, is  turgid and  suffused  with
livid blood : and the general symptoms are given with so much  truth
and emphasis  by Shakspeare, in Suffolk's description of the body
of Henry  VI, that I copy them as a guide to  the medical student;

          ' See how th^  blood is settled in his face!
           Oft have I seen a timely parted ghost
           Of ashy semblance, meagre, pale and'bloodless;
           Being all descended to the labouring heart:
           Who, in the conflict that it holds with death,
           Attracts the same for aidance 'gainst the enemy,
           Which, with  the heart, there cools, and  ne'er retumetli
           To blush and beautify the cheek again.
           But see !  his face is black and full of blood;
           His eye-balls further out than when he lived,
           Staring full ghastly, like a strangled man.
           His hair up-rear'd, his nostrils stretched  with struggling;
           His hands abroad display'd, as one that grasp'd
           And tugg'd for life, and was by strength subdued.'*
* Henry VI. Second Tart. Act HI. 
GE. VIII.-SP. 1.]
NERVOUb FUiNCTlO.N.
309
    This description, however, applies more fully  to asphyxy from
 hanging than to that from drowning, in which last there is more flacci-
 dity in the limbs, and consequently less of" struggle and grasp, and tug
 for life."   In both cases, however, the countenance has a semblance
 of apoplexy, as though there was a congestion of blood in the head,
 to which  the application of the rope to the neck, in  the case of
 hanging,  affords some  countenance.  And  hence, many  eminent
 writers of earlier times, as Boerhaave, Wapfer, and Alberti referred
 suffocation from both the causes before  us to apoplexy;  while
 Cullen made it  as a subdivision  of this last disease: and M. Portal
 has, still more lately, entered into the same view*  But in apoplexy*
 there is always oppressive, generally stertorous sleep, which never
 exists in asphyxy, unless indeed, the exciting cause has only partially
 operated  and produced  a  different disease, or apoplexy instead of
 asphyxy;  affording us a proof of what in fact we have noticed in
 a thousand instances already, that different maladies may  issue from
 the same cause, according to the degree of its violence, or perhaps the
 accidental condition or constitution of the  patient.   In asphyxy,
 wherever we can  trace any sign of  diseased action, the lungs are
 chiefly affected ; in apoplexy, the brain.  In the  first the irritability
 of the system is sudden and total, in the second it is  progressive
 and partial.  In  the former the patient is often restored after all the
 common symptoms of death  have, for some  minutes,  perhaps for
 nearly an  hour, fixed upon him :  in genuine apoplexy this is never
 the case   The appearances on the dissection of drowned animals
 are very  accurately given  by Dr. Curry  and  precisely coincide
 with the distinction here  offered.   The vessels  of the brain were
 found, in every instance, free from distension, or any other morbid
 condition,  while the lungs were  over-loaded.
   The author has observed that the immediate  cause  of asphyxy,
 or,  in other words, an occlusion  of the larynx, may be  partial, and
 in such case give a tendency to apopletic symptoms.  And in effect,
 wherever  the larynx or glottis is only imperfectly closed we meet
 with such  a tendency; and  it is on this  account that the face of
 those who die by hanging is more generally turgid, and  the muscles
 give proof of more convulsive action than the face of those who die
 by drowning; for in the former  case, either from a rigidity in the
 coats of the larynx, or from the rope not being properly applied, a
 small current of air is often capable  of moving backward and for-
 ward for some  time,  and  particularly in suicides, many of whom
 suffer much before they die in consequence of applying the rope
 very bunglingly, and  whose cheeks, lips, eyes,  and  tongue are
 peculiarly  turgid and prominent.   The reason of this may be partly
 collected from the history already given, in the Physiological Proem
to the  third  class,t of the  state of the heart in  the act  of dying.
  * Observations sur less effects de6 vapeurs mepbytiques.  Nouv. Edit. Pari?.
1774.
  + Vol. h. p. 9.
  VOL.  Ilf.                  47 
370
NEUROTICA.
[CL. IV.-OR. IV.
 The immediate cause of the contraction or systole of the heart, we ob-
 served, has not been satisfactorily settled :* but we may safely affirm
 that a part of this cause, if not the whole, depends on the change,
 whatever that change consists  in, which  takes place in the blood
 during its ventilation in the lungs, by which it is rendered more ac-
 tive and stimulant;  for  as thi» "change gradually subsides in those
 who are in the act of dying, the heart contract? more feebly; and
 when, with the  last expiration  of air, it ceases altogether, the
 heart as instantly contract* no  more :  the consequence of which is
 that the lungs, the  heart, and the larger vessels in the  vicinity  of
 the heart, are usually found  filled  with blood, the smaller vessels
 empty, and the general surface of the body pale.  Now whatever
 has a power of instantaneously cutting off inspiration must necessa-
 rily  produce  the same  effect:  and hence,  as  we  have already
 observed, the  gorged state of  the lungs and  the livid  hue of the
 countenance  in most cases of suffocation by drowning:  and conse-
 quently the only  reason why the lungs are not quite so full, and the
 countenance  more  turgid in most cases of suffocation by hanging,
 is that  from  the  inexpert manner  in which the  rope  is  usually
 applied, and the  necessary admission of a certain portion of air  to
 the lungs, the heart is, for some time, able to contract feebly, and
 to keep up a feeble  circulation, while the pressure of the rope on
 the jugulars  prevents a  ready return  of the blood from the head,
 and consequently  accumulates it in all the vessels of the face;  and
 hence, the more  inexpertly this operation is  performed the more
 turgid  these vessels must become, and the more apoplectic the gene-
 ral appearance.
   It is the same,  as we shall presently have occasion to notice more
 fully, with persons  who are exposed to the action of carbonic acid
 gas or  other mephytic vapours, so far lowered  or intermixed with
 respirable air as to render them  incapable  of destroying  life  in-
 stantly ; in which ca-;es there has not only been  sometimes a feeble
 prolongation of the circulation, but even a stertorous breathing and
 many other symptoms of apoplexy, of which we shall have to speak
 further under  the next variety.
   There are some  of the narcotic poisons that seem to act in the
 same manner.   Given in a toll dose they destroy the life instantly,
 but ip an underdose the  circulation is continued feebly, and apople-
 tic symptoms ensue.  Thus, according to Mr. Brodie's experiments,
infusion of tobacco, when injected into the intestines, and the upas
 antiar, when applied to a wound,  have a power of rendering the
 heart insensible   to the  stimulus of the blood,  and thus suddenly
 stopping the circulation: while alcohol, the juice of the leaves of
 aconite, the woorara, essential oil of  almonds, whether applied  to
 wounded surfaces or taken internally,  produce death  by destroying
 the functions of the brain, while they act only  indirectly  on the cir-
culation.
•  Vol. u. p. 12. 
GE. VHI.-SP. I.]          NERVOl'S  FCNCTION.               371

  In like manner, De Haen gives one instance of apoplectic signs
discovered on the dissection of a criminal who had been publickly
executed by hanging;  in which the  pia mater was  found unusually
florid, the vessels of the brain turgid, and  some degree  of  serous
effusion  had taken place under the tunica arachnoides : but  in this
case he found, also, that the lungs were equally overloaded, and that
the  rope had not pressed upon the trachea, but upon the part lying
between the scutiform cartilage and the os hyoides, and consequently
that the  compression had been imperfect.*
   But, except  in cases where the occlusion of the trachea has not
been entire, the patient,  who suffers from asphyxy produced by
hanging, is as void of apoplectic symptoms as he who suffers the same
disease from drowning.  In the dogs hanged by way of experiment
by De Haen,t and cut down as soon as they were dead, and in those
drowned  by Dr. Goodwin,| there was an equal absence of apoplectic
signs: and, in truth, wherever an executioner does his duty com-
pletely, the death is  too  sudden to allow  of accumulation   as its
cause.  By the double effect,  however, of stopping the circulation,
and obstructing the passage of the  air, the public punishment of
hanging, when dextrously conducted, is probably attended  with very
Jittle pain.  It  has been said of late, that another, and indeed  a chief
cause of the suddenness of  the death hereby produced is to be found
in a luxation of one of the upper vertebrae.  Such an effect  may
take place at times upon our public  scaffolds, on which the harden-
ed  criminal jumps from the gallows to produce a rapid result, but
it is rarely met with in the private retreat of the more timid suicide.
   That a total  obstruction  to the respiration, moreover, is the chief
cause  of death on hanging  is  clear from the cases in  which  the as-
phyxy has been cured by inflation of the  lungs  after  the  unhappy
wretch has been cut down; and from one or two instances in which
the individual has escaped death from an ossification of the trachea ;
of which  we have a few curious examples in Bonet, and Fallopius ;§
and more particularly from the case of Inetta de Balsham, stated by
Dr. Plott in his Natural History of Staffordshire :  who having been
hung, in  the reign of Henry VI., according to the due form of law,
was cut down alive,  after suspension from nine o'clock on Monday
till later  than sun-rise on the ensuing  Tuesday ;  in consequence  of
which she received the king's  pardon. Dr.  Plott ascribes this ex-
traordinary escape, and with great reason, to an  ossification  of the
larynx: " She could not," says he, " be hanged,  upon account that
the larynx or upper  part of her wind-pipe was  turned to bone."||
  * Rat. Med. continuat. Tom. i. part n. 8vo.
  t Abhandlung iiber die art. des Todes der Ertrunkenen, Emhenkten, und Erstik-
ten. Wien. 1772.
  X Connexion of Life with Respiration, or an experimental Inquiry into the effects
of submersion, strangling, &c. Lond. 178S.
  } Bonet. Lib. vn. Sec. xii. Obs. ii.
    Fallop. Tom. i. Obs. vi.
  || Hist. p. 292. 
372
NEUROTICA.
[CL. IV.—OR. IV.
    It has hence been occasionally proposed to  save a  criminal con-
 demned to the gallows by introducing a silver canula, into the tra-
 chea.  It  is commonly reported that such an attempt was in agita-
 tion among the friends of the  unfortunate Dr. Dodd, but we have
 no reason  to believe it was  then, or ever has been actually tried.
    The following experiment, however, as related by  Dr. Curry, is
 almost demonstrative as to the  immediate organ through which the
 attack of death is received in hanging. It was performed at Edinburgh,
 many years ago, by the senior Dr. Munro, and in the language of Dr.
 Curry " clearly proves that the exclusion of air from the lungs is the
 immediate cause of death.  A  dog  was suspended by the neck with
 a  cord, an opening having  been previously made in the wind-pipe,
 below the  place where the  cord was applied,  so as to admit air in-
 to the lungs.  In this state he was allowed to  hang for three quar-
 ters of an  hour, during which time  both the circulation  and breath-
 ing went on.  He was then  taken down without appearing to have
 suffered much from the experiment.   The cord was now  shifted
 from above to below the opening made into the wind-pipe, so as to
 prevent the ingress of air into the lungs, and the animal being again
 suspended  he was completely dead  in a few minutes."*
   Asphyxy from submersion has been very generally accounted for,
 pven by many who have regarded it as an  effect of suffocation, by
 supposing  the suffocation produced by a rush of the water into the
 cavity of the lungs which prevents  the access of air and consequent-
 ly  of respiration.  This idea first, perhaps, advanced by Galen, has
 been in modern  times adopted  by Hallen,  Goodwin,  Ponteau, and
 indeed most physiologists, and attempted to be  supported by vari-
 ous experiments  on  drowned  cats.  It  is now well  ascertained,
 however, that in many cases of death from  drowning not a drop  of
 water enters into the lungs; that where it does enter, the quantity
 is,  for the  most part, very small; and that, whether small or large,
 it passes the trachea after death instead of before it, and consequent-
 ly cannot be a cause of death.
  The immediate  cause, as in the case of suspension, is suffocation.
 The glottis is extremely irritable;  the access  of the surrounding
 water produces a  rigid or entastic spasm upon its muscles; and
 the rima is as completely closed against the entrance  of  air,  as in
 the case  of a cord round the  throat.  And hence, the  suffocation
 often produced by  a very small  substance of any  other  kind acci-
dentally thrust into or stimulating its aperture, as a minute crust of
bread, a hair or blade of grass,  a peach  or even a  grape-9tone; to
which last  Anacreon is well known to have  fallen a victim.
  How long the living principle may, under  these  circumstances,
remain attached to the animal frame, and afford  a chance of  reco-
very, is not ascertained, with any degree of accuracy, even in the
present day : and the answer to the question must, in a considera-
'"• Observations, p. 71. 
GE. VIII.-SP. I.]
NERVOUS FUNCTION.
373
 ble measure, depend upon the degree of irritability, or perhaps the
 idiosyncrasy, of the individual.
   It has been known, however, from a very early age, that torpi-
 tude from drowning may be induced and continue for some minutes,
 without much  danger: since  this, as we have  already observed,
 was a common practice among the Greeks and Romans for the cure
 of lyssa :* and was carried by Van Helmont so far that he would
 not suffer the individual to be raised  from under the water till the
 psalm Miserere had been solemnly chaunted, which was the measure
 of time he allowed.   If  the submersion have not exceeded five mi-
 nutes, and no blow against a stone, or  other  violence  have  coinci-
 ded, persons will usually be found to recover without much difficul-
 ty.  After a quarter of an hour, recovery is not common, and  after
 twenty minutes or half an hour, it is nearly hopeless.
   The first report of the establishment for the recovery of drown-
 ed persons, at  Paris,  divides the cases that had occurred to  it into
 three  classes, the first of which includes those that were restored to
 life, and comprehends twenty-three instances.  Of these one recover-
 ed after having been three quarters of an hour under water; four after
 having been half an hour, and three after a quarter of an hour ; the
 rest after a still shorter period.t  Of twelve dogs,  drowned  by De
 Haen for the purpose  of experiment, not a single one was recovered
 though only  confined  under water for a few  minutes.  It is  very
 possible, however, that in these cases  the force necessary to keep
 them submerged, may have considerably added to the  extent of the
 mortality.  Among mankind, where no such force is  applied, this
 eminent physiologist  conceives that one in sixteen  is  no unfavour-
able average of the proportion that recover.|
   There are cases, indeed, on record, of recovery from drowning
after a submersion of some hours;  but these are rare  and wonder-
ful, and some of them altogether incredible : for we have histories
of recovery after eighteen hours,§ four and twenty hours,|| and even
three days,1F while some  of the  retailers  of the  marvellous have
stated intervals of fifteen days, and in one  instance, related  with
much gravity, not less than seven weeks.**  From all  which, how-
ever, we may at least learn the useful lesson of the necessity of re-
doubling our exertions when called  upon for  medical  aid,  and of
not despairing very early.
  Unfortunately we have no means of determining whether  the vi-
tal principle  lies latent in the body or  has utterly  dropped its con-
  * Vol. in. p. 243.
  t Detail des succes de l'Etablissement que la Ville de Paris a faite en faveur
des Personnes noytes, &c. Paris 1773.
  X Rat. Med. Cont. Tom. I. Part n.
  I Pechlin, De aeris et alimentorum defectu et vita sub aquis.  Kiel,  1676. 8vo.
  || Lepi, Submersos per 24 horas vitam protrahere posse, Rom. 1670.
  T Eph. Nat. Cur. Dec. i. Ann. vi. vn. Obs. 20.
  ** Id. Observ. 125. 130. 192 
374
NEUROTICA.
[CL.  IV.-OR. IV.
 nexion.   Want of heat is no more to be relied on than cessation of
 the pulse or of breathing :  for while in submersion,  heat in conse-
 quence of its rapid absorption by the surrounding  elements, is  one
 of the first properties of life that disappears, whether the patient
 recover or not; in death from convulsions and various other sudden
 causes, it often continues for  hours, and sometimes even for days
 after the event, cheating the by-standers  with  an empty and  un-
 founded hope of a restoration never to take place.  The present
 author was lately sent for in haste, to a female domestic of Mr. Salmon
 of Mecklenburg Square, who however died under a convulsion-fit be-
 fore his arrival.   In the evening, nearly twelve hours afterwards,
 he was again requested to attend, as notwithstanding the body had
 been laid out from the first  and merely  covered with a sheet, it still
 possessed a considerable degree of warmth.  He was sorry to  re-
 press a hope which he  found fondly  and highly  cherished, but  the
 symptom was illusive, and the heat gradually disappeared.  On the
 decease  of a robust and corpulent lady  whom he lately attended in
 Bedford Row, and who  died of a spasmodic asthma,  this  symptom
 continued, or rather showed itself afresh, eight and forty hours af-
 ter death, so that the author was requested to attend at the time the
 body was on the point of being put into the coffin.  In this case the
 heat was produced by putrefaction, for  the body was livid and offen-
 sive.   Bartholine has an example or two of the same kind; and
 the Ephemerides,  among other cases less marvellous, one  in which
 the heat is said to  have continued till the  fourth day after death :
 but which should no doubt fall within the solution just given.*
   As heat has occasionally maintained itself for hours after death,
 so also has perspiration.  Paullini mentions a case in which  tears
 flowed from the eyes ;t  Riedlin  another in which  the eyes them-
 selves recovered  their brightness ;J and Hagendorn  a  third,  in
 which the face swelled and  looked  red.§   In all  these  cases we
 have  proofs of a lingering of the  irritable  principle in particular
 parts after the sentient  principle  has totally  disappeared.  And
 hence, in a few instances some of the  muscles  have  been thrown
into irregular action, the penis has become erect,||  the jaws have
 opened and shut, as though  masticating ;1T  and,  as  is well known,
the heart, when dissected from the pericardium, has  leaped  from
the table.
  In attempting a cure of suffocation by submersion, the two grand
means by which we are to operate are  those of warmth  and infla-
tion of the lungs.  The body should  be  quietly conveyed to a warm
and dry situation, and rubbed all over with  moderate  stimulants, as
 * Eph. Nat. Cur. Dec. II. Ann. iv. Obs. 18.
 t Cent. m. Obs. 10. Franc. 1698, 8vo.
• X Lin- Med. 1696. p. 203.
 } Cent. m. Obs. 46.
 || Eph. Nat. Cur. Dec. I. Ann. ix. x. Obs. 34. 158.
 f Commerc. Nor. 1732. pp. 82. 90. 173. 
GE. V1I1.-SP. I.]       NERVOUS FUNCTION.                375

diluted flower of mustard, or the warmer  balsams;  while the nos-
trils are plied with volatile ammonia, and the  eyes exposed  to a
strong light.   But a restoration of the action of the  lungs is chiefly
to be  aimed at:  and for this purpose, a full expiration of warm air
from the lips of a by-stander, should be repeatedly forced into the pa-
tient's mouth, and his nostrils held close to prevent its escape by
that channel.  Inflation may also be attempted by a pair of common
bellows;  or, which is far better if it can be readily procured, by  a
pair  of  bellows communicating with  a pipe introduced into the
larynx,  or  as some have  recommended, into  on  aperture  made
between  the  rings of the trachea.   Stimulating injections  of acrid
purgatives, of camphor, ammonia, and brandy, or other spirits, have
often been introduced with success into  the rectum,  and  sometimes
injections of warm air alone: and it would be better  that the air
introduced into the lungs should be also moderately  warm.  Besides
this active process, it may be possible  to convey some  warm and
 cordial stimulant, as volatile alkali,  or  the  compound spirit of la-
 vender, into the stomach by means of  a canula; or what may pro-
 bably in this case answer better, by  a piece of sponge, impregnated
 with one of these, fixed  to the end of a small rod of whalebone ; for
 the sides of the stomach may be, so to  speak, mopped round by
 the sponge thus charged, and stimulated in every direction   In the
Berlin Translations is recommended the use of a ventrtcuh excutia,
 or stomach-brush,  to produce  internal friction in  the  same man-
 ner ; but the stomach-mop, prepared as above, will be found a more
 serviceable contrivance.             ,...,.<    i     e „una
   There is no family of diseases in which the internal use of phos-
 phorus seems to promise more success.  The  German physicians
 have employed it very generally in the last ebb of typhous  fevers,
 in apparent death from convulsion,* and in most cases in which the
 nervous fluid seems to be suddenly discharged as by an explosion,
 or not secreted at all, and they have often employed it with success.
 It is  one of the most powerful stimulants we  know, and in asphyxy
 should be given to the amount of two  or three grains for a dose,
 dissolved in ether.                                  .
   Venesection, and especially that of the jugular  veint, has  been
 strenuously recommended  by  physicians of high  authority; and,
 wherever there is reason to believe that the drowning has followed
 upon a sudden tit of apoplexy, the recommendation is rational enough
 provided it can be practiced with effect. But commonly speaking it is
 advice to no purpose, for the blood will not flow : and in other cases
 if it would,  such depletion, we have   reason to believe,  would do
 more iniwy by weakening, than good  by removing what is errone-
 ously supposed to  be congestion.   It may occasionally, perhaps, be
 serviceable as soon as the living powers  begin to show themselves,
 but it is rarely to be tried  in the  first instance.

   * De Phosphori, loco Medicament! adsumpli, virtute medica, &c. Anat. J. Gabi,
 Mentz.
   t Jo. Wences Nachtigal, Dissertatio de Submersis.  Vindobon. Svo. 
 376                      NEUROTICA.          [CL, 1V.-OR. IV

   Returning life is first usually discoverable by the symptoms of sigh-
 ing, gasping, twitching, orsubsultus, slight palpitation, or pulsation of
 the heart: in effect by  a weak or clonic action in mc-t of the organs.
 Our efforts should here be redoubled, for the feeble spark still requires
 to be  solicited  and  nourished  into  a permanent  flame—and has
 often  disappeared from a  relaxation of  labour.  A spoonful or
 two of warm  wine, or  wine  and  water, should  now  be  given
 by the  mouth as soon as the  power of swallowing is sufficiently re-
 stored ; which should be  shortly succeeded by a little light, warm,
 and nourishing food of any  kind,  with gently  laxative clysters, a
 well-heated bed, and perfect tranquillity.
   I have dwelt the  longer  upon  this subject because the general
 principles of the remedial treatment  here recommended,  apply to
 most of the other varieties under  which asphyxy or suspended ani-
 mation  is to be traced: and the reader who i<* desirous of following
 the operative plan  into a still minuter detail, will do  well to con-
 sult Dr. Cullen's letter  to Lord Cathcart the president of the Board
 of Police in  Scotland, concerning the  recovery  of persons  drowned
 and seemingly dead; an able extract of which is given in the Medi-
 cal Commentaries  of Edinburgh.*   We may  observe, however,
 that in attempting the recovery of those who have been hung, and par-
 ticularly who have inexpertly hung themselves, bleeding from the ju-
 gulars may be more frequently found necessary than in attending the
 drowned, since in the former, as  we have very fully observed above,
 there is a greater tendency to apoplectic symptoms than in the lat-
 ter : yet even here the  quantity abstracted needs not be large.
   In the second variety of asphyxy,  or that from an  inhalation of
 irrespirable auras, death in many cases takes place instantaneously;
 and, consequently, for reasons already advanced, the  general sur-
 face of the body, and even the countenance itself, is  pale.t   Yet as
 the gas is often in some degree diluted with atmospheric  air, the
 circulation, and even the  breathing are occasionally continued for
 some time in a feeble and imperfect state, and the asphyxy is unit-
 ed with symptoms of apoplexy, or genuine apoplexy  takes  place in
its stead.  In Cornwall and other mining regions, these gases are
vulgarly called damps, from the  German dampff, L' a vapour or ex-
 halation."
  The direct effect of such gases, when in a concentrated state, is
utterly and instantaneously to destroy the irritability and sensibili-
ty of the nervous system, of which we have  perpetual examples
occurring in persons who incautiously descend  foul  beer-casks, or
the shafts of mines.  By what means, however, such  exhalations
when they have penetrated the  lungs become so rapidly communi-
cated to the nervous system as to  prove instantly destructive, we
do not seem to be very  well  informed. Absorption  would be the
* Vol. m. p. 243,
t Briikser von den ungewisheit der Kcnnzeichen des Todes. 
GE. VIII.-SP. I.]       NERVOUS FUNCTION.                 J' '

most ready way of accounting for it, but till the  objections thrown
out by Mr. Ellis against an absorption of oxygene or any other gas
by the lungs, and which we have  noticed in the Physiological fro-
em to our second Class, are more satisfactorily replied to than they
appear to have been, it is an hypothesis that can hardly be allowed.
In the case of hanging or  drowning, it does not seem to be  owing
to a direct want  of irritability that the heart ceases instantly to con-
tract, but, as we have already remarked, to  its being  deprived of
the  necessary stimulus  which is no longer afforded by the  lungs,
however  they may act, in providing it.  Yet in the present case
there seems to be not  only a cessation of action, for want of a pro-
per stimulus, but a total abstraction of both sensific  and  motitic
power : and  this as completely in one  part of the  frame as in  an-
other.
   The gases of the description before us that are found most fatal*
are the carbonic acid,  hydrogene, nitrogene, and several of a more
compound kind  which  are thrown forth from  putrefying animal  and
vegetable substances,  and especially from cemeteries,  on opening
fresh graves,  in which  the  process of decomposition is proceeding
rapidly,  and the concentrated effluvium bursts forth with an intole-
rable stench.  Of the powerful effects of this last exhalation, Four-
croy has  furnished us  with a very  particular and  striking account
from the  narration of grave-diggers examined for the  purpose :
from which  it appears that those who are  immediately hanging
over a corpse, whose abdomen is accidentally struck into by  a pick-
axe, often fall down instantly in a state of senselessness and apparent
death, while persons who happen to be at a  little  distance,  and re-
ceive the exhalation  in a  form  diluted  with atmospheric  air,
are attacked  with nausea,  vertigo, faintness, and tremors, which
continue for some hours.
   The most common of these gases is the carbonic acid, which is
chiefly  found in the  guise  of a torpefying vapour in close rooms
where charcoal has been burnt, at the bottom of large beer-casks,
or of wells, and in many natural caverns in the earth's surface.   Its
weight prevents it from  escaping  readily, even  when there is an
accession of atmospheric air: and its want of smell,  when pure,
prevents it from being detected  otherwise than by its effects.   As
it will not support flame, the common and easiest test, where  it is
suspected to exist, is that of a lighted candle, which is well known
to be extinguished immediately, if this gas be present in a quantity
 sufficient to be injurious to respiration.
   Nitrogene  and hydrogene,  when pure,  have  probably  as little
 smell as carbonic acid gas ; but they are generally combined with
other gases, sulphur, carbone,  or phosphorus.   The first, formerly
 denominated phlogistic air, and sometimes mofette, is thrown forth
 largely during the decomposition of animal matter, and  in a small
 degree during that of vegetable matter.  Combined with hydrogene
 it forms ammonia; with oxygene, nitric  acid.  Fourcroy asserts that
 it possesses a peculiar and distinct  odour,  resembling  that of fishes
    vol.  in.                  48 
•i/8                      NEUROTICA.          [CL. 1V.-OR. IV.

just beginning to putrefy : but this is probably at all times produced
by  a combination with other materials.  It seems chiefly concerned
in  giving the greenish  colour to parts,  and especially muscular
parts, in a putrid state.  In some  gases of this  kind a candle will
burn freely.
  Hydrogene issues also from fecal matter, and, in combination with
sulphur, phosphorus, and  carbone,  produces the chief part of the
nauseating and putrid stench thrown forth from decomposing animal
and vegetable substances.   It is emitted in a much purer state  from
the sides of coal and metallic mines, and often exists in considerable
abundance without being perceived by the nostrils.  If mixed with
an  equal  proportion of oxygene,  it may be breathed for about an
hour without any great inconvenience. If inhaled beyond this time,
or in a more concentrated form, it has a great tendency to occasion the
effects we have just  noticed, lower  the  irritability of the  animal
frame, and induce stupor or an inclination to sleep.
  The fumes of mercury, lead, and some other metallic substances,
when highly concentrated,  seem to operate not very dissimilarly to
those of charcoal, and give a check  to the mobility of the nervous
power at once.
  The  fumes of charcoal are generally inhaled in a diluted form,
but they are still highly  deleterious and produce  asphyxy more or
less complete,  according to their  degree of concentration,  and in
some cases according to the strength or weakness of frame of those
who are exposed to them.   We have a striking  illustration of this
in the  case of two  persons communicated by Dr. Babington to the
Medico-Chirurgical Society,  who had gone to bed in a room in
which a charcoal fire was kept up through the whole of the night,
with whose gas the  surrounding atmosphere  was strongly impreg-
nated.   According to the  principle  we  have  endeavoured to es-
tablish,  we ought here, from the  dilution of the  vapour, to expect
that whatever tendency there might  be to asphyxy would be united
with a tendency to apoplexy.  And such we  find  to have been the
fact: for, of these two persons, the younger and less vigorous, a boy
of thirteen, died  apparently during his sleep, and without commo-
tion :  while the elder and  more robust, a man of thirty-eight, was
found,  upon being called in the morning between six and seven, in
an apoplectic state,  with a swollen, projecting tongue, suffused and
prominent eyes, and laborious breathing.
  The  patient, if any degree of  sensibility remain, should in this
variety  be freely exposed to the open air, instead of to a heated at-
mosphere as in the  preceding : and, if he can swallow,  acidulated
liquids  should be given him.   If insensible,  cold water  should be
dashed on his face, strong vinegar, and especially aromatic vinegar,
be rubbed about his nostrils,  and  held under  them,  and stimulating
clysters be injected  as recommended  under the first variety.   The
lungs should be inflated with the warm breath of a healthy  man,
or,  which is better with ogygene  gas.
  A proper use of voltaic electricity  is also in many instances found 
GE. VIII.-SP. I.]      NERVOUS FUNCTION.                  3/9

highly serviceable as a nervous stimulant.  No advantage, how-
fver/is likely to accrue  from passing the electric aura  across  he
chest,  directly through  the heart and lungs, which is a common
practice.  The fluid Ihould be transmitted along the  channel of the
nerves, from the seat of the phrenic nerve in the neck, to the beat
of the diaphragm, or that of the par vagum and great sympathetic
nerve  immediately under  the sterno-mastoid muscle, where they
lie in a common sheath,  and send forth branches to the heart.   In
Dr. Babington's case, the application of voltaic  electricity surpris-
ingly increased the power of the muscles of respiration, but appear-
ed rather to diminish the  action of the heart.   It was hence used
alternately  with a forcible inhalation of oxygene gas, and various
external  stimulants.  Venesection was tried, but  does not seem to
have been beneficial.  The man recovered in a few days.
   M.  Portal recommends a division  of the  jugular vein, but  the
blood  will  rarely flow from any vein, and is still more  rarely suc-
ceeded by any advantage even where it is obtained.  And if every
other  remedy fail,  he advises bronchotomy, and a scarification of
the feet and hands.t
   The sprinkling or dashing of water upon the body seems to be
useful on two accounts;  first, from having a tendency to rouse  the
vessels on the surface to contract;  and  next as  affording an oppor-
tunity for a disengagement of oxygene.
   In the third, or electric variety, the whole system  appears to
be not so much rendered inirritable to stimulants, as to be suddenly
exhausted of its entire stock of nervous power, like  a Leyden phial
upon an application of the discharging rod : in consequence of which
the limbs are flexible, the countenance pale, and the blood  uncoa-
gulable.  The mode in which the electricity is communicated is of
little importance ; for, if sufficiently powerful for the purpose, real
or apparent death is instantaneously  produced,  whether the stroke
flow from lightning, an electric battery, or a voltaic trough;  and
every organ is equally affected and emptied.
   Upon plants, on the contrary, we often find a stroke of lightning
of the  same  intensity occasion very different  effects in different
kinds or branches of the same plant, in consequence of the variety
they exhibit as conducting powers.   Upon some, it  descends with-
out mischief; in others, it exhausts itself on  particular parts, which
are withered, as though attacked  by a  hemiplegia.   In the be tula
alba or common birch, it never runs along the stem,  but confines its
stroke to  the top alone, beating off the boughs in every direction.
   In animal life, however, there is also  a difference of effect, but
only in proportion to the degree  or intensity of the electric power
that attacks the  system; and it is curious to observe the nature of

  * Greg. Consp. Med. Theor.
    Hiifelanrl, Diss, usus vir. elect, in asphyxia.   Goet. 1783.
  + Observations sur les effets des vapours mephytiques sur les corps de l'homme,
.&c. nouv. edit. Paris, 1774. 
380
NEUROTICA.
[CL. IV.-OR. IV.
 this effect.  Small doses of electricity prove a powerful stimulus to
 the nervous function, increase the flow of sensorial fluid, and aug-
 ment the  irritability of the muscles:  while  a violent shock, as we
 have just  seen, exhausts the nervous system instantaneously, carries
 off the entire stock from the animal fabric, and leaves the muscular
 fibres flaccid and flagging.   This singular result is extended to the
 blood, and extended to it in both cases:  for its coagulability, or the
 firmness of its texture, is increased by the application of small doses
 of electricity, while the shock of lightning which renders the mus-
 cles lax and uncontracted renders the blood loose and uncoagulable.
 It is to this variety of effect that Mr. John Hunter makes a power-
 ful, and certainly a very impressive appeal, in proof that the blood,
 though a fluid, is actuated by the same living principle as the mus-
 cular fibres.
   The general principle of medical treatment  has been laid down
 under the  first variety.  Stimulants of the most  active kind should
 be resorted to without loss of time : but of all  stimulants that  of
 electricity, or voltaism, seems to  be  especially called for in the
 present modification of asphyxy.  I  do not  know that it  has  ever
 been  tried to  any great extent, in the variety before  us, on the
 human subject, but M. Abildgaard, in the Transactions of the Copen-
 hagen  Medical Society, has  related a  few  experiments  on other
 animals that are well worthy of attention, and  were found highly
 beneficial.  The animals chiefly selected were from the poultry-yard,
 and consisted of  cocks and  hens.  These were  first  rendered as-
 phyctic, or apparently dead, by a strong shock of electricity passed
 through the  head; and  afterwards  recovered  by  another shock
 passed  through from the chest to the  back, the animal  instantly
 walking about as if nothing had happened.  M. Abildgaard does not
 say what interval he allowed between the shocks  thus  administered :
 but he  observed that where no  second shock  was employed the
 apparent  was converted into real death, for the animal, in no in-
 stance, showed any tokens of resuscitation : and he observed farther
 that, if the second shock were  thrown  through  the  head like the
 first, instead of from the chest  to the back, the same lifelessness
 continued,  and no benefit whatever was  produced.*
   In frost-bitten asfhyxv, or that produced by intense cold, the
 limbs are  rigid, and the countenance  pale  and shrivelled.  This
 variety is always  preceded by an  insurmountable desire to sleep,
 which the  utmost exertion  of the will is  unable to overpower.
 The sleep is, in most cases,  fatal and becomes the  sleep of death.t
Captain Cook, in the account he has given of his first voyage round
the world,  has strikingly exemplified this remark in  the case  of
 Dr. Solander and Mr. (afterwards Sir Joseph) Banks.   " Dr. Solan-
der," says  he, " who had more than once crossed  the mountains
  * Societatis Med. Havniensis Collectanea, Sic. Vol. ii. Art. Tentamina Electrica
in Animalibus.
  + Rhazes ad. Almans. Tract, vi. Cap. v. vii. 
GE. VIII.-SP. I.]
NERVOUS  FUNCTION.
381
 which divide Sweden from Norway, well  knew that extreme cold,
 especially when joined with fatigue, produces a torpor and sleepi-
 ness that are almost irresistible :  he therefore conjured the company
 to keep moving whatever pain it might cost them.  ' Whoever sits
 down,' said he, ' will sleep, and whoever sleeps will wake no more.'
 Dr.  Solander  himself was  the  first who found  the  inclination,
 against which he had warned others, irresistible, and insisted upon
 being suffered to lie down.  He soon fell into  a profound sleep,
 from which, however, by the exertion of Mr. Banks he was awakened.
 Several  others of the party very  narrowly  escaped;  and two of
 them slept, and perished from the cold."*
    For these symptoms, and their effects, it is easy to account.  Cold,
 so long  as the living power is capable of producing a reaction, is
 one of the most strenuous tonics we are possessed of, and  the glow
 that accompanies the  reaction, is  felt to be peculiarly vigorous and
 elastic.   But if it exceed  this proportion  and no reaction ensue,
 the contraction of the vessels on the surface is converted into a rigid
 spasm, the blood is driven into  the interior,  and  the surface must
 necessarily be pale.   In this extremity of temperature, moreover,
 cold, instead of being a tonic, is one of the most formidable sedatives
 in animal chemistry : it carries off  the heat of the body  far more
 rapidly than it can be  recruited, and as effectually exhausts it of all
 its irritable and sensible  power.   But such exhaustion,  as  we have
 already shown under  the genus paroniria, is a cause of stupor or
 sleep, and a cause so cogent that the will is, in many cases, incapa-
 ble of resisting it, and falls a prey to its power.
   In applying remedial means to this modification of asphyxy great
 caution is necessary respecting the employment of warmth; and
 particularly where the limbs are  peculiarly rigid, and under the
 influence of frost.  In this  last case it will be generally found most
 adviseable, in the first instance, as in frost-bitten limbs, to plunge
 the body  for a few minutes into a bath of cold sea-water or salted-
 water, at  the  same  time that warm air  may be breathed  into the
 lungs,  and the  stomach and  rectum gently  excited by moderate
 stimulants: for it does not  follow  that,  because the limbs  and  sur-
 face of the body are frozen from frost-bite, the central parts have
 suffered to the  same extent.  After a short immersion in sea-water
 the body should be taken out, wiped perfectly dry, laid in flannel
in a moderately warm room, and submitted to the friction of warm
hands, several persons  being engaged in  this process simultaneously.
* Hawkesworth's Account of Voyages, Vol. II. p. 46. 
 382                      NEUROTICA.


                          SPECIES  II.

                   CARUS ECSTASIS.



 TOTAL  SUSPENSION OF SENSIBILITY AND VOLUNTARY  MOTION ;  MOSTLY OF
   MENTAL POWER ; PULSATION AND BREATHING CONTINUING :  MUSCLES RIGID :
   BODY ERECT AND INFLEXIBLE.

 There is so close a connexion between the present and the ensuing,
 and in truth, most of the ensuing species of the  order  before us,
 that they are occasionally apt to run into  each other, or  to exhibit
 a  few aggregate symptoms.  And  on this  account  they have been
 very differently arranged by different writers.  Sauvages, and most
 of the  continental nosologists have  regarded them as distinct genera,
 Dr. Mead  and  Dr. Cullen, as  species or subdivisions of apoplexy,
 and Dr. Cheyne as the  same of lethargy.   Dr.  Cooke has treated
 of them more  cursorily than those who  are acquainted  with his
 talents and learning, could wish : and has so far followed Dr. Cullen
 as to place  them conjointly in a chapter  under the  head of apo-
 plexy :  while Dr. Young,  coinciding  with the  view taken in the
 present work, has arranged  the whole  as species under the generic
 name of carus.
  To understand the nature of their distinctive  symptoms, and the
 reason of their occasional combination, it is necessary to bear in
 mind the remarks offered in the Physiological Proem to the present
 class respecting the natural division of the  nervous ramifications into
 fibres of different sets and powers, and the different kinds  of fluids
 which  these several sorts are capable  of secreting or conveying, as
sensific.and motific fibres,  and sensific and  motific fluids: since it
happens that some  of these  diseases  are  confined  to one  set,  and
 others  to another, while other diseases again, extend equally to both.
And hence  we are able to account for disorders in which the percep-
tion or sensibility is abolished, while the irritability continues with-
 out much interference : or in which  there  is a disturbed flow or
total cessation of the  irritable power,  with little interference with
the percipient,  and  sometimes also with the sentient, as in some
cases  of paralysis:  or in  which there is a disturbance or cessation
 of all  these, with the exception  of a partial supply of irritative
 power to the  involuntary  organs.  It will also  be necessary to
 recollect, as we have endeavoured to show in many of the preced-
ing pages, and particularly under the genus clonus, that where there
is a disturbance in the flow  of the motific or irritative power, this
 disturbance is of two kinds, one from excess, and one from deficiency ;
 and that in  both cases  there  is great irregularity of action,  and
 consequently entastic or rigid, and clonic or agitatory spasms, exhi-
 biting, by their continuation, innumerable  modifications.
[CL. IV.-OR. IV- 
<,E. VIII.-SP. II.]      NERVOUS  FUNCTION.                J0J

  All the divisions of the nervous system, moreover, have a natural
tendency to sympathize in the same  action,  however  combined or
interchanging;  and hence in whatever division  of it  a  disease
commences, one or more of the other divisions are peculiarly apt
to participate in the  affection :  and  the more so as it is not very
common for abnormal actions, when once communicated, to proceed
with much order or regularity;  for  if trismus and tremor  give us
examples of such order,  tetanus very generally,  convulsion-fit,
epilepsy,  and hysteria furnish proofs of the most  capricious alter-
nations of spastic and  clonic action, or of their existing in different
trains of muscles simultaneously.
   These  remarks peculiarly apply to ecstasy,  the species imme-
diately before us, compared  with catalepsy or trance, the  species
that immediately follows.  In both, the nervous fluids contributory
to sensibility and  irritability are disturbed in their flow or regularity
of action, but not equally, nor in the same  manner:  for while the
flow of the  former seems to be totally suspended, that of the latter
continues, though with a striking deviation from the uniform tenour
of health.  1 hus far  the two diseases  agree.   They differ in the
nature of the disturbance of the motific  fluid.  In ecstasy,  this
seems to be secreted in excess  and  irregularly  accumulated ;
in consequence of which the muscles are thrown  into a rigid  and
permanent spasm, not incurvating the  body,  as  in  the different
modifications of tetanus, but maintaining it erect from an equal
excess of supply  to the extensor and flexor  muscles.  In catalepsy,
on the contrary, the motific fluid seems to be secreted in deficiency
rather than in excess, though it  is   often  irregularly distributed;
and  hence,  while some muscles appear sufficiently  supplied, the
action of others, and even the involuntary ones is often  peculiarly
weak.  Whence  also, the limbs, instead of resisting external force,
yield to it with readiness, and assume any position that may be given
to them.
   In  both cases  the  torpitude of the external senses, appears to
extend to those of the mind; for the patient, on returning to him-
self, has no recollection of any train  of ideas that occurred to  him
during the fit.  Yet, we shall find presently  that, in a few instances,
the power of sight and of judging, and perhaps some other powers,
do not seem completely to have  failed.
   It deserves, however, to be specially remarked, that both these
diseases are  most common to persons  constitutionally disposed to
some mental estrangement, as melancholy or revery, hypochondrism,
or morbid elevation of mind ; thus pointing out to us the outlet at
which the sensorial power is often carried off: for we have already
seen that under intense revery the external senses  are, for the most
part,  inactive or  torpid to  the  impressions  of surrounding objects
during wakefulness: while the mind is alike dead to every thing
but the train of ideas which immediately constitute the subject of
the revery.   The same tendency to abstraction, though not carried
so completely into effect, is often to  be found  in  melancholy,  and 
384
NEUROTICA.
[CL. IV.-OR. IV.
still more so in that species  of alusia which, in the present work,
is denominated elatio, mental elevation or extravagance, and parti-
cularly the variety called elatio  ecstatica, false inspiration,  vision-
ary conceits.  If the person labouring under any of these be  attack-
ed at the same time with a general entasia, or rigid tetanus, erecting
instead of incurvating the body,  he will be thrown into an ecstacy,
constituting the  present  species.   And if, instead  of an excessive
there be a deficient supply of irritable power, and consequently a
flaccidity  or flexibility  of the muscles instead of a  rigidity, his
disease will  be  a catalepsy,  constituting the ensuing species,  with
this difference alone, that in  most cases of the two diseases  before
us, the faculties of the mind unite in the torpitude  of the  senses,
instead of giving rise to it.
   I say, in most cases, and have kept to the same  limitation in the
specific definition :  for if it  be true that  one of the causes of both
these affections  is profound contemplation or attention of mind, or
some overwhelming passion, as  we  are told by many writers, the
mind does not seem, in 6uch  cases, to be without ideas, nor without
them in a very energetic degree.  And it is to ecstasis under this
modification that 1 am inclined to think we should refer the catochus
of most of the nosologists, which they arrange in the same order as,
and next to  tetanus, and define a " general spastic rigidity without
sensibility."
   Ecstasis is of rare occurrence, its predisponent cause is unques-
tionably a highly nervous or irritable temperament: the exciting or
occasional causes it is not easy, at all times, to  determine. For the
greater part they seem to be of a mental character, as profound and
long continued meditation upon subjects of great interest and  excite-
ment ; and terror or other .violent emotions of the  mind.  It seems
also to have  proceeded, like most of the spasmodic affections already
treated of, from  various corporeal irritations, and particularly those
of the  stomach,  suppressed  menstruation,  repelled  chronic erup-
tions, and plethora.  The duration  of the  fit  varies,  from a  few
hours to two or three  days.   The  patient rouses  as from a sleep,
seems  languid, and  complains of nausea and  vertigo  :—evidently
showing that the morbid  supply of sensorial power is exhausted,
and that the spasm  has ceased in consequence of such exhaustion.
   As the disease evidently consists in a disturbance of the balance of
the sensorial power, or in an excessive secretion of irritable, but a
deficient or suspended secretion of sensific fluid, the curative inten-
tion should lead us to aim at a restoration of this balance : and hence
the remedial process will run so nearly parallel with that for  tetanus
that it is only necessary  to refer the reader to the treatment already
laid down for that disease. 
 GE. VIII.-SP. III.]     NERVOUS FUNCTION. .                3o.r)


                         SPECIES  III.

                 CARUS  CATALEPSIA.

                     <£atalrjjsg.  France.

 TOTAL SUSPENSION OF  SENSIBILITY AND VOLUNTARY MOTION J  MOSTLY OF
    MENTAL POWER ; PULSATION AND  BREATHING  CONTINUING ;  MUSCLFS
    FLEXIBLE : EODY YIELDING TO, AND RETAINING ANY  GIVEN  POSITION.

 This  species is  chiefly  distinguished  from the preceding by the
 flexibility instead of inflexibility of the muscles.  The cause of this
 difference has been  explained under the preceding species, and
 needs not be repeated in the present place.  The  specific  term
 common to the  Greek  writers is derived from xxrxXxfjtZxioftxi,
 " deprehendor"  " to  be seized or laid hold of" and  alludes to the
 suddenness of its  attack.
    The predisponent  and  exciting causes  are the same as those of
 ecstasis: and the state of the habit or idiosyncrasy alone produces
 the difference  of effect.   The countenance is commonly  florid,
 and the eyes open, and apparently fixed intently upon an object, but
 in  most  cases  without  perception.  Yet here, as in ecstasis, we
 sometimes meet with examples in which one or more of the senses,
 mental as well as corporeal,  do  not associate in the  general torpi-
 tude.  So, in paroniria, the sight or hearing continues  awake, while
 the other external senses are plunged into a  deep  sleep, and in
 some cases of paralysis, the sentient fibres retain their activity while
 those of motion are torpid.
   The paroxysm commonly attacks without any previous warning,
 and closes with sighing or a clonic effort of the nervous power to
 re-establish its  regular flow.   Its duration is from a few hours, or
 minutes, to  two or three  days; and, according to  weli established
 authorities, sometimes for a much longer period.  And so complete-
 ly exhausted of irritable power are some of the organ*, and even
 those of  involuntary action, that we have one example in a foreign
journal of forty grains of  emetic tartar having been given without
 any effect.*
  The disease, like the last, i.* not common.  Dr. Cullen affirms
 that he never saw an instance of it, except where it wa« altogether
counterfeited, and  asserts  the same of  other practitioners:  which
in fact, he offers as an apology for  not knowing exactly  where to
arrange it.  « Therefore," says he, " from the disease being seldom
difterently described, and  almost always feigned, 1 can  scarcely tell
where to place it with certainty :  but I am well persuaded that it
does not at all differ from the genus  apoplexy, and I have hence

          * Behrends, Baldingers, N. Magazine. B. ix. 190.
  trOL.  m.                  40, 
38G
NEUROTICA.
[CL. IV.—OR. IV/
 arranged it as a species of this division."   Plethora or  pressure of
 the brain may, perhaps, be an occasional cause of this, as of most
 other nervous diseases,  in some habits; but the greater number of
 cases that have occurred show  very clearly that this disease, in its
 genuine form, is as distinct from apoplexy as from epilepsy.
   We have said that both catalepsy and ecstacy are  most frequent-
 ly found in  constitutions disposed  to  mental  estrangements.   Dr.
 Gooch has given a very interesting case  in illustration of this re-
 mark in his paper on puerperal insanity published in the  Medical
 Transactions.  The patient was twenty-nine years of age, had been
 often pregnant, but had only borne one living child;  and was now
 confined after  delivery of a dead  child in her  seventh  month of
 gestation.  " A few days after our first visit," says Dr. Gooch, " we
 were summoned to  observe a remarkable change in her symptoms.
 The attendants  said she  was dying or in a trance.  She was lying
 in bed motionless, and apparently senseless.  It had been said that
 the pupils were dilated  and motionless, and some apprehensions of
 effusion on the brain had been  entertained. But, on coming to ex-
 amine them closely, it was found that they readily contracted when
 the light fell  upon them;  her eyes  were open,  but no rising of the
 che?t,  no movement of the  nostrils, no  appearance of respiration
 could be seen ; the only signs of life were her  warmth and pulse;
 the latter was,  as we  had hitherto observed it, weak, and  about
 120; her feces and urine were voided in bed.
  " The trunk of the body was now lifted so as to form rather an
 obtuse angle with the limbs (a most  uncomfortable posture,) and
 there left with nothing  to support it.  Thus she continued sitting
 while  we  were asking questions  and conversing,  so  that  many
 minutes must have passed.
  " One arm  was now raised, then the other, and where they were
 left,  there they remained; it was now a curious sight to see her,
 sitting up in  bed, her  eyes open,  staring  lifelessly, her arms out-
 stretched, yet without any visible sign of animation; she was very
 thin and pallid, and looked like  a corpse that had been propped up,
 and had stiffened in this  attitude.   We now took her out of bed,
placed her upright, and  endeavoured to rouse her by calling loudly
 in her ears, but in vain;  she stood  up,  but as inanimate as a statue;
 the plightcst push put her off her balance; no exertion was made to
 regain it; she would have fallen if I had not caught her.
  bhe  went into this state  three several times, the first time it lasted
 fourteen hour-, the second time twelve hours,  and the third time
 nine  hour?, with waking intervals of two days after  the first fit, and
 one day after  the  second  After  this,  the disease resumed  the
 ordinary form of melancholia,  and three  months from the time of
 her delivery, she was well enough  to resume her domestic duties."
  From the rarity of the complaint and the singularity of many of
its symptoms, many  physicians who  have never  witnessed an exam-
ple of it,  are too much  disposed,  like  Dr. Cullen, to  regard it in
every case  as an imposture.  The instance just given is sufficient 
CE. Vin.-SP. III.]        NERVOUS  FUNCTION.             J<>'

to clear it from this charge ;  yet the following from Bonet is added
in confirmation.  George Grokatski, a Polish soldier, deserted from
his regiment in the  harvest of  the year 1677.  He was discovered
a few days afterwards, drinking and making merry in a common ale-
house.  The moment he was apprehended he was so much terrifi-
ed that he gave a loud shriek and was immediately deprived of the
power of speech.   When  brought to a court-martial, it was impos-
sible to make  him  articulate a word:  he was  as immoveable as a
statue, and appeared not to be conscious of any thing that was going
forward.   In the prison  to which he was conducted, he neither ate
nor drank, nor emptied the bowels or the bladder.  The officers
and the priest at first threatened him, but afterwards endeavoured
to soothe and calm him ; but all their efforts were in vain.   He re-
mained senseless  and immoveable.   His irons were struck off,  and
he was tpken out of the  prison, but he did not move.  Twenty days
and nights were passed  in this way, during which he took no kind
of nourishment, nor had any natural evacuation.  He then gradually
sunk and died.*
  The pliability of the muscles to any stimulus that acts upon them
is sufficiently  evident from both these  cases:  but it  has not been
generally observed by pathologists, that the force of  the  stimulus
which is acting upon them at the time of the attack continues after-
wards, so that the same state of motion or  rest is still  maintained.
In the case of a school-boy aged eleven years, related by Mr. Stearns
in the American Medical Register,! the  paroxysms returned ten
times in  twenty-four  hours, and never  exceeded  three minutes at
a time.   And if it commenced  while the patient was  walking, the
same pace was maintained, though without the direction of the mind.
The present author was consulted a few years ago on a similar case
by a student of Gray's  Inn, about nineteen years of age.  Having
been attacked with  a fit of catalepsy while  walking,  within a few
minutes  after having left his  chambers, he continued  his pace in-
sensibly, and without the slightest knowledge of the course he took.
As  far as he could judge, the paroxysm  continued  for  nearly an
hour, through the whole of which time his  involuntary walking
continued ; at the end of this  period  he began a little to recover
his recollection  and the general use of his external senses.  He
then found himself in a large street, but did not know  how he got
there, nor what was its name. .Upon  inquiry he  learned that he
was  at the further end of Piccadilly  near Hyde Park corner,  to
which, when he left his chambers, he  had no intention of going.
He was extremely frightened,  very much exhausted and  returned
home in a coach.   He was not conscious of  any particular train  of
ideas that had passed in his mind during the fit; but if such there
had been, there can be little doubt that, like the visions of a dream
the recollection of them would have been  completely banished by
* Medic. Septentrion. Lib. i. Sert. xvi. Cap. 6,
+ Vol. I. Art. viit. 
3/38                     NEUROTICA.           [CL. IV.-OR. IV.

the terror he felt on first  recovering his recollection  and finding
himself in a strange place, to which he had been irregularly wander-
ing through a great number of streets without  consciousness.  He
had several slighter attacks antecedently, shorter in duration, and,
from his being at rest at the time, unaccompanied with a tendency
to perambulate.
   In this case, and in all of a similar kind, from  the power  which
the patient seems to possess of avoiding danger, the faculty of the
will and of sight, must be in some degree  of activity, however ob-
tunded:  bearing a near resemblance to paroniria ambulans, or  sleep-
walking, with the exeption of the suddenness of the attack.   Some
pathologists,  indeed, have noticed a modification in  which  the
powers of deglutition and  digestion continue, as well  as those of
pulsation and breathing, provided the food be thrust into the mouth.
If we were right in ascribing the catochus of the ancients to that
form of ecstacy in which the mind retains some  train of ideas, we
shall probably  be right also in referring  their catoche to this modi-
fication  of catalepsy;  though Galen seems to  have regarded the
term as a mere synonym of catalepsy, and iEtius adopted his opi-
nion.
   Instead, however, of most of the involuntary organs being in a
joint state of activity, instances  have occasionally occurred of an
apparent cessation of activity in all of them, from the scanty as well
as irregular  flow of the sensorial current.  A critical  examination
of the region of the heart, will mostly, indeed, give proof of  a very
feeble flutter,  and if a clear mirror be  applied to the mouth and
nostrils it will  generally be found to have a thin vapour on its face.
But even these signs have not always been  given : insomuch  that
the disease  has  been  mistaken for real  death: and,  in  countries
where the rite of sepulture takes place speedily, it is  much to be
feared that the unfortunate sufferer  has,  in  a  few instances, been
buried alive.*   In a case of asphyxy of a singular kind, related by
31. Pew, the patient, a female, was peculiarly  fortunate in having
had her interment postponed  for the purpose  of ascertaining the
cause of her supposed death by dissection : for  on being  submitted
to the scalpel, its first touch brought her to her senses, and threw
her into a state of violent agitation, the  anatomists being almost as
much frightened as herself.!  So Diemerbroeck relates the case of
a rustic, who was supposed to be dead of the plague, and  was laid
 nut for interment.   It was by accident three days before he could
 be carried to the grave, when, in the act of being buried, he show-
ed signs of life,  recovered, and lived many years.J  Mathaeus, Hil-
danus, and the collectors of medical curiosities are full of stories of
  * Pincau, Sut le danger des Inhumations preciptees.  Paris, 1776.
  t Practique des Accouchemens, &c.
    Tozzett's Raccolta de Teorie, Osservationi e Regole per distingucre e prompte
mente dissipare le Asphyssie, a Morte apparente.  Fiorer.za.  8vo. 1772.
  X Tractat de Peste. Lib. iv. Hist. S5. 
GE. VIII.-SP. III.] *     NERVOUS FUNCTION.                 389

this kind: many of them, indeed, loosely related; but  many  also
possessing every requisite authority for belief:  and urging the ne-
cessity of waiting for signs of putrefaction before the lid of^the cof-
fin is screwed down, or, 1 should rather say, before the body is re-
moved from its death-bed.                       .
  We have  already  observed, that the predisposing  and exciting
causes are the same as those of estacy, and that the state  oTthe
habit or idiosyncrasy alone produces  the difference of effect.   ihis
distinction has not been sufficiently attended to by pathologists  in
their mode  of treatment: and hence one common plan has been too
generally laid down and pursued in ecstacy, catalepsy, lethargy, and
even apoplexy, the general treatment being as much confounded as
the diseases themselves.
   Commonly speaking, copious bleedings and purgings  have  been
chiefly trusted to in all of them : and as the present disease, in some
cases, arises from plethora, or obstruction or some irritation of the
stomach, it  is not to be wondered at that  this process should some-
times succeed here also.  But, if we have been correct in our pa-
thology, if catalepsy be not only a nervous disease, but a disease of
nervous debility, in which  the sensorial power flows with enfeebled
and clonic irregularity, and consequently  with  a  necessary distur-
bance  of the balance of the nervous system, it is perfectly  clear,
that a reducent treatment, however serviceable in a few cases, can-
not be laid down as the proper plan to be pursued in general, nor
even in any case as an adviseable practice, further than it may  be
Called for by the contingency of the exciting cause.  Stimulants of
most kinds will  usually be  found far more serviceable,  particularly
in the form of blisters to the head and heart, sinapisms and  other
rubefacients to the  extremities, and injections to the rectum.
   It is  now well known that the simplest substances,  as a solution
of gum arabic, or merely warm-water infused, to the  amount of not
more than an ounce or two, into the current of the blood by  open-
ing a vein,  will not only excite the heart to a more violent action,
but affect the stomach  and intestinal canal with  a  like  increased
action by sympathy, producing sickness in the former, and looseness
in the latter: and hence, Dr. Regnaudot, in an ingenious inaugural
dissertation, has thrown out a hint well worthy of being followed
up, that such a stimulus may probably  succeed  in  rousing the sys-
tem generally in the present and most of the preceding species.
   Electricity or voltaism, in the manner  already  recommended,
may also be tried with a hope of success;  and if it be possible to
introduce any thing into the stomach by  means of a canula, brandy.
ether, ammonia, camphor,  or even phosphorus, in the form and dose
already recommended, may be attempted in rotation.   The body in
the mean-while  should be kept warm, with a free influx of pure air,
and general and persevering friction should often be  had recourse
to.  A steady use of the metallic tonics should be chiefly confided
in after the paroxysm is over 
390
NEUROTICA.
[CL. IV.-OR. IV.
                        SPECIES IV.

                 CARUS  LETHARGUS.

                          Sctharfig.

     mental and corporeal  torpitude  with Deep quiet sleep.

 Lethargv, from the Greek terms Mfa and «gyoj, " oblivio pigra," is
 distinguished from all the preceding species of the  present  genus,
 by the apparent ease and quietism of the entire  system;  the limbs
 retaining that gentle and placid flexion which they are  wont to ex-
 hibit in natural sleep, and the eye-lids  being  consequently closed :
 by both which signs  it is also distinguished from apoplexy.
   Lethargy is sometimes produced by congestion or effusion in the
 brain,  by violent  mental  commotion,  as that of fright or furious
 anger;  by retrocedent gout, or repelled exanthems; but more ge-
 nerally  by long-continued labour of body, or severe  exertion of
 mind.
   The common causes of sleep, therefore, whether natural or mor-
 bid, are in many cases causes of lethargy.  The proximate  cause,
 however, of idiopathic lethargy does not seem to have been suffi-
 ciently pointed out, and  on this account it is that it has too frequent-
 ly, like  the preceding species, been confounded with apoplexy, and
 regarded as a mere modification of it.
   We had occasion to take  a glance at the general physiology  of
 sleep, under the genus ephialtes,  or night-mare, and observed that
 its proximate cause is to be sought for in a torpitude or exhaustion
 of sensorial power from  the  ordinary stimulants of  the  day.   Now
 it is possible that the same effect may be  produced by  a  defective
 supply of sensorial power as well  as by its exhaution ; and  conse-
 quently  that the torpitude of sleep may ensue whenever such defi-
 cient action or energy exists, even where there is  no  exposure  to
 its ordinary exciting  causes.   And this  it  is,  as it appears to  me,
 which constitutes the real difference between genuine lethargy and
 sound healthy  sleep : in which sense the former hecomes a strictly
 nervous affection dependent upon a weak  and irregular action of the
 sensorial organ, accompanied with a diminished secretion of senso-
 rial power," and this  power,  so diminished, irregularly distributed
 over its different  departments  or ramifications, being altogether
 withheld from the  external senses and the voluntary organs,  while
 the current to the involuntary organs is little interfered with, as in
 the case of common sleep.  The faculties of the  mind seem also in
most cases to  partake  of the  torpitude of the external senses :
though as the whole  is a disease  of debility, and consequently  of
irregular action, we can readily account for a few  singular cases 
c;e. viii.-sp. iv.]     nervous  function.                 391

that have been met with, in which the lethargy has been broken in
upon by short returns of sensation, or even of speech, or by an irre-
gular flow of ideas, which the patient is sometimes apt to mistake for
sensations.   And hence, lethargy has been observed  under  the  fol-
lowing varieties:

x Absolutus.                      Without intervals of sensation,
  Genuine Lethargy.                waking or consciousness.
£ Cataphora.                      With short remissions or inter-
  Remissive Lethargy.              vals of imperfect waking, sen-
                                    sation and speech.
y Vigil.                          Perfect  lethargy of body, but
  Imperfect Lethargy.               imperfect lethargy of  mind;
                                    wandering ideas, and belief of
                                    wakefulness during sleep.

  The  first variety has, in some instances, been considerably pro-
tracted.  We have examples of its continuance for forty days,* and
even for seven weeks.!  In one instance it is said to have  resulted
from insolation, or exposure to  the direct  rays  of the sun; and at
length,  with great singularity,  to have yielded to a large flow of
urine loaded with pus that fell to  the  bottom.\   In this case, the
cause must have been congestion, and the inflammation have passed
off by a secretion of pus, probably without any abscess whatever.
  The  second  variety, or cataphora,  is the coma somnolentum of
many writers :  and is also a frequent accompaniment of many fevers
and other diseases of great debility.   It occurs at  times, however,
as an idiopathic affection;  and  I  was  some years  ago acquainted
with a very singular example, that continued for five years.   The
patient  was a young lady of delicate constitution, in her eighteenth
year at the time of the attack: her mind  had been previously in a
state of great anxiety : the remissions recurred irregularly  twice or
three times a week, and rarely exceeded  an  hour or two : during
these periods she sighed, ate reluctantly what was  offered  to her,
had occasional  egestions,  and instantly relapsed  into  sleep.  Her
recovery was sudden, for she seemed to awake  as from a night's
rest, by a more perfect termination of the paroxysm, not followed
by a relapse.
  A  less fortunate case of the same kind is  related  by  Mr. Brews-
ter, in the Edinburgh Philosophical Transactions, and was connect-
ed with depressed animal spirits,  and probably congestion  or ple-
thora.   The patient was a female servant about the  middle of life.
The first paroxysm was preceded by a hemorrhage from the nose.
and lasted three days;  the next continued  six weeks ; during which
she occasionally swallowed food and  had alvine  evacuations.  She

      ■' Plott, Natural Hist, of Staffordshire.
     t Bang, Collect. Sot. Med. Havn. ii. 17.
     X Morgagni, de S.d. et Caus. Morb. Ep. v. 13, 14. Albertino. 
392
NEUROTICA.
[CL. IV.-OR. IV.
had two subsequent fits, neither of which  lasted above a few days.
 Not long afterwards she hung herself.*
  The  THIRD VARIETY, Or IMPERFECT LETHARGY, is the TYPHOMANIA of
the Greek writers;  the  coma vigil of many later pathologists.  It
is a frequent sequel  upon fevers, or other causes of great nervous
debility, in circumstances on which  the sensorial power has not
recovered its regularity of current, or stability of balance : during
which the patient uniformly assures his physician and his friends,
from morning to morning, that he has passed a restless and hurried
night, without a moment's sleep, while the nurse has been  a witness
to his having been asleep the whole night long.
  The  mode of treatment must depend upon the nature of the cause,
as far as we are able to ascertain it.   If this have consisted in any
suppressed discharge or eruption, we  should endeavour  to repro-
duce it  by all possible means.  If we  have reason to  suspect com-
pression on the brain, copious bleedings, purgatives,  and  other
reducents are imperative.  And  if, as  is more commonly the case,
it be  a strictly nervous affection, and  depend on atony and a  dis-
turbed secretion or balance of the sensorial power, the warm nervine
irritants, as musk, camphor, valerian, with blisters,  sternutatories,
and oth >r stimulants  are the means we  should have recourse to.
  These different  processes have  been pursued in most ages,  but
unfortuuately they  have been pursued indiscriminately; and bleed-
ing, purgatives, and ethers and other diffusible excitants have been
employed on like  occasions,  or  even at  the same time.   Forestus
and Dr. Cheyne, who regarded lethargy as chiefly dependent upon
plethora or congestion,  seem  uniformly  to  have adhered to a
reducent plan : and Celsus who contemplated it as a nervous affec-
tion, equally confines himself to external and internal pungents, and
advises  pepper, euphorbium, castor, and vinegar, with the fumes of
burning galbanum or hartshorn applied  to  the  nostrils:  as also
shaving the head, fomenting it with a decoction of laurel leaves, or
rue, and afterwards  applying sinapisms or some other rubefacient
epithem.
  All  these are consistent with themselves how much soever they
may differ in their view of the proximate cause.  Yet both lines of
conduct cannot be right as a general practice ; and hence, it is that
other practitioners  have incongruously intermixed the  two,  and
consequently have sometimes done less mischief, as at other  times
they have done less good.
  That genuine lethargy is, not unfrequently, a strictly nervous
affection, and even closely connected with an irregular or debilitated
state of the mind ;  and that a reducent plan is not always calculated
to afford it radical relief, however it may give a temporary  promise,
must,  1 apprehend, be obvious to most practitioners who have paid
a due attention to their own circle  of cases ;  but  the  following
example from Dr. Cooke, bearing a close resemblance in its termi-
* Edin. Phil. Trans. 1817, 
GE. VIII.-SP. IV.]        NERVOUS  FUNCTION.
393
nation to that already quoted from Mr. Brewster, is  peculiarly in
point, and ought not to be omitted on the present occasion : " A
lady about twenty years of age, who had usually enjoyed very good
health, was one  morning found in a state of profound but quiet sleep,
from which she  could'not be awakened, although the preceding eve-
ning she had gone to bed apparently quite well.   Various means had
been tried with a view of exciting her from this state, but in vain. Un-
der these circumstances I recommended cupping in the neck; and
after she  had lost a  few ounces of  blood in this way, she  opened
her eyes perfectly recovered, and  remained through the day, quite
free  from all symptoms of disorder.   The  next morning,  and for
several successive mornings, she was found in a similar state, from
which she  was recovered by  the  same  remedy, no stimulating
external  applications producing  any good  effect.   As she was
considerably weakened by repeated depletions, it was determined
that, on the next recurrence of the paroxysm, the case should be
left  to the effects of nature as long as was consistent with safety.
The  experiment was tried;  and at the end of about thirty hours
she  spontaneously awoke,  apparently refreshed, and wholly uncon-
scious of her protracted  sleep.  On the future returns of these
paroxysms,  which were frequent,  the same plan was adopted, and
she  awoke  after intervals of thirty-six,  forty-eight,  and,  on one
occasion,  sixty-three hours, without seeming to have suffered from
want of food, or otherwise.   In the early part of the disease, various
means were employed without the smallest advantage, except that
while under  the influence of  mercury,  Which  produced  a very
severe salivation that lasted more than a month, she was free from
the complaint.   For a considerable length of time these paroxysms
recurred: but at length they gradually left her; and soon  after-
wards she became deranged  in  mind, in which  state I believe she
still remains.*
  When,  therefore,  there are no symptoms  leading  to a peculiar
cause, it will be advisable to bleed by cupping, once or twice, but
not oftener, to open the bowels and keep them in a state of slight irri-
tation ; to employ blisters or other external stimulants occasionally,
and to have recourse  to a repeated use of the voltaic trough,  sending
the line of action from the occiput down  the spine, and varying it
to the extremities,   in the mean time, if the patient can be made
to swallow, we should try the effect of musk, or camphor, with free
doses of the metallic tonics, of which the sulphate of" zinc, in doses
of a grain,  three or four times  a-day offers  the best  prospect  of
success.
      * Treatise on Nervous Diseases, Vol. i. p. TO
vol.  m.                  SO 
394                     SEUROTICA.            [CL. IV.-OR. IV^


                         SPECIES  V.

                  CARUS APOPLEXIA.



4ENTAL AND CORPOREAL TORPITUDE WITH PULSATION AND  OPPRESSIVE,
                    MOSTLY STERTOKOUS, SLEEP.

There is a considerable difference  of opinion  among  pathologists
whether stertor is a necessary and invariable, or only an occasional
sign of apoplexy.  Sauvages,  Linneus,  Vogel, Sagar, Forestus,*
Kirkland,! Young, and  by far the greater number of writers have
arranged it as an essential symptom ; and, hence, the present author
was induced to view it  in the same light  when he published his
volume of Nosology.  He has since, however, met with one or two
cases of atonic apoplexy,  in  which, although  the  disease  proved
fatal, the breathing  was  at no  time noisy or stertorous,  though
uniformly laborious or oppressive :  and  he has  hence been induced
to modify the specific character in the manner it stands at the head
of the present division : and  thus to approximate  it to the opinion
of  Forestus, Cullen,  and Portal, who do not  regard  stertor as  a
necessary index.   Dr.  Cullen is generally conceived to have omitted
this peculiar mark, in  consequence of his having included asphyxy
and catalepsy tinder the genus afoplexia, which have no pretensions
to stertor.   But, as we shall have  to return to this subject when
discussing the  different forms or varieties  under which  apoplexy
shows itself, I shall only further observe at present, that Dr. Cooke
has, with  great judgment, steered  a  middie course in  laying down
his own definition, which characterizes apoplexy as " a disease in
which the  animal functions are suspended, while the vital  and natu-
ral  functions continue ; respiration  being generally laborious  and
frequently attended with stertor "J
   Apoplexy is  strictly a disease of the nervous system, dependent
upon a suspension of the sensorial power in almost all  its modifica-
tions, sentient, percipient, and motory, with the exception of a cer-
tain portion which still continues to be  supplied to the involuntary
organs, the  faculties of the mind participating  in the  torpitude of
the body.   In these  respects it  bears a very near approach to the
preceding species of carus;  it chiefly differs in its being  generally
connected with an oppressed state of the vessels o  the brain from
overdistension  or  effusion :  so generally, indeed, that  apoplexy is,
by almost all the writers on the subject, regarded rather as a dis-
ease of the  sanguineous  than of the nervous  system;  the  morbid
* Lib. x. Obs. 73.
t Comment, p. 16.
X On Nervous Diseases, Vol. r. p. 166. 
GE. VIII.-SP. V.]     NERVOUS FUNCTION.                 395

action of the latter being supposed to be entirely dependent on that
of the former, and, consequently, only a secondary affection.
  This view of the subject, however, is by  far too limited: for
although in most cases the more prominent symptoms  concur with
the appearances on dissection in  leading us to compression of the
brain  as the primary cause of the  disease, yet  we shall find pre-
sently that  it has  sometimes taken place where no such compres-
sion seems to have existed,  whilst we have already had occasion to
notice a variety of affections of the bead attended with forcible and
severe compression, as inflammation and dropsy of the brain, that
have run  their  entire course  without any mark of  apoplexy what-
ever- to  which should  be added that, while in most other diseases
or lesions accompanied with compression of the brain, and a suspen-
sion of sentient and motory power as a consequence hereof, such
suspension ceases  almost the moment the compression is removed,
when the nerves of feeling and motion, together with the  faculties
of the mind, resume their wonted activity, and evince no tendency
to a  relapse ; in  apoplexy, on the  contrary,  the  result is always
doubtful;  for a palsy of some part or other is a frequent and perma-
nent eflect, or the mind suffers in some of its faculties, and a relapse
is generally to be  apprehended.  So that though compression of the
brain, and particularly from a morbid state  of the sanguineous and
respiratory functions,  may  be justly regarded  as the ordinary effi-
cient  cause, there seems to be  at the  same time some  peculiar
dibility or other diseased condition of the sensorial system to  which
apoplexy is  primarily to be referred, and without which  it might
not  take place; and which  has not been sufficiently adverted to by
practitioners.  Though  there can be no difficulty in our affirming
that  wherever  such a morbid  condition exists,  compression, from
whatever cause, will be  sure to produce the disease.
   We may hence  see why advancing age should prove a predispos-
ing  cause ;  and account for the  statement of Morgagni, who tells
that, of thirty cases of apoplectic patients that fell within the reach
of his observation, seventeen were above the age of sixty,  and only
five below that of forty.   Hippocrates, on a more general estimate,
calculated that apoplexies are chiefly {pxXurrx) produced  between
the  fortieth and sixtieth year.*  This, indeed, is somewhat earlier
than we should expect on  the ground of  advancing age; but when
we take into consideration thatit is the precise period in which the
mind is most agitated  and exhausted with the  violent and  contend-
ing passions of interest, and ambition, and worldly honours, and the
blood most  frequently determined  to  the head by this  impulse of
sudden and  irresistible emotions, we shall, perhaps, readily accede
to the Hippocratic aphorism as a general rule.
   How far apoplexy is  occasionally the result of an hereditary in-
fluence on the frame it is  not easy to ascertain.  Forestus, Portal
and  VVepffer refer to decided  instances of such facts within then
« Aph. Sect. vi. 57. 
396
NEUROTICA.
[CL. IV.-OR. IV.
own knowledge; the first, indeed, relates  the history of a father
and his three sons, all of whom died  in succes-ion of  this disease ;
but as the chronology drops with the second generation, it does not
descend quite far enough for the purpose.  There is great reason,
however, for believing that an hereditary tendency does sometimes
show itself;  and, as  this exists without external  or  manifest signs,
it is probably seated in the. sensorial system, and constitutes another
of the morbid conditions of this system, to which we have referred
above, as often giving effect to subordinate causes.
  There is no difficulty in conceiving how heat may become a pre-
disponent cause, since nothing tends more effectually  to quicken the
action of the  heart, drive the blood forcibly into the ascending trunk
of the aorta, and, consequently, overload the vessels of the brain.
Buf cold is said to be a  predisponent cause  as well, and  one that
operates quite as extensively, while the reason of this has not been
at all  times very clearly explained.   Now  as a hot temperature
acts chiefly upon the sanguiferous system, extreme cold acts chiefly
upon the sensorial,  benumbs  the feeling,  weakens  the  muscular
fibres,  diminishes the sensorial secretion,  and consequently induces,
as we have already seen under one of the varieties of asphyxy, an
unconquerable propensity to sleep.  And hence again, in apoplexies
produced by severe  cold, the primary or predisponent cause is  to
be  sought for in a  debilitated  state of the  nervous  system,  f he
Greek physicians are  perpetually  alluding to  this cause  as one  of
great frequency, and the explanation now given, does not essentially
vary from that offered by Galen.*. If, indeed, the cold be  exquisite-
ly intense, carus Asphyxia is more likely to be produced than carus
Apoplexia;  for  we  have already  observed under  the  preceding
species that  the  very same cause  which, operating  in a  vehement
degree,  excites the former, operating less  powerfully has often a
tendency to excite the latter.
   The other predisponent causes, so  far  as they  have been traced
out, are more obvious to  the senses,  and, for the most part, more
directly referable to the state of the sanguineous function ; as ple-
thora,  corpulency, and grossness of habit, a short thick neck, and an
inordinate indulgence in wines and heavy fermented liquors.   Dr.
Cheyne, indeed, believes the last to be  so common a cause as even
to produce the disease when employed  without  any inordinate in-
dulgence whatever : " the daily use," says he,  " of  wine  or spirits
will lead  a man of a certain age and constitution to apoplexy,  as
certainly as  habitual  intoxication."!  This may be  true as  here
limited, but then the limitation  must be attended  to ;  in which case
we are only  told in other words, that  wherever such a kind of sen-
sorial  debility  exists as that which we  have already adverted to,
the  result of age, or habit, or constitution, one man will be as readi-
ly led to apoplexy under a moderate  use of wiae, as  another  man
* De I,oc. Aff. Lih. in. cap. vi.
"  Cheyne, p. 1-H. 
GE. VHI.-SP. V.]      NERVOUS  FUNCTION.                 397

destitute of such predisposition will be under a state of habitual in-
toxication.  Under this  explanation,  however,  a moderate  use of
wine becomes only an accessory,  and not a primary cause.
   How far there may he any other effisient or exciting causes of
apoplexy than  compression of some kind or other, it  is difficult to
determine, though various cases  on record should induce us to sup-
pose there are.  Hydatids,  humours of almost  every consistency,
gelatinous, steatomatou?, and bony, pus and polypous  caruncles and
indurations of the membranes, have, in various  cases,  been discov-
ered on dissection, and are generally supposed  to operate by com-
pression, in the same manner as an accumulation of blood or serum.
But in  many instances  these appearances  seem  to have been  too
minute for  any such effect; and, if causes of any kind, can only
fairly be regarded as  concomitants or  allied powers—as local irri-
tants, stimulating  and exhausting the sensorium,  and preparing it for
attacks of apoplexy against the accession of some superinduced and
occasional cause.  Though where there exists already  a  strong
predisposition to the disease from hereditary or any other affection,
it is not improbable that such local irritants may alone be sufficient
to perfect the complaint.  And we may hence account for that form
of apoplexy which is said to proceed from intestinal worms, or some
other acrimony  of the stomach, or from teething; and which, con-
sequently, occurs  at an early instead of at  a late period of life, and
has  been specially denominated apoplexia infantum.   Other organs,
however, besides the teeth and the stomach, seem not unfrequently
to have given occasion to apoplectic attacks from irritation, disten-
sion, or organic lesion.   Thus, according to M. Portal, superinduc-
ing  tumours and  congestions have been found  in the neck,  in  the
breast,  or in the abdomen ;  ossifications in  the  thoracic and ventral
aorta, as well as in the arteries of the upper and lower extremities.
in the superior vena cava, and in the  right ventricle  and valves of
the  heart which has also indicated various other changes."*
   Most of these morbid actions and appearances, however,  are as
common to various other affections of the sensorial  system  as to
apoplexy.  We have already noticed them in lethargy, convulsion,
epilepsy, various  species of cephahxa, and some forms of insanity:
and, hence, wherever they become causes  at all, it is most probable
that the disease they immediately produce, is regulated by the pre-
disposition of the individual to one rather than to any other of  the
above sensorial  affections, resulting from family taint, idiosyncrasy,
habit, or period of life : and, consequently, that the  same exciting
or occasional cause, which, in one person, would produce apoplexy.
in a second, would form  epilepsy, in a third,  convulsion, and in a
fourth,  madness.
   It is highly singular that  this view of the subject should scarcely
ever have been attended to by physicians  ; and that, whilst all  the
writers  have  pretended to  regard apoplexy as a disorder of  the
* Portal, ch. Requitals dc fovcrturc de? Corp?, p. 320. 
398
NEUROTICA.
[CL. IY.-OR. IV.
nervous system, none of them  have  suffered such ideas to  enter
fairly into their pathology, or in any way whatever into their prac-
tice :  the nervous organ being  supposed by all of them to be in a
state of soundness at the time pf the attack; and whatever mischief
it suffers to be merely secondary  and  consequent upon a morbid
state of the blood-vessels, or of some other cause that as suddenly
and effectually interrupts  the  secretion or  flow of  the sensorial
power, as retrocedent gout, mephitic vapours, or narcotic poisons.
  Now all these accidental or effective causes of apoplexy are well
known to be causes, also, of the  other nervous affections we have
just referred to.  But if this be the  case, how comes it that they
should thus vary in their result, and that what in one person,  and at
one period of life, should produce apoplexy, should in another per-
son, and in another period  of life, produce lethargy, palsy, convul-
sions, or  epilepsy ?  or that some of them should exist without pro-
ducing any of these diseases or any other disease whatever 1  It is
not, perhaps,  possible, for us to develope the precise condition of
the sensorium that leads to any one of these effects,  rather than to
any other;  but that there  is such a condition, forming a predispo-
nent or remote cause of the specific  disease that shows itself, must, I
think, be allowed by every one who seriously considers the sub.
ject.
  Nor is there, in effect, any other means of reconciling the dis-
crepant and opposite opinions that  have been held concerning the
proximate cause of the disease.   This we have stated to be, for the
most part, compression, and especially  sanguineous compression.
Mr. John Hunter was  so strenuously attached  to this  cause that  he
would allow of no other; and if a man died of apoplexy from  atonic
gout, and without effusion, he distinguished it  as a disease similar to
apoplexy.   He  regarded apoplexy and palsy as  one and the same
disease, merely differing in degree :  and he gives us his  sentiments
very forcibly, in the following words : " For  many years," says he,
" I  have  been particularly attentive to those who have been attack-
ed  with  a paralytic stroke forming a hemiplegia.  I have watched
them while alive that  I might  have an opportunity to open them
when dead : and in all I found an injury done to the brain in conse-
quence of the extravasation of blood.—I must  own I never saw one
of  them which had not an extravasation of blood in the brain, ex-
cept in one who died of a gouty affection in  the brain  with  symp-
toms similar to apoplexy."*
  In direct hostility to this hypothesis, many  other writers of great
eminence and  experience have contended that compression is  no
cause whatever, and that an accumulation of blood in  the head, as a
prominent symptom in  apoplexy, is  a doctrine rather than  a fact.
Of this sentiment is Dr. Abercrombie, who, after examining the
question with much  ingenuity,  brings  himself to  the following
conclusion: " Upon all these grounds," says  he, " I think we must
* Treatise ou Blood, Sic. p. 213. 
GE. VIII.—SP. V.]         NERVOUS  FUNCTION.               399

admit that the  doctrine of determination to the head is not supported
by the principles of pathology, and does not  accord with the phae-
nomena of apoplexy."*  M. Serres, however, a physician of consi-
derable distinction in France,  and who followed up this subject for
many years by a careful examination of the  bodies of persons who
died of apoplexy  and  paralysis, both at the Hotel Dieu,  and the
Hospital de la  Pitie, has carried his inroad upon the popular doctrine
of the day still farther; for he has not only, in  his own opinion,
completely subverted it, but has endeavoured to establish  another
doctrine, of a very different character,  upon its ruins.!  To deter-
mine the question  he has gone through a long series of experiments
upon the brains of dogs, pigeons, rabbits, and other animals, whose
crania were  trepanned,  their  lateral, or longitudinal sinuses  laid
open,  and  their brains lacerated and excavated in various ways, so
as to be gorged with effused blood, yet  in none of them did somno-
lency or any other apoplectic symptom take place.  And he hence
triurrlphantly  concludes  that extravasation of blood  does not pro-
duce apoplexy,  whether lodged between the cranium and the dura
mater, or between the dura mater and the brain :  whether the blood
occupy the great interlobular scissure, and thus lies upon the corpus
callosum ;  whether cavities be made in the fore, the back, or the
middle part of the hemispheres, or run from the one into the other ;
or, lastly,  whether piercing through the corpus callosum we reach
and fill up the  ventricles  of the  brain.  " On whatever animal,"
says he, " we try  these experiments, whether on birds, rabbits, or
dogs, the result is the  same, and  hence apoplexy in  man ought not
to be ascribed to such effusions."
   How are these discrepancies to be reconciled ? by what means
are we to  account for it, that pressure may be a cause, and may not
be a cause ?  and  that apoplexy is sometimes found  with it, and
sometimes without it ?  It is the peculiar state of the. sensorium or
nervous system at the time that makes all the  difference—it is the
morbid predisposition or debility, or whatever other deviation from
perfect health it may labour under at the moment of the application
of the exciting cause, that gives an effect  which would  not other-
wise take place: aud something  of which, in  many cases,  often
discovers itself by precursive signs for a considerable period before
the apoplectic incursion.  The facts stated  by Mr. John Hunter no
one can call in question : and we have as little right  to question the
 experiments  of M. Serres: the error consists in taking an unsound
and a sound state  of brain for like premises, and  reasoning from the
effects produced on the one, to those that are found to follow on the
other.  This, in truth, is an error  too often  committed ; and  heca-
tombs of quadrupeds  and  other  animals in  a condition of perfect
health are tortured  in a thousand ways for the  purpose of deter-
mining what  they never could determine,  though the trials were
* Treatise on Apoplexy, &c. p. 19.
t Annuaire Medico-Chinngicale, aviil, 1020 
400
NEUROTICA.
[CL. IV.-OR. IV-
to be repeated to the end  of time ;  I mean the effects of certain
causes on a diseased state of body in man, from their influence on a
sound state of body in brutes.
  M. Serresrs actual examinations of apoplectic patients after death,
however, though conducted also  upon a large scale, do not seem to
afford much countenance to his  hypothesis, nor,  in effect, to  offer
any thing  out of  the  common way.   In a  considerable number of
subjects there was serous effusion, sanguineous  effusion,  or  both ;
sometimes  in  the circumvolutions of the  brain,  sometimes in the
ventricles, sometimes  in all these ; and not  unfrequently the vessels
of the meninges appeared distended with blood, and the membranes
themselves thickened.  Such appearances seem to furnish  some-
thing of a stumbling-block to  M. Serres's new doctrine, yet  he
readily  gets  over the difficulty by satisfying himself that,  in  all
these cases,  the  effusion did  not produce the apoplexy, but the
apoplexy the effusion.  In other dissections he found some material
alterations  in  the structure of  the brain, but  without  effusion :
and, as the last class  of individuals had evinced  palsy rather than
apoplexy, he is inclined to think that apoplexy, or that state of the
disease  in  which the  stupor is greater and more ^general, is  occa-
sioned by a morbid  irritation of the  membranes  of the  brain  ; and
palsy, or that state  in which the stupor is  less by a morbid change
in its substance ; in consequence of which he proposes to call the
first meningic, and the second cerebral apoplexy.   In this conclusion,
however,  there seems to be a striking mistake, and the very reverse
is what we should have expected; for if there be one pathological
principle more established than another, it is that  stupor and dull-
ness of pain  appertain  to  the parenchymatous irritation or inflam-
mation  of  an organ,  and rousing, restless, and  acute  pain  to  its
membranous  irritation; a principle we have already explained at
some length; and whence, indeed, the lancinating pain of pleuritis
compared with pneumonitis, and of meningic or brain-fever, com-
pared with acute  dropsy of the  head.*
   We hold then, after all, that the grand exciting  cause of a^pTfixy,
is compression; and  this shows itself in various ways, which are
well  enumerated  by Dr.  Cheyne in the following  passage:  " I
mention first," says  he, " the  remains of an excited state of the
minute arteries of the brain and its membranes, this probably  being
the most important, as  it is the most unvarying  appearance: then
the extravasation of blood, probably the consequence  of the excited
state  of the  vessels; the  turgescence of  the venous system;  the
enlargement of the ventricles,  partial or general; and lastly,  the
serous  effusion which is generally  found  in various parts  of  the
brain, and which would seem to imply previous absorption  of  the
brain."!
   It is singular that the congestive fluid, instead of proving a  mate

             *  See Vol. ii. Empresma Cephalitis, p. 214.
               Cheyne, p. 24. 
GE. VIII.-SP. V.]
NERVOUS FUNCTION.
401
 rial elaborated by the animal frame itself, should sometimes consist
 of a foreign material  recently received  into the stomach.  Dr.
 Cooke has given a case  strikingly  in  proof of this, which I shall
 offer in his own words:  " I am informed by Mr. Carlisle that, a few
 years ago, a man was brought dead into the Westminster Hospital,who
 had just drank a quart of gin for a wager.   The evidences of death
 being quite conclusive, he was immediately examined ;  and within
 the  lateral ventricles of the brain was found a considerable quantity
 of a limpid fluid distinctly impregnated with gin, both to the sense
 of smell and taste, and even to  the test  of inflammability.  ' The
 liquid,' says Mr. Carlisle, ' appeared to the  senses of the examining
 students as strong  as one third gin to two thirds water.' "*  It is cu-
'rious, and seems to baffle all explanation, to see  how  readily  sub-
 stances foreign to the blood, when they once enter into its current, are
 often carried from one organ to another, undiluted and undissolved,
 and deposited in an entire, or nearly an entire state,  in a remote
 quarter.  Absorbed pus  affords us  frequent  examples  of this,  and
 morbid poisons, as they  are called,  still more frequent.   It is hence
 that various medicines are enabled to  act by a specific power;  that
 mercury  travels chiefly  to the salivary glands, and perhaps several
 of the demulcents to the lungs.
   On examining the different sources of a compressed brain, as we
 have just enumerated them, it will be obvious that they bespeak a
 very different, and, indeed, opposite state of vascular action in diffe-
 rent cases; and that while some of them necessarily imply a vehe-
 ment and entonic power, others as  necessarily imply an infirm and
 atonic condition.  The external symptoms,  from the first,  speak to
 the  same effect; and hence, from an early period of time, apoplexy
 has  been contemplated under two distinct forms or  varieties, which
 have commonly been denominated sanguineous,  and pituitous, or
 serous ; as though the former proceeded from an overflow of blood
 highly elaborated  by a vigorous and robust constitution, and rushing
 forward with great impetuosity; and the  latter from  thin  dilute
 blood, or a leucophlegmatic habit, from the relaxed mouths of whose
 vessels  a serous effusion is  perpetually flowing forth.  Morgagni
 has endeavoured to show, but without success, that this  distinction
 was in existence among the Greek writers.  It is a distinction, how-
 ever, that runs, not only  through his own works, but-through those
 of Boerhaave, Sennert, Mead, Sauvages and Cullen, and is acknow-
 ledged by most practitioners of the  present day.
   The term pituitous or serous,  however,  has been objected to as
not always expressing the actual state of the brain in  atonic apo-
plexy ;  since no serum has been found at times in  cases where  the
symptoms of debility have peculiarly led those pathologists to  ex-
pect it who have employed the distinctive term;  while the cavities
* On Nervous Diseases, Vol. I. p. 221.
  Schrader has a similar case, Observ. Anat. Med. Decad. iv. Amst. 1674.
  As also Wepffer, Observ. Medico-pract. p. 7. Scaph. 1722.
 VOL. III.                  51 
402
NEUROTICA.
[CL. IV.-OR. IV.
and interstitial parts of the brain, have, on the contrary, been some-
times found as much loaded with blood, as in what they denominate
sanguineous apoplexy.   And hence, Forestus and a few  other  wri-
ters have been disposed to exchange the terms sanguineous and se-
rous, for strong or perfect, and weak or imperfect apoplexy.  How
far a modification of this disease, strictly serous, may be said to ex-
ist, we shall examine  presently; but that apoplexy  is  continually
showing itself under  the two forms of entonic, and atonic action
seems to be admitted by all.  And, as the terms sanguineous and se-
rous do not sufficiently express this change  of  condition in every
instance, the  author, in proceeding to treat of these  two varieties,
will, for the future, distinguish them as follows

x Entonica.                      With a hard  full pnlse, flushed
  Entonic apoplexy.                countenance,  and  stertorous
                                   breathing.
€ Atonica.                        With a feeble pulse,  and pale
  Atonic apoplexy.                 countenance.

  In entonic apoplexy the fit is, for the most part, sudden and with-
out warning; though a dull pain in the head occasionally  precedes
the attack, accompanied with a sense of weight or heaviness, som-
nolency and vertigo.  The inspirations are deeper than natural j
the face and eyes are red and turgid, and blood bursts from the nos-
trils.  On the incursion of the paroxysm, the patient falls to  the
ground, and lies as in a heavy sleep from which he cannot be rous-
ed.  The breathing is strikingly oppressive: though at first, per-
haps, slow and regular, increasing in frequency,  weakness, and ir-
regularity with the progress of the fit, till at length it becomes, in
many cases, intermitting and convulsive.
  It is in this form of the disease that  we chiefly meet, and are al-
most always sure  to meet, with a snoring or stertorous breathing;
nor is this difficult to be accounted for, since the vessels of the trachea,
and particularly those of the larynx and fauces,  labouring under the
same augmented action as those of  the head,  a  larger portion of
mucus is secreted by their excretories, than is  carried  off by  the
corresponding absorbents; in consequence of which it accumulates,
and impedes the free flux and reflux of the air in  respiration.  And
hence, stertor, though not a symptom to apoplexy, as a species, may
be ranked as  a pathognomic character of the particular form before
us.   And to the same effect Dr. Cooke and the most  celebrated pa-
thologists who have preceded him.   "  Boerhaave," says he, " mea-
sures the strength  of the disease  by  the  degree of stertor;  and
Portal agrees with him in opinion on this subject; observing that
respiration in apoplexy is greatly impeded and  the  motions of the
breast are very apparent.   We hear a  noise of  snoring or stertor,"
he says," which is great in proportion as the apoplexy is strong.  In
all the cases of strong apoplexy which I have seen, the  respiration
in the beginning of the  paroxysm was  laborious,  slow, and  sterto- 
GE. VIII.-SP. V.]
NERVOUS FUNCTION.
403
rous ; and in those which proved fatal, this symptom, as far as I can
recollect, remained, even when the breathing had  became weak
and irregular."*
  The author has witnessed it in  the same  manner  continuing to
the last  gasp of life : the reason of which is, that, although in con-
sequence of the  debility  which  has now, perhaps, succeeded to
morbid strength of action, there is less mucus secreted in the larynx
and fauces than on the commencement of the disease, the absorbents
of these organs, participating in the growing weakness,  are  only
capable of carrying off the finer and more attenuate part of the fluid,
and thus leave the more viscid in a state of accumulation.   And it is
for the same reason that from first to last there is often, also, an ac-
cumulation of frothy saliva or foam, which, as it becomes trouble-
some by its increase, is occasionally blown away from the lips with
considerable force.
   The skin is about the ordinary temperature, and covered with  a
copious perspiration, or a clammy sweat:  the pulse is full and hard,
the face flushed,  the eyes blood-shot and prominent, and generally
closed.  The cornea is dull and glassy,  and the  pupil for the most
part dilated.  In  a few cases, however, there is a tendency to either
spastic or convulsive action, spreading sometimes over  the limbs,
but more generally confined to the muscles of the face :  insomuch
that, under the first, the teeth are firmly closed,  and deglutition is
impeded.  And where this state exists the pupil is contracted, as in
a synizenis, sometimes, indeed, almost to a point.  This last feature
has been rarely dwelt  upon by pathologists whether of ancient or
modern times: but it has not escaped the observant eye of my accu-
rate and learned friend Dr. Cooke:  " In some instances," says he,
" I have seen the pupil contracted almost to a point, and a physician
of eminence of my acquaintance has likewise observed this appear-
ance of  the eyes in apoplexy: yet although all writers on the sub-
ject mention  the dilated  pupils, I   do not find any one, Aretaeus
among the ancients, and Dr. Cheyne among  the moderns excepted,
who has noticed  the contracted pupil in these cases."!
   The paroxysm varies in its duration, from  eight to eight and for-
ty hours, and sometimes exceeds this period.  Dr.  Cooke  quotes
from Forestus the case of a woman,  who. being seised with an apo-
plexy, which he calls fortissimo, lay in the fit for three days, and
afterwards recovered.   We have already observed  that where it
does not prove fatal it  predisposes to a relapse, and often terminates
in a lesion of some of the mental faculties, or in a paralysis more
or less general; commonly, indeed,  in a hemiplegia,  which usually
takes place on the opposite side of the body from that of the brain
in which the congestion  or effusion is  found, on examination,  to
have taken place, " This," says Dr. Baillie,  " would seem to show
that the right side of the body derives its nervous influence from

              * On Nervous Diseases, v*bl. i. p. 171.
              * Ibid. p. 174. 
 404                     NEUROTICA.           [CL. IV.-6R. IV-

 the left side of the brain, and the left side of the body its nervous
 influence from the right side of  the  brain.  It  is rarely indeed, it
 ever, that some of the turgid vessels  of the brain are  not  ruptured
 in  this form of the disease, and consequently produce an effusion of
 blood into some part of the organ  of the  brain."   And, according
 to  the same distinguished writer, the part  where the rupture most
 commonly takes place is  its  medullary substance near the lateral
 ventricles, some  portion  of the  extravasated fluid  often  escaping
 into these cavities.*
   Atonic apoplexy i* the  disease of a constitution infirm by nature
 or  enfeebled  by  age, intemperance, or over-exertion  of  body or
 mind.   It has more of a purely nervous character,  as we have  al-
 ready observed, than the  preceding variety, and is  more  a  result
 of vascular debility than  of vascular surcharge, and consequently
 where effusion of blood is found, as it often is, in the  present form,
 the vessels have been ruptured, not from  habitual distension  or  vi-
 gorous plethora, but from  accidental, often, indeed, slight causes,
 that have produced a sudden excitement and  determination to the
 head beyond what the vascular walls are capable of sustaining
 Hence, a sudden fit of coughing or vomiting, a sudden fright, or fit
 of joy, an immoderate fit of laughter,! the jar occasioned by a stum-
 ble in walking, or a severe jolt  in  riding, have brought on the
 present form of apoplexy, and  with so  much the more danger as
 the system possesses less of a remedial  or rallying power in itself.
  In most of the  cases the effusion detected* after death has, there-
 fore, been  as truly sanguineous as in  entonic  apoplexy; and hence
 a valid objection  to the use of the term sanguineous as descriptive
 of the entonic form alone.  " It  is,"  says M.  Portal, " an error to
 believe that the apoplexy to which old  men are  so much subject is
 not sanguineous."   Daubenton  and Le Roy,  Members of the  Insti-
 tute, died of this  precise kind of the  disease at an  advanced  age :
 and Zulianus describes a case marked by a pale countenance, and a
 pulse so weak as scarcely  to  be  felt, which,  on examination  after
 death, was found to be an apoplexia vert sanguinea: and another in
 which, after all the symptoms of what is ordinarily called serous apo-
 plexy had  shown themselves, extravasated blood was discovered in
 the brain without any effusion of  serum, or the smallest moisture in
 the ventricles.!
  It is nevertheless  true  that  atonic apoplexy is often  found  with
 an effusion of serum instead of an infusion  of blood,  and apparently
 produced by such serous effusion  ; and  hence,  notwithstanding the
 objections of Dr.  Abercrombie, and, in  the latter years of his  prac
tice of M. Portal, to serous effusion as  a  cause at  all, the experience
 and reasoning of Boerhaave and Hoffman, and Mead, and Sauvages,
* Morbid Anat. p. 227.
t Aretaus de Sign. eUCaus. Diut. Morb. Lib. I. Cap. 7.
X See also Burscr. De Apoplex. p. 82.
  Cooka ut sup. 
GE. VIH.-SP. V.J
NERVOUS FUNCTION.
40;i
 and Cullen, must not be abruptly relinquished without  far graver
 proofs than have hitherto  been offered:  for if it be  a question,  as
 Stoll has made it, whether effused serum,  when  discovered in the
 brain of those who have died of apoplexy, be a cause of the disease
 or an effect,* we may apply the same question to effusion of blood.
 It is possible, indeed, for effused serum  to  become  occasionally a
 cause even of entonic apoplexy, or  that which, from  its symptoms
 is  ordinarily denominated  sanguineous apoplexy; for  it is possible
 for the  exhalants of  the brain to participate so largely in the high
 vascular excitement  by which this form  of the disease is character-
 ised, as  to secrete an undue proportion  of effused fluid into any of
 its cavities, and thus become as direct a cause of apoplexy as extra-
 vasated  blood.
   This, however, is not what is generally understood by the term
 serous apoplexy as  distinguished from  sanguineous, and,  indeed,
 ought only to be regarded  as  an effect of sanguineous distension.
 Serous apoplexy, properly so called, is strictly the result of a debili-
 tated  constitution, and especially of debility existing in the ex-
 cement  vessels of the brain, whether exhalents or absorbents.  I
 say absorbents, because although lymphatics have  not  yet  been'
 discovered  in  this organ,  there must be vessels of some kind  or
 other to answer their purpose, and the extremities  of the  veins
 have been supposed thus to act; a  supposition which has derived
 countenance  from various experiments of M.  Magendie, to which
 we  shall have to advert  in  the  Proem to  the  sixth  class,  and
 which may at least stand as an hypothesis till the proper system  of
 vessels is detected.
  A serous effusion, under  these circumstances, may take place from
 three causes.   The  mouths of the exhalants  may be  relaxed, and
 consequently let loose a larger portion of fluid than they are accus-
 tomed to do in a state of health, and a larger  portion than can  be
 carried off by the absorbents.   Or the extremities of the absorbents
 may be torpid  and inactive, and  not  imbibe the fluid that  is thus
 thrown forth, and the balance may be disturbed in this as well as  in
 the preceding  way.   Or the blood itself, may be of too watery a
crasis, and too large an effusion take place from this cause ; whence,
indeed, we frequently meet with apoplexy as the result of general
dropsy.
  Hence, atonic apoplexy rarely makes its  attack  altogether so
incontinently as entonic; and is commonly preceded by a  few warn-
ing symptoms.   These are often, however, nothing more than the
ordinary  precursors of other nervous affections, as vertigo, cepha-
laea, imaginary sounds, a  faltering in the  speech, a failure in the
memory  or some other mental faculty,  and at length a sense  of
drowsiness, and a tendency to clonic spasms.  On the attack of the
paroxysm the  patient is  as completely prostrated as  in the atonic
variety,  but the  symptoms are  less violent,  though  not on  this
account less alarming, in consequence of the greater debility of the
* Praelect. p. 367. 
406
NEUROTICA.
[CL. 1V.-OR. IV.
system.   The countenance is here pale or sallow, instead of being
flushed, but at the same time full and bloated ; the pulse is weak
and yielding,  sometimes, indeed,  not  easy to be  felt; and the
breathing though always heavy and laborious, not always, as  we
have already observed, noisy or stertorous.  If spasms occur, they
are uniformly of the convulsive or clonic kind.  The duration of the
fit varies as in the preceding variety, and if the patient recover, he
is more liable to a relapse, and  more  in danger of hemiplegia or
some  other  form of paralysis than in  the stronger modification of
the disease.
  From these remarks on the two  varieties of apoplexy, we  may
readily see why this complaint, and its ordinary associate or sequel
palsy, should be about equally common to the poor and to the rich:
for frequent exposure to cold and  wet, severe and long protracted
exercise,  and a diet below what is called for will often be found to
produce  the  same debilitating effects as ease, indolence, luxury,
and indulgence at too sumptuous  a table.  And hence, contrary to
what  many would  expect,  Sir Gilbert Blane has  observed from
accurate tables  kept with minute attention and derived from a prac-
tice of ten years in St. Thomas's Hospital, and his private consulta-
tions, that " there is a considerably greater proportion of apoplexies
and palsies" among the  former than among the latter: or, in other
words,  that  these disorders bear  a larger proportion  to  other
diseases among the lower  classes than  among those  in high life.
" Some cases of hemiplegia," says he, " occur in full habits; some
in spare and exhausted habits.  The former being most incident to
the luxurious and indolent, most frequently occur in private practice,
and among the  upper ranks of life.  The latter occur more among
the laborious classes, and among such of the rich  as are addicted to
exhausting pleasures."*
   In forming our prognostic, a special regard must be had to the
peculiar character of  the  disease.   Generally  speaking, atonic
apoplexy is more dangerous than entonic, for we  have here a more
barren field to work  upon, and  nature herself, or  the instinctive
power of the living frame, has less ability to assist us.  As to the
rest in either modification, the degree of danger will be generally
measured by the violence of the symptoms.  Where, under the first
variety, the breathing is not much disturbed, the pupil is relaxed,
and there is no appearance of spastic action ; where the perspiration
is easy, the skin warm rather than hot, the bowels are readily kept
in a due state of evacuation, and more especially where there is any
spontaneous hemorrhage, as from the nose or hemorrhoidal vessels,
and of sufficient abundance, we may fairly venture to augur favoura-
bly.   But where the symptoms are directly opposed to these ; where
the stertor is deep and very loud,!  and particularly where it is

         * Trans. Medico-Chir. Soc. Vol. iv. p. 124.
         t Dolseus, p. 144. 
GE. VIII.-SP. V.]       NERVOUS  FUNCTION.
407
accompanied with much foaming at the  mouth ;*  where the teeth
are firmly clenched, or a spasm  has fixed rigidly on the muscles of
deglutition, and the pupil, instead of being dilated, is  contracted to
a point, we have  little reason to expect a favourable termination.
  The  great hazard resulting from this  tendency to spastic  action,
and particularly as evidenced in a strongly contracted pupil, is thus
forcibly pointed out by Dr. Cooke.   " Among the dangerous signs
in apoplexy, many authors mention a dilated state of the pupil of
the eye :  but the contracted pupil,  which I consider to be a  still
more dangerous  appearance,  has been scarcely noticed.  I am of
opinion that  this  ought to be reckoned among the very worst symp-
toms of the disease.   I never knew a person recover from apoplexy
when the pupil was greatly contracted.  My opinion on this subject
is confirmed  by that of Sir Gilbert Blane and Dr Temple."!
   Dr. Cheyne, in like  manner, regards convulsions as a source of
great danger: while  M.  Portal,  on the contrary, thinks they some-
times announce a diminution of  the  morbid cause.   The latter  rea-
sons from the fact  that when, in living animals, a slight pressure
has been  made on the exposed brain, convulsions have taken place ;
while, if  the pressure be increased in power, general stupor with
stertor  and difficult respiration have followed instead of convulsions:
an  ingenious conclusion  but not exactly applicable,  since, in the
one case the brain is in  a morbid and in  the  other in a sound state,
whence the  premises on which the reasoning  is founded  are not
parallel.                                                    .
   In the treatment of apoplexy, if we be timely  consulted during
the existence of the  precursive  signs which have  been noticed as
occasionally  taking  place,  we  shall  often  find  it in  our power
completely to ward off a paroxysm by bleed.ng, purgatives, perfect
quiet, and, in the entonic  variety,  a reducent  reg men.    Where,
however, the pulse, and other symptoms give proof of weak vascu-
lar action, and nervous debility, the depleting plan should  be  pur-
sued with caution, and  it will be better to employ cupping-glasses
than  venesection, and,  in some instances,  to  limit  ourselves to
purgatives alone.  Yet, whatever be the degree of general debility, if
the proofs of compression or distension be clear as those of drowsiness,
vertigo, and  a dull pain in the head, it will be as necessary  to have
recourse to bleeding either locally  or generally, as in entonic  apo-
plexy ;  for such symptoms will  assuredly lead to a fit unless timely
counteracted and subdued.
  " In  the  actual paroxysm of apoplexy," says Dr. Cooke, and 1
quote his  words because it is impossible to exchange them for better,
" the patient should, if possible, be immediately carried into a  spa-
cious apartment,  into which cool air may be freely admitted.  He
should be placed in a posture  which the  least favours determination
of blood to the head:  all ligatures,  especially those about the neck,
* Burser. p. 97.
t lb. p. 280. 
408
NEUROTICA.
[CL. IV.-OR. i>.
should be speedily removed, and the legs and feet should be placed
in warm  water,'or rubbed  with stimulating applications.   These
means may be employed in all cases of apoplexy :"* and are conse-
quently equally applicable to both the forms under which we have
contemplated the disease.  The collateral means to be had recourse
to require discrimination, and it will be most convenient to consider
them in relation to the actual form  under which the  apoplexy pre-
sents itself.
   In entonis apoplexy, copious and repeated bleeding seems, prima
facie, to offer the most  rapid and effectual  remedy  we  can have
recourse to :  yet the  opinions of the best practitioners,  as well in
ancient as in modern  times,  have been  strangely at variance upon
this  subject.   Hippocrates, who regarded  apoplexy as chiefly de-
pendent upon a weak  and pituitous  habit, discountenanced  the  use
of the lancet,  as adding to the general debility:  and even  where
it is accompanied with symptoms of strong vascular action,  he  dis-
countenanced it equally, from  an  idea  that  the  case  was  utterly
hopeless when it assumed this  form, and that to have  recourse to
bleeding would only  bring a reproach upon the art of medicine.
The authority of Hippocrates has had too much influence with phy-
sicians in all ages,  and  has extended its baneful effects to  recent
times, and in  some instances even to our own day.  Hence Forestus
tells us, that in strong or entonic apoplexy no courageous plan ought
to be attempted, no venesection, no pills : we may, indeed, to please
the by-standers have  recourse  to the remedia  leviora of frictions,
and injections, and ligatures  round |he arms and thighs;  " and
where,"  says  he, " we  have not found  these succeed in rationem
sacerdotibus commisserimus."
   In our own country, the same timid feeling has been particularly
manifested by  Dr. Heberden  and Dr. Fothergill, but on grounds
somewhat different.   Those excellent pathologists have chiefly re-
garded apoplexy as a disease  of nervous  rather  than of general
debility, and have been fearful of adding to  this debility by abstract-
ing blood, and hereby of almost ensuring hemiplegia or some other
form of paralysis.  Hence Dr. Heberden  speaks with great  hesita-
tion concerning the practice rather than with an absolute and  ge-
neral  condemnation of it: he observes, which is true enough, that
many persons have been injured by large and repeated bleedings,
and then lays down his rule, not to  bleed either in an attack of apo-
plexy or palsy if there would  have been just  objections to taking
away  blood before the incursion of either.!
   Dr. Fothergill, however, expresses himself still more  decidedly
against bleeding than  Dr. Heberden.  He suspects that the weak-
ness it occasions checks  the natural effort  to produce  absorption;
and that even the hard  and full and .irregular pulse, which seems
imperatively to call for a very free use of the  lancet,  u is often an
* Burser, p. 288.
t Medical Transaction.-, i. p. 47^. 
GE. VIII.-SP. V.]
NERVOUS FUNCTION.
409
 insufficient guide;" since  " it may  be that struggle which arises
 from an exertion of the  vires vitoe to restore  health."   And hence,
 he adds in another place,  "I am of opinion  that bleeding in apo-
 plexy is, for the most part, injurious, and that we should probably
 render the most effectual aid by endeavouring, in all cases, to pro-
 cure a plentiful discharge from the bowels: as by these revulsions,
 the head is, perhaps, much more effectually relieved from plenitude,
 and that without  weakening or interrupting any  other  effort of na-
 ture to relieve  herself than by venesection."*
   It is singular that in drawing such  conclusions from the instinctive
 efforts or remedial power of nature,  where a cure has been effected
 spontaneously, these distinguished writers have not felt more deeply
 impressed by the salutary efforts of spontaneous and copious hemor-
 rhages, as from the nose, the lungs, and the hemorrhoidal  vessels,
 which have never perhaps poured forth blood freely, without ope-
 rating a cure ;  and that  they have not endeavoured to follow these
 footsteps,  as far as they  might have done, by substituting an artifi-
 cial discharge of blood  where a natural discharge  has not taken
 place.
   Other  physicians, however, both in ancient and  modern times,
 have  not  been  equally  insensible to  this important fact   Galen,
 though he always hesitated in  departing from the practice of Hip-
 pocrates, ventured to  deviate  from  him upon the point before us.
 Aretsus, Paulus of .<Egina, and Coelius Aurelianus  carried the re-
 medy of bleeding to a still further extent, and Celsus regarded it as
 the  only means  of effecting  a cure.!
   " The  Arabians  adopted the practice  of the  ancients, as far as
 relates to the employment of blood-letting in  the strong apoplexy,
 and  by far the greater number of modern  physicians have, in this
 respect, followed their  example.  In support of this practice we
 might adduce the opinions of all who have written on the disease :
 we might quote from the works of Sydenham, Wepffer,  Boerhaave,
 Van Swieten,  Morgagni, Baglivi,  Sauvages, Tissot,  Mead, Friend,
 Pitcairn, Hoffman, Cullen, Portal, Cheyne, and many other eminent
 modern  writers."];   As this  paragraph is quoted  from  Dr.  Cooke,
it is almost superfluous  to add his own name to the list of those
 who strenuously recommend blood-letting.
   A question  has been made as to the side from which it may be
 most advantageous to take blood.  Aretaeus drew it from the sound
 side, wherever this could be distinguished.  Valsalvi and Morgagni
 recommend the  same;  as does also Cullen, observing that, " dissec-
tions show that  congestions producing apoplexy  are always on the
side not affected."§  Baglivi recommends bleeding from  the dis-
        * Works, Vol. in. p. 208.
        t De Medicin. Lib. hi. cap. xxvn.
        X Cooke, ut supra 292.
        I Pract. of Phys. Vol. in. p. 184.

VOL.  III.                  r>~ 
 410                   NEUROTICA.            [CL. IV.-OR. IV-

 eased side, except where blood is abstracted locally.  The question
 appears to be of no great importance : the grand object in general
 bleeding is to diminish the quantity and momentum  of the circulat-
 ing fluid, to enable the  ruptured  vessels to contract with  greater
 facility, and to afford time for an absorption of whatever may have
 been effused.
   In entonic apoplexy, general and local bleeding  should go hand
 in hand; and the quantity  drawn should in every instance depend
 upon the urgency of the  symptoms.  Dr. Cheyne advises us to be-
 gin with abstracting two pounds,  and tells us that it will often re-
 quire a loss of six or eight pounds before the disease  will give way.
  Dr. Cullen and many other writers,  as Morgagni, Valsalva, and
 Portal,  have recommended that the opening should  be  made in the
 temporal artery or the jugular veins.  u In all cases  of a full habit,"
 says Dr. Cullen,  " and where  the disease has been  preceded by
 marks of a  plethoric state, bloodletting is to be immediately  em-
 ployed, and very largely.  In my opinion it will be most effectual
 when the blood is taken  from the jugular  vein ;  but if that cannot
 be done  it may be taken  from  the arm.  The opening of the tem-
 poral artery, when a large branch can  be  opened so as suddenly to
 pour out a considerable quantity of blood, may also be an effectual
 remed}'; but, in execution, it is more uncertain and may be incon-
 venient.  It may in some measure be supplied by cupping and sca-
 rifying on the temples or hind-head.  This, indeed,  should seldom
 be  omitted, and these scarifications are always preferable to the
application of leeches."!
  In  bleeding from the  temporal  artery we may  safely  let the
 stream flow as long as it will, for in common it  will cease before
 we  have obtained  enough, and all tight ligatures about the head,
 or indeed any other part  of the body,  should be avoided as much
 as possible.   For the same reason Heister advises that, on opening
 the jugular vein, no ligature should be made use of,  as the smallest
 pressure on the part may do  harm by interrupting the circulation
 of the blood on the external veins of the neck.
  M. Dejean, of Caen, proposed,  not  long ago, to the Academy of
 Sciences, to open the superior longitudinal sinus after raising the
 bone which covers it, and asserted that he had employed this mode
 with great success on  strangled dogs.  M.  Portal,  and M.  Tenon,
 however, who  were appointed commissioners to report on M  De-
 jean's memoir, agreed that bleeding from the jugular  vein is pre-
 ferable to that from the  sinus, as  producing the same effect more
 speedily, and with more  facility of restraint when  a sufficiency of
 blood has been taken away.
  What seems to be the  fair result, the author will  give in the
 words of Dr. Cooke.   " General  opinion, then, as  well as reason-
 ing, appears  to be very much in favour of free and  repeated  eva-
 cuations  of blood, both general and topical, in the strong apoplexy;
 and I am persuaded that  greater advantage may be  reasonably ex-
* Pract. of i'lvi.  Vol. in. p. 182. 
GE. VIII.-SP. V.]      NERVOUS FUNCTION.
411
 pected from this than from any other practice : yet I am very much
 inclined to  think that it may be, and actually  sometimes has  been,
 carried  too far.  I  have seen  several cases, and heard of many
 others, in which very large  quantities of blood  have been drawn
 without the smallest perceptible advantage, and  with an evident
 and considerable diminution of the strength  of the patient."*
   The next important means to be pursued is that of exciting  the
 bowels by active purgatives, and then endeavouring  to lessen  the
 pressure on  the  brain  by revulsion.   The particular purgative
 is of no importance: whatever will operate  most speedily and most
 effectively  is what should be preferred  in the first  instance:  and
 hence a combination of calomel and extract of jalap will be  found
 among the  best: though a free action may afterwards be more con-
 veniently maintained by colocynth or sulphate of magnesia.   Do-
 laeus employed calomel  so  as  to  excite salivation,  from an  opi-
 nion that all evacuations are  useful; and he gives  an  account of
 several cures he was hereby enabled to effect, and particularly re
 lates the case of a woman who was in this manner considerably re-
 lieved, and  died on the  cessation of the ptyalism.!
   The collateral remedies are of  less importance though  some of
 them may add to the general effect.   Emetics are of  a very doubt-
 ful character in the form of the disease before  us,  though often
 highly useful in atonic apoplexy.  They  have been given upon the
 principle of their producing a sudden prostration of strength,  and
 faintness : but this  is a result of nausea rather than of vomiting:  and
 the  languor hereby occasioned is not exactly of the kind we stand
 in need of;  regard being had to  the disease as a  nervous  affection,
 and  the danger of inducing hemiplegia.   Full vomiting may, indeed,
 determine from the head  to the  surface of the body, but  we cannot
 answer that the straining  will not renew  the extravasation, or even
 rupture a vessel where no rupture has existed.  It is true the same
 plan has at  times  been  employed in haemoptysis, apparently with
 success; but it has in other  instances been so decidedly productive
 of mischief, as to  urge those who  have made choice of it  to aban-
 don it abruptly, with a determination never to return to  it in  any
 other case,  as we have already observed  when treating of  haemop-
 tysis under  Class in.  Order iv.  in  the preceding volume.!  The
 only instance in which it  may be prudent to prescribe an  emetic,
 is where the disease has  evidently proceeded  from a surcharged
 stomach.
  Blisters and sinapisms promise but little in this  form of the  dis-
 ease : they tease and irritate to no purpose when  applied to the ex-
 tremities, and are still more injurious when they are made to  cover
 the scalp; for they effectually prevent the use of epithems of cold
 water, or vinegar, or pounded ice, which afford a rational chance of
producing benefit.
* Ut supra, p. 311.
t Dolseus, p. 149.
X Vol. II. p. 464. 
412
NEUROTICA.
[CL. IV.-OR. !Vr.
  Cordials were in high reputation among the Greek practitioners,
from a belief that apoplexy is in almost every case the result of a
debilitated and pituitous habit: and the custom has too generally de-
scended to the present day, even where the ground on which it was
founded has been relinquished.   Stimulants and cordials of all kinds
should be sedulously abstained  from: and the  neutral  salts  with
small doses of the antimonial powder, or any other cutaneous relax-
ant be employed in their  stead : cooling dilute  drinks  should  be
freely recommended ; and if we should hereby be enabled to excite
a gentle  moisture on the  skin, it  may  prove of incalculable ad-
vantage.
  The curative  process under our second variety of the disease, or
atonic apoplexy, must vary in many points from the preceding.  It
is here, if at any time, we should pause, before we employ bleed-
ing.   Yet as  dissections show us that even here also compression,
and that too from an efflux of blood, is very general, and either from
blood or serum, almost constant,—whatever be the degree  of con-
stitutional debility, I  can  hardly conceive of any case in  which we
should be  justified in withholding the lancet or the use  of cupping-
glasses.  The argument stands precisely upon the ground of the ex-
pediency of bleeding  in typhus accompanied with congestion : it is
in itself an evil;  but it is only employed as a less evil to fight against
a greater.  With it we may succeed: without it, in either instance,
the case is hopeless.
  Generally speaking, however, local bleeding will here be prefe-
rable  to that of the  lancet; but cupping should always be preferred
to leeches  whose operation is  far too slow for the urgency of the
occasion.   The  last, however, are recommended by Burserius, and
Forestus quotes an  instance in which they succeeded by a formida-
ble application over the  entire body.*  Aretaeus after abstracting
blood by cupping-glasses, recommends also the  use of  dry-cupping
between the shoulders, and the recommendation is highly ingenious
and worth attending to.!
  Purgatives, though less violent than in entonic apoplexy, should
in like manner be had recourse to:  and as we have less danger to
apprehend from the use of emetics, they may be given more freely.
They are  strongly recommended by Sauvages, and were regarded
by Grubelius almost as a specitic.   They have the triple advantage
of freeing the  stomach from  morbid acrimony, rousing the sys-
tem  generally, and  determining  from the head  to the  surface of
the body.
  Here also we  may  use both  external  and internal stimulants in
many cases with considerable success.  Of the former, volatile  al-
kali, rubefacients, and blisters may be made choice of in succession,
and applied alternately to different parts of the body.  Of the latter
We should chiefly  confine  ourselves  to the  warmer verticillate
* Lib. x. Obs. 76.
t De Cur. Morb. Acut. i. 4. 
GE. VIH.-SP. V.]
NERVOUS FUNCTION.
413
plants, as lavender, marjoram, and peppermint, or the warmer sili-
quose, as horse-radish and mustard, or the different forms of ammo-
nia ;  and even of  these we are debarred by Dr. Cullen, at least in
that  particular modification of atonic  apoplexy, which we have
described under the name of serous, though he does not enter into a
consideration of any other.
   In that peculiar kind  of apoplexy which is sometimes produced
by taking immoderate doses of spirits or some narcotic, and  espe-
cially opium, in which we meet with an  almost instantaneous  ex-
haustion of the nervous power, or an instantaneous stop put  to  its
secretion or flow, making a near approach to asphyxy, though with
a heavy drowsiness and stertorous breathing, the patient should first
have his stomach thoroughly  emptied by an emetic of sulphate of
copper; he should be generally stimulated by blisters, and  kept in
a state of perpetual motion by walking  or other exercise, so as to
prevent sleep till the narcotic effect  is over.  An interesting case of
this  kind will be found related by Dr.  Marcet in the Medico-Chi-
rurgical Transactions.*
   After all it should not be forgotten that apoplexy is in most, per-
haps in all  cases,  not secondarily alone, but primarily a  nervous af-
fection, and dependent upon a predisposition to this disorder in the
sensorium itself, if not upon a  morbid condition of it: and that hence
the patient, though we should recover him from the actual fit, will
be subject to  a recurrence of it.   In  this view the interval becomes
a period of great importance,  and should be as much submitted to a
course of remedial treatment  as the paroxysm itself.
   After entonic apoplexy, the patient should  habitually accustom
himself to a plain  diet, regular exercise,  early hours of meals  and
retirement, and uniform tranquillity of mind: and the state of the
bowels should particularly claim his  attention.  After the atonic va-
riety the same general plan may be followed with a like good effect,
but the diet may be upon a more liberal allowance ;  and a course of
tonic medicines should form a part  of the remedial system.   If it
were true,  as suspected by Dr. Cullen, that  all bitters contain in
the bitter principle itself a narcotic and mischievous  power, these
ought to be carefully abstained from, but we have already observed
that  this does not seem to be the fact.  And hence  much of the
treatment laid down under   limosis Dyspepsia,! may be  pursued
here:  together with  a use of the  waters  of Bath, Buxton,  and
Leamington.
* Vol. i. p. 77.
t Vol. I. p. 111. 
414                     NEUROTICA.           [CL. IV.-OR. IV.


                        SPECIES VI.

                 CARUS PARALYSIS.

                            Hal*!?.

corporeal torpitude and muscular  immobility more or  less gene-
                 ral,  BUT  WITHOUT  SOMNOLENCY.

Palsy is a disease which makes a near approach to apoplexy in its
general nature and symptoms, and is  very frequently a result of it.
It is, however, still more strictly a nervous affection, and less con-
nected with a morbid state of the sanguiferous or the respiratory
organs.   In examining  it more  in detail, we  shall find  that some-
times the motory fibres alone are affected in  any considerable de-
gree, while the sentient are only rendered a  little more obtuse,
sometimes both kinds are equally torpid  and sometimes  several  of
the faculties of the mind  participate in the  debility, though they
are never so completely lost as in apoplexy.
  The Greek writers contemplated the two diseases under the same
view, considering them  as  closely  related to each other, or, in
other words, as species of the same genus.  " The  ancients," says
Dr. Cooke, who has  accurately gone over the entire ground and
taken nothing upon trust, " very generally considered apoplexy and
palsy as diseases of the same  nature, but different in degree ; apo-
plexy being an  universal palsy,  and  palsy a partial apoplexy.  Are-
taeus says, apoplexy, paraplegia, paresis, and paralysis, are  all of the
same kind ; consisting in a  loss of sensation, of  mind, and of mo-
tion.  Apoplexy is a palsy of the whole  body,  of sensation, of mind,
and of motion.  And  on this subject Galen, Alexander Trallianus,
iEtius, and Paulus iEgineta, agree in opinion  with Aretaeus.  Hip-
pocrates  who, in various parts of his works speaks of apoplexy, no
where, as far as I know, mentions paralysis; and when he  refers to
this disease  he employs  the term apoplexia.  Both  Aretaeus and
Paulus jEgineta represent him as speaking of apoplexy in  the  leg.
Celsus describes palsy and apoplexy  by the general terms resolutio
nervorum."*  It is  only  necessary  to add that paresis and palsy
were used sometimes synonymously; and that, when a  distinction
was made between them, paresis was regarded as only a very slight
or imperfect  palsy.
  Palsy and  apoplexy, however, are something more than the same
disease merely varied in degree; the one, indeed, may lead to  and
terminate in  the  other, but  they very  often  exist separately  and
without  any interference ; and, notwithstanding their general re-
semblance, are distinguishable by clear and specific symptoms.   But
* Treatise on Neivous Diseases, Vol. n. p. I. 
CE. VIII.-SP. VI.]      NERVOUS FUNCTION.                415

if the Greeks approximated  them too closely, the greater part of
the nosologists of modern times as Sauvages, Linneus, Vogel, Sagar,
Cullen,  and Young, have placed them too remotely, by regarding
each as a distinct genus:  the proper nosological arrangement seems
to be that of co-species, as they are ranked by Dr. Parr, as well as
under the system before us.
   The  common causes of apoplexy are usually asserted to  be those
of palsy :  and considering how  frequently palsy occurs  as a sequel
of apoplexy, the assertion has much to support it: for compression
is here  also a* well as in apoplexy a  very frequent cause.   Yet as
compression does not seem to be  the  only cause of apoplexy, it is
still less so of palsy in all its modifications, and we shall still more
frequently have to resolve the disease into some of those causes  of
general and especially of nervous debility which we have already
noticed as occasionally giving rise to  apoplexy, and which we. have
more particularly illustrated under the genus clonus of  the preced-
ing order.
   Palsy is often preceded by many of the precursive signs we have
already noticed as forewarning us of apoplexy ; and it commonly
commences slowly and insidiously; a single limb, or a part of the
body being at first troubled  with an occasional sense of weakness or
numbness, which continues for a short time and then disappears.  A
single finger is often  subject to this token, as is one of the eyes, the
tongue, or one side of the face.
   The  nerves chiefly affected  are those subservient to voluntary
motion, but the  accompanying nerves of feeling in most cases par-
ticipate in the torpitude though not  in an equal  degree, and some-
times not at all.  " I  never," says Dr. Cooke, " saw a case of palsy
in  which  sensation  was entirely lost:" though such  cases seem
sometimes to have  occurred.  The action of the involuntary organs,
and especially of the heart and lungs, are but little interfered with,
though  in a few instances something more languid than  in a state of
ordinary health.  And in this respect we perceive  a  considerable
difference between paralysis and apoplexy, in which last  the heart
appears to be always oppressed, and  the breathing laborious.  The
faculties  of the mind, however, rarely escape without injury, and
especially the memory ;  insomuch that not only  half the vocabula-
ry the  patient has been in the habit of using is sometimes forgotten,
but the exact meaning of those that are remembered, so that a sense-
less succession of words is made use of instead of intelligible speech,
the patient perpetually misusing one  word for another,  of which we
have given various  examples under moria  imbecilis, or mental im-
becility.*  And it is hence  not to be  wondered at that  palsy should
occasionally impair all the mental faculties  by degrees, and termi-
nate in  fatuity or childishness.
   We have frequently had  occasion  to observe and to prove by ex-
amples, that where any one of the external senses is peculiarly ob-
•■  See Vol. hi. pp. 125, 126. 
416
NEUROTICA.
[CL. IV.-OR. IV.
 tuse or deficient,  the rest are often  found in a more than  ordinary
 degree of vigour and  acuteness, " as though  the sensorial  power
 were primarily derived from a common source, and the proportions
 belonging to the organ whose outlet is  invalid,  were  distributed
 among the other organs."*  Something of this law seems to operate
 in  many cases of palsy, and is more and  more conspicuous in pro-
 portion to the extent of the disease: for in hemiplegia and paraple-
 gia, the  half of the body that is unaffected has not  unfrequently
 evinced  a morbid increase  of feeling.   Dr. Heberden  attended a
 paralytic  person whose sense of smell  became so exquisite as to
 furnish perpetual occasions of disgust and uneasiness;  and he men-
 tions one case in which all the senses were exceedingly acute.
   It is to this principle we  are to resolve it that where the disease
 confines  itself to the motory nerves  of an organ alone, and the sen-
 sific are  not interfered with, the feeling of the palsied limb itself,
 is sometimes greatly increased,  and sometimes exacerbated into a
 sense of formication, or some  other  troublesome itching.  " I have
 seen several instances," says Dr. Cooke,  " in which paralytic per-
 sons have felt very violent pain  in the parts affected, particularly
 in the  shoulder  and  arm;"! and the  remark, if necessary, might be
 confirmed from numerous  authorities.
   Palsy,  however, is  strictly a  disease  of nervous debilitjt, and
 where it shows  itself extensively, the  whole nervous  system is af-
 fected  by it.  The  consequence  of  which is, as  we have already
 shown in treating of entastic, and  particularly clonic spasm, that the
 sensorial fluid in all  its modifications is secreted or  communicated
 irregularly, and its balance  perpetually disturbed, so as  to operate
 upon the  mind as well as upon the  body : whence some parts are
 too hot and others too cold, and even the affected limb itself, accord-
 ing to the nature of  the affection, and its limitation or  extension  to
 different  sets of nerves,  will be warmer or colder than in its natural
 temperature, and will  waste  away, or  retain its ordinary bulk;
 while the passions of the  mind will  participate in  the same morbid
 irritability, and  evince a  change  from their constitutional  tenour.
 Persons of the  mildest and most placid tempers will often discover
 gusts of peevishness  and irascibility; and men of the strongest men-
 tal powers have been known to weep like children on  the slightest
 occasions.  In a few instances, however, an opposite  and far more
 desirable alteration has  been effected.  " I had several years ago,"
says Dr.  Cooke,  " an opportunity of seeing an illustration of this
 remark in the case of  a  much respected friend.   The person to
whom I allude had always, up to  an  advanced age, shown an irasci-
ble and irritable disposition : but after an  attack of palsy his temper
became perfectly placid and remained so until  his death about two
years afterwards."!
* See Vol. in. p. 19G. 256., and compare with p. 27.
t Ut supra, p. 5.
J-See Vol. in. p. 12. 
wE. V11I.-SP. VI.]      NERVOUS FUNCTION.

  It is the general opinion that paralytic limbs are uniformly colder
than in a state of health :  and Mr. Henry Earle has ably supported
this opinion  upon an extensive  scale of examination,  in an article
introduced into the Transactions of the Medico-Chirurgical Society.*
Dr. Abercrombie, on the  contrary, in a  correspondence upon  this
subject with Dr. Cooke, gives it as his opinion that paralytic parts
do not become  colder than  natural; and adds, " that he had long
ago observed that they are  sometimes  warmer  than  sound limbs,
but without being able to  account for it."  The present author has
frequently made the same remark,  though he has more commonly
found them  below the ordinary temperature.   The facts, therefore,
on both sides are correctly stated;  and the discrepancy is to be re-
solved into the nature and extent of the  sets of nerves that are im-
mediately affected, whether  sensific, motific, or  both, and  into the
disturbed and  irregular,  the hurried or interrupted  tenour with
which the nervous fluid is secreted or supplied.
  The learned Pereboom, who has followed Boerhaave and Heister
in attaching  himself to the probably correct doctrine of the Galenic
school, that the nerves issuing from the sensorium are of two  dis-
tinct sorts, one subservient to sensation, and the  other to muscular
motion, and  has so far accorded with the physiology  attempted  to
be established in the commencement of  the  present  volume, has
divided palsy, which he describes as a genus, into three species; a
nervous, muscular, and nerveo-muscular ; by the first meaning that
form of the  disease in which there is a deprivation of sense without
loss of motion; by the second, loss of motion while the sensibility
remains;  and by the third loss both of sense and motion.t  The
specific names are here  at variance with the physiology;  for  if it
be true that  muscular  motion is as  dependent upon the nerves  as
sensation, then, palsy affecting the moving  fibres, is as much enti-
tled to be called nervous  as  palsy affecting the sentient.  Nor are
the few cases to be met with of privation of feeling without loss of
motion, strictly speaking, to be regarded as palsies.  They are
rather, as Aretaeus has correctly observed, examples of anaesthesia,
or morbid want of the sense  of  feeling,  and as such will be found
described in  the present system under the name of parapsis expers.:{:
  On this account the  present  author, in his volume of nosology,
thought it better to follow up, though with a considerable degree of
simplification, the subdivisions of Sauvages and  Cullen, and to dis-
tinguish  the  disease under the three following  varieties founded
upon the  line or locality of affection:

x Hemiplegia.                    The disease  affecting and  con-
  Hemiplegic Palsy.                fined to one side  of the bodj'.
% Paraplegia.                     The disease  affecting and  con-

           * Medice-Chirur. Trans. Vol. vu.
          r Acad. Nat. Cur. Soc. De Paralysi. 8vo. Horns.
          X Class, iv. Ord.  ii. Gen. v. see supra, p. 189.
  VOL. hi.                    53
417 
 118                      NEUROTICA.           [CL. IV.-OR. IV.

   Paraplegic Palsy.                 fined to the lower part of the
                                    body on  both sides, or an}
                                    part below the head.
 y Particularis.                    The disease affecting and con-
   Local Palsy.                      fined to particular limbs.

   Some  nosologists have transferred to  this division  the local in-
 sensibilities and atonies of the external senses  or parts of them, as
 though  they were idiopathic affections.  It is rarely, however,  or
 never, as Aretaeus has justly remarked, that they are not connected
 with other symptoms and  other  derangements of such organs and
 their respective functions: and hence, they rather belong to the
 second  order of the present class, than  to paralysis  in the  strict
 sense of  the  term.   They are  anaesthesiae,—voaoi -xx^xXvrtxoi,  or
 axpTtxei, rather than xx^xXvat?; and in  the  system  before us are ar-
 ranged  accordingly.
   Hemiplegia, the  first of the  above varieties of palsy, is far most
 frequently met with as a sequel of apoplexy, and especially of atonic
 apoplexy, or that in  which the  energy  of the nervous system  is
 peculiarly diminished, and irregular.   The usual exciting causes  of
 apoplexy are in consequence those of palsy, and need not be enume-
 rated in the present place.   In a few instances, however, hemiplegia
 occurs without preceding apoplexy;  and hence, distinctly proves
 that pressure, or at least 6uch a pressure as is demanded to produce
 somnolency, is not essentially necessary.   Mr.  John Hunter, as we
 have already observed, was inclined to think that  pressure from ef-
 fused blood,  was,  in every  instance, the cause both of this disease
 and of apoplexy : but in allowing, as he has done, that on one occa-
 sion at  least he was called to a patient who died of a gouty affection
 of  the brain " with symptoms  similar to apoplexy,"  and without any
 extravasation whatever, he directly concedes the  point of compres-
 sion as  an universal cause : for if atonic or retrocedent gout may
 produce  apoplexy or palsy without pressure on the brain, so may
 many other atonic powers, operating as effectively on the sensorium.
 One of the most  frequent of  these powers is  a debilitated and pa-
  retic state of  the liver; and  hence  those persons are  peculiarly
  subject to this variety of palsj', who have spent the earlier part  of
  their lives in an habitual course of  intemperance.  Hoffman has
  particularly noticed this cause;  and Morgagni describes the case  of
  a man  advanced in years who was attacked with jaundice and hemi-
  plegia  simultaneously ;  the jaundice  affecting the  hemiplegic side
  alone,  which  was the right, and that with so much precision, that
  the nose  was  of  a deep  yellow on the  one side, and of its proper
  colour on the  other, which were divided from each  other  as by a
  ruled line.  Other causes are exposure  to the rays of  the sun, drink-
  ing cold water and bathing in it when  heated, repelled  eruptions,
  and chronic rheumatism.
     As apoplexy has  its  prccur-ive symptoms  occasionally,  so also
» has  hemiplegia, and particularly when it is  connected  with a 
uiE. VHI.-SP. VI.]
NERVOUS FUNCTION.
419
plethoric habit:  for in this case, the veins of the neck and face
often appear turgid, there is an obtuse pain  in the head, the tongue
moves with some difficulty, and particularly on one side, the per-
ception and memory become impaired, and the patient feels a ten-
dency to drivel at one corner of the mouth rather than  at the other.
The  onset, like  that  of apoplexy,  is  at last sudden  ; and  if the
patient be standing he drops down abruptly  on the affected side.
   The progress of the disease is uncertain ; and depends very much
upon the state of  the nervous  system at the time of the attack.
If there be no chronic  debility, or other morbid condition of the
sensorium, the patient will sometimes recover entirely in a week
or even less;  but if this  system, or some particular part of it, be in
an infirm state, he recovers only imperfectly; and obtains, perhaps,
a thorough or  a  limited use of the  lower  limb,  while the  upper
remains immoveable ;  or he  is compelled  to  pass  through  the
remainder of a wretched  and  precarious existence with onfy one
half of his body subservient to his will, the other half being more
dead than  alive, and withering,  perhaps, with a mildew-mortifica-
tion.*
   We have stated that  in this  disease, as, indeed,  in all  others
accompanied with  an atonic  disturbance of the  nervous energy,
there is not only a great irregularity in the flow, but  a great and
confused disproportion in  its  distribution to different  parts  of the
body ; so that the stock,  whether of  sensific or motific fluid, which
is  altogether deficient  in some parts, seems to be sent in a hurried
and tumultuous accumulation to others,  which are in  consequence
irritated with an undue degree of sensation or motivity, in the most
capricious manner.  Dr. Cooke! and Dr. Abercrombie!; have  col-
lected numerous  and highly interesting examples of these  curious
anomalies, and  may be consulted  with great advantage by those who
are desirous of following up the subject more minutely.
   Sauvages gives a case from  Conrad Fabricius, of what he calls
transverse hemiplegia, in which the disease  was confined to the arm
on one side, and the foot on the other :§  and  Ramazzini speaks of
a patient whose leg, on one side, had  lost its feeling, but retained its
power of motion, while  the other leg had lost its power of motion
but retained its feeling.||   In some  instances, indeed, the  entire
feeling of one side is said to have been lost, and the entire motivity
on the other side ;1F and  in a few rare examples persons during the
paroxysms,  and even for some time  afterwards, have felt on the
affected side, a sensation  of pungent heat from cold, and especially
* See Vol. II. p. 603.
t Ou Nervous Diseases, Vol. 11. Part I.
X Treatise on Apoplexy and Piilsy.
I Spec. Gen. xix. Ord. m. CI. vi.
|| De Morb. Artif. 286. See also Heister, Wahrncmungen. I. 20-5.
T Eph. Nat. Cur. passim. 
420                     NEUROTICA.            [CL.  1V.-OR. IV.

  olished bodies,  and of painful  cold  from an  application of  hot
  odies.
   It is not, perhaps, very difficult to account for this last singularity.
Where  the sensibility is morbidly accumulated in a weak limb, as
it often is  in  hemiplegia,  sometimes so much as to give a painful
sense of formication,  cold not  only excites action but becomes
almost as pungent an irritant as an actual  cautery ; in  the  correct
language of the poet

               —Bores penetrabile frigus adurat.*

And hence in climbing lofty mountains, as the Alps and the Andes,
the traveller  frequently finds his skin  more  completely blistered
from the sharp cold by which he is surrounded than by an exposure
to an equinoctial sun.   On  the  contrary, the  morbid halitus  or
perspiration into  which the application of hot bodies  often throws
a  limb, in  the same relaxed  and  debilitated state,  produces  an
unusual sense  of  coldness in consequence of the evaporation.   And
we may hence explain the  singular case recorded by Dr. Falconer,
of a gentleman who  after a paralytic attack, felt Jus shoes very hot
when he  first  put them on, and gradually become cool, as they
acquired the  warmth of  his feet;  the reaction,  and consequent
increase of moisture thrown forth  from  the surface  of the feet
producing the difference of sensation.
   In the Transactions of the Medico-Chirurgical Society! there is a
very singular case of Dr. Viesseux, who was gradually attacked with
an imperfect  hemiplegia  which at first  showed its approach by
perturbed sensations, and vertigo, with a feeling of sea-sickness, a
sight  of objects reversed,  a difficulty in swallowing liquids, and a
total loss of voice, while the powers of the mind  remained unim-
paired,  so that he could watch all his symptoms.  Shortly after this
the whole of the right side  became utterly insensible, the insensible
part being divided from the sensible  by a  geometrical  line running
down  the body in a vertical direction: and in about three  months
more  the insensibility of the right side of the head, accompanied
with a debility of all the voluntary muscles, was transferred to the
left, the right re-acquiring its antecedent powers ;  but all the right
side below the head  still continuing  to possess its former torpitude.
Here, also, there was a very different sense of heat and cold on the
opposite sides;  for  whilst the  left was  influenced naturally,  the
right had the falsified sensation just noticed in Dr.  Falconer's  case,
so that in getting into a cold bath or a cold bed,  the right side had
a  feeling  of heat, while the left side felt cold, as it  should  do.
Hot bodies in like manner, felt cold to the diseased  side, apparently
from the cause just stated.   And  that this was the real cause seems
manifest from  the patient's  having often a feeling of a cold dew, or
I
* Virg. Georg. i. 93.
+ Vol. Vii. p. 216. 
«E. VlII.-SP. VI.]       NERVOUS FUNCTION.
421
of cold  water on the surface, and especially over his face, which
induced him to wipe himself as if he had been wet.  It is, perhaps,
more singular, that though plunging his right or affected hand into
cold water gave him a sense  of lukewarmness, plunging it into
boiling water gave him a disagreeable sensation, but very different
from that of either  heat or  cold.  This sensation seems  to  have
been that of numbness, and was probably produced in consequence
of  the  accumulated  sensibility  being  rapidly carried off by the
extreme heat of the water,  as a like torpitude is produced by the
opposite effect of  extreme cold, and the rapid  exhaustion of sensi-
bility which is so well known to follow on its application.
  This  morbid disturbance and  irregular  distribution  of sensorial
power is sometimes productive of the most  alarming consequence :
for in a hemiplegic state of the bowels some  parts are, in certain
cases, so  acutely  sensible, and others  so  utterly insensible, that
while ordinary purgatives are incapable of exciting evacuations from
the  torpitude and irresponsibility  of the palsied parts, they are
sufficient to occasion  inflammation,  and  have actually occasioned it
in  the parts exacerbated  by accumulated  sensibility,  as  certain
experiments of M. Magendie  have sufficiently established.
  It is owing to the same irregular distribution of sensorial power,
where every department of the nervous system participates in the
diseased state  of the sensorium, that we sometimes behold hemiple-
gia, and particularly imperfect hemiplegia united with other affec-
tions of the same  system.  The  symptoms  of hypochondrism are
peculiarly apt to associate  with it, in which case the  bravest hero
will often lose  all  his magnanimity  and  sit  down  and weep like a
child: and in the celebrated  geologist M.  de  Saussure, we find a
still more complicated instance of hemiplegia, hypochondrism, and
chorea.   The disorder crept on by imperceptible degrees, and was
accompanied with various anomalies.   Both sides were  weakened,
but the  left suffered chiefly: yet, by the aid of a stick, he could
still drag  forward  the  left  leg.  By some  unknown means he had
taken up a morbid notion, very common to hypochondriac patients,
of  the  difficulty of passing  through a  door-way  when  wide open
without being squeezed to death ;  and hence, at the  very time m
which he could cross his room with a tolerably firm step, the mo-
ment he reached  the door, which  was of  capacious  breadth and
thrown  open for his passage, he tottered  and precipitated his mo-
tions with the jerk of a St. Vitus's dance, as though he  were prepar-
ing for the most perilous leap : yet as soon as he had accomplish-
ed  the arduous undertaking, he again became collected, and passed
on  with comparative  ease till he had to encounter  another  adven-
ture  of the same kind  which was sure  to try  him in the same
manner *  Tulpius  gives a somewhffrsimilar case in  which hemi-
plegia was united  with beribery.!

                  * Medico-Chir.  Trans. Vol. vn. p.  214.
                  t  Lib.  iv. Cap. 5. 
 422                     NEUROTICA.          [CL. IV.-OR. IV.

   Paraplegia or the second  variety of palsy, has generally been
 conceived  to depend altogether upon a diseased affection of the
 spine in its bones, ligaments, or interior, most frequently in the re-
 gion of the loins ; in consequence of which  the spinal marrow  be-
 comes  pressed upon, or  otherwise  injured, independently of  any
 complaint of the brain.  That this is a common cause is unquestion-
 able, and a cause that often operates long without external signs:
 for the vertebral  extension of the dura mater may be thickened,
 or a serous fluid effused, or blood be extravasated within the verte-
 bral cavity; or a tumour may be  formed in some part of it, or the
 spinal marrow itself may undergo some morbid  change.   But  the
 best practical observers of the present day concur in opinion that
 paraplegia, like hemiplegia, is produced  still  more  frequently by
 causes operating on the  brain than confined to the  spine.  Of  this
 opinion is Dr. Baillie, who ascribes  it chiefly  to pressure on  the
 brain,* Sir Henry  Halford, Sir James Earle, and  Mr. Copeland.!
 Some kind of affection of the head,  indeed, will  commonly be dis-
 covered from the first, if we accurately attend to  all the symptoms ;
 some degree of pain, or  giddiness,  or sense of  weight  or undue
 drowsiness, or imperfection in the sight.  And  hence, many of the
 causes of paraplegia are evidently those of hemiplegia, operating
 probably upon a  different part of the brain.
  This form  of paralysis may take place at any age, but it is more
 frequent as we advance  beyond the middle of life ; and Dr. Baillie
 has observed that  it occurs oftener in men than  in  women; for
 which it is by no means difficult to account, considering the  great-
 er hurry and activity of life pursued by the former.  The disease,
 in many instances,  makes an insidious  approach.   There is at  first
 nothing more than a slight numbness in the lower limbs with an ap-
 pearance of stiffness or awkwardness in the motion  of the muscles :
 these symptoms increase  by degrees; there is  great  difficulty in
 walking, and  an inability in preserving a balance  ; the aid of a staff
 or the arm of an assistant is next demanded: and  the urine is found
 to flow in a feeble stream, or  perhaps involuntarily.   The bowels
 are at first  always  costive ;  but as the sphincter  loses its  power of
 constriction, the motions at length pass off involuntarily.  The dis-
 ease may continue for years, and the patient at  last  sink from gene-
ral exhaustion.   It sometimes, but rarely, terminates in a  recovery.
  When an injured or  diseased state of the spine  is  the origin of
paraplegia, the complaint shows itself suddenly, or makes its advan-
ces insidiously according  to  the nature of the cause: and  for  a
knowledge  of this  form  of the malady we  are  chiefly indebted to
Mr.  Pott,J  who, however, does not  think that  it properly belongs
to the  species paralysis, though  there seems no sufficient  reason
  * Trans. Med. Vol. vi. Art. ii.
  t Treatise upon the Symptoms and Treatment of the diseased Spine.
  X Remarks on that kind of Palsy of the lower limbs which is frequently found
to accompany a curvature of the spine. 3vo.  1788. 
GE. VIII.-SP. VI.]     NERVOUS FUNCTION.                423

why it should not be so arranged, as in  truth it has been  by most
pathologists from the  time of Galen, who seems not only to have
understood its nature, but to have contemplated it in this view.*  It
sometimes happens,  that one or more vertebrae have been  pushed,
by sudden force, a little way out of their proper position; and in
this  case a considerable  degree of numbness, together with  less
motion in one or both  the lower limbs, is almost sure to follow, too
often succeeded by a paralysis of the sphincters of the rectum  and
bladder,  and  consequently  an involuntary discharge of feces  and
urine : and if the luxation should take place in the dorsal or cervical
vertebrae, the organs of digestion may all, more or less, suffer, the
respiration become affected, and the spine itself exhibit a conside-
rable  degree of curvature.  And  the  same  effects  are  still more
likely  to  follow, and even to a  greater extent and with still more
serious mischief, from an idiopathic affection of some part of the
spinal  chain, arising from scrophula, inflammation, or caries ; from
compression by some  effused fluid,  or a thickening of its  external
tunic,  or even of the substance of the spine itself; of which last M.
Portal has given a singular example.!
   In the last case the  disease, for the most part, makes its approach
slowly,  and  is  often found in weakly, and  ill-nursed infants.  Its
precursive symptoms  are commonly languor, listnessness, weakness
in the knees and a pale and shrivelled skin.   As it advances, there
is a  difficulty in directing the feet  aright when walking,  the legs
involuntarily cross each other, and  the little patient is perpetually-
stumbling upon level ground, till at  length he  is incapable of walk-
ing at all.  In  adults the progress of the disease is more rapid  than
in childhood.
   Like hemiplegia,  this variety is sometimes connected with a mor-
bid state of the mental powers, and particularly  with hypochondrism,
and  this too where  the  disease proceeds from an organic  lesion of
the spine.  Dr. Cooke has an instructive case in illustration of this,
in an officer of the army, aged forty-five, who had for many years been
exposed to the hardships of a military life, particularly to extremes
of heat and cold in  various climates.  " For  two or three years
previous to the paralytic attack, he  had complained that his state of
health was deteriorated, although no  precise  symptoms of disease
could  be pointed out either by himself or by his medical friends.
His  appetite was good, his bowels  regular, though inclined to cos-
tivenesi, and his usual robust appearance  was not diminished.   He
entertained some fanciful notions respecting the state of his health :
and from some uneasy sensations about the sacrum he supposed that
he had internal hemorrhoids, though no evidence of their existence
could  be perceived  by his physicians, by whom he was considered
as hypochondriacal."  After having suffered for two or three years
he gradually lost the power of walking  without some support for
* De Locis affectis, Lib. iv. cap. vi.
t Anatomic Medicale, p. 117, 
424
NEUROTICA.
[CL. IV.-OR. IV.
one of his hands.   He went to Bath and had the hot water pumped
upon his loins :  soon after which he complained of pain in the lum-
bar region, which  was followed by a collection of fluid behind  the
great trochanter of the  left side, which  burst externally, and was
discharged daily,  in considerable quantity.  The paraplegia was
now complete:  the lower extremities being quite useless: the feces
and  urine, which, for a  considerable  time,  the  patient had with
some difficulty  retained,  came away involuntarily:  h s strength
rapidly wasted; he became much emaciated; and, at the  end of
three months after his return from Bath he died;  retaining the  use
of his senses  and his intellectual faculties to almost the  last instant
of his life."*
  Local palsy is often produced by the general causes of the other
varieties, probably operating in a less degree or more partially on
the brain.  We have already seen that it frequently takes the lead,
and  appears  for some days or weeks  antecedently,- in  an imper-
fect  movement of  the tongue, or of one eye, or of one side of  the
mouth, sometimes of one or more  of the fingers, or of an entire arm.
And  if,  in this  incipient state of the disease, proper evacuants, or
other means, be instantly had recourse to, the paralytic tendency
may be subdued, and the complaint be  limited to these local affec-
tions, and in a few days be entirely removed.
  This  variety, however, is often the effect of other causes tending
to destroy the irritability  of the nervous system such as exposure
to certain metallic fumes, or  other means of absorbing metallic
particles, especially those of mercury,  and lead : and above  all  ex-
posure to keen blasts of cold and damp air.   This last is perhaps the
most common and effective cause of local palsy, and  is  peculiarly
operative where the limb or organ so  exposed is  in a state of re-
laxation and perspirable moisture, whether from previous exercise,
or great  heat of the atmosphere.  A palsy on one side of the mouth,
of the muscles of  one eye, of  one of  the  cheeks, of an arm or a
leg, is in this manner frequently produced, and becomes, at times,
of very great obstinacy.  Occasionally, indeed, the  torpitude  ex-
tends much further than to a single  limb, and  various organs  are
involved in its  mischief.  " A watchman," says Dr. Powell,! " on
quitting  his duty  after  a night of severe cold,  was attacked by
sudden and violent general pains in his  limbs, which soon departed,
and left him in  a state of universal palsy of the muscles of voluntary
motion.   He  had lost all command over the muscles of his limbs or
trunk ; but the joints were unaltered in their external appearance :
they were perfectly flexible ; and it gave him no pain if you  moved
them in  any direction.   The sphincters also  of  the rectum and
bladder  had lost their usual powers of retention, and he passed both
stools and  urme involuntariry and unconsciously.  His circulation
was not affected in any cognizable degree, and his mind retained its
* On Nervous Diseases, Vol. n. Part. i. p. 4".
* Med. Trans. Vol. v. p. 105. 
 GE. VIII.-SP. VI.]     NERVOUS  FUNCTION.                  42.1

 usual powers.   His voice was not lost:  the hot bath and other reme-
 dies were tried in vain ;  he died : but, on examination there was
 no congestion, or effusion, or alteration of structure of any kind dis-
 coverable."
   In the treatment of palsy, it is necessary to distinguish between
 its attack and its confirmation, and as much as possible to ascertain
 the nature of its predisponent and exciting cause.
   Generally speaking, in hemiplegia,  and very frequently in para-
 plegia, and even  in local palsy, the causes of apoplexy are those of
 the present affection.  And as of these causes, compression of the
 brain  has appeared  to be  by far the  most frequent in the  former
 disease, so we  ought to regard it, and  shall generally find it, in the
 latter.   And  hence,  copious  bleeding,  and  purgatives,  not only
 recommend themselves to us from the  good effects we have already
 seen them produce in apoplexy,  but from the actual and  general
 advantage which  has been  derived from them in  palsy  itself.  Mr.
 John Hunter was so  fully convinced of the benefit of sanguineous
 depletion, that  he made it his unicum remedium, though he allowed
 of cathartics subordinately.  Upon this subject, however, he writes
 with more force than discrimination.  Referring to the stimulant plan
 pursued  by some, practitioners, he observes, " this is even carried
 further than blistering," to which he also objects:  " We hardly see
 a man taken with all the signs of an apoplexy, where a paralysis in
 some part takes place, or hemiplegia, but he is immediately attack-
 ed with  cordials,  stimulants, electricity, &c.  Upon a  supposition
 that it  is  nervous debility, &c.;  the  poor body  is  also tortured
 because it cannot act, the brain not being in a condition to influence
 the voluntary muscles.  We might, with exactly the same propriety,
 stimulate the  fingers  when their  muscles are  torn to pieces.   We
 ought  to bleed at once very largely, especially from the temporal
 artery,  till the patient begins to  show  signs  of  recovery, and to
 continue  it till he may begin to become faintish.   We should give
 saline purges  freely to diminish impetus, and  promote absorption;
 then quietness should be enjoined, and as little exercise of body as
 possible,  and especially to avoid coughing and sneezing.   Plain food
 should be directed, and but little of it."*
   All this is excellent, as a  general rule ; but,  the rule  must admit
 of exceptions.   In treating  of  apoplexy we  have  noticed it as de-
 pendent on two very different and opposite states of the constitution,
 an etonic and an atonic.  And the  same diversities of constitution
 are to be found  in  paralysis.  Now under the entonic state  there
 can  be  no question, and  there  ought  to be no exception:  and
 the  boldness  of the  practice should be regulated by the  nature
 of the exciting cause.   Where  this is over eating  or intoxication,
eighteen or twenty ounces of blood may be  taken away, with  ad-
vantage, at once ;  in a few  hours after, twelve or  fifteen ounces
more ; and the venesection may be repeated a third  or even a fourth
        * On Blood and Inflammation, p. 213.
VOL. HI.              54 
420"
NEUROTICA.
[CL. IV.-OR. 1>.
time, if necessary.  Dr. Cross pursued this active plan, in the case
of a man thirty-five  years  old  who became hem'plegic from ex-
cess of drinking, and at the same time  gave  calomel to the amount
of twenty-five grains  to a dose, and  in a few  days effected a com-
plete cure*  And similar instances of success are to be found in all
the writers  upon the  subject.
  Even in atonic apoplexy, it  has been observed  that venesection
is occasionally necessary;  and it may be equally necessary in atonic
paralysis ; for here also effusion  may take place  both of blood and
serum: of serum, indeed,  more  frequently  from  deficiency than
from excess of vigour; and of blood, from a  debilitated stale  of the
vessels, and  their greater facility to be  ruptured  from slight causes,
as a violent fit of coughing or sneezing, of joy or terror.  Absorption
may not easily take place in this state of constitution, but emptying
the vessels alone will gain space by  stimulating  them to contract
their diameter.
  I cannot  better illustrate  this, than by  the following case from
Dr.  Abercrombie:  "  An old and  very poor woman,  aged  about
seventy, thin, pale, and  withered, having gone out to bring  water
from one of the public wells, on the morning of the second  of July,
1818, fell down  in the street speechless,  and  completely paralytic
on the  right side.  Nothing was done till  about  two p.m., when she
was found stupid, but not comatose, yet completely speechless and
paralytic: her pulse of  good strength,  and  about ninety-six.  She
was bled to  fifteen ounces.   Purgative  medicine  was  ordered, and
cold applications  to the  head: on the third she was  considerably
improved both in speech  and  motion;  but  having become rather
worse at night, the bleeding was repeated, and the purgative medi-
cine continued.   From this time  she improved gradually : at the
end of a week she was  able to  walk with a little  assistance, and
speak  pretty distinctly,  and by  the end  of another week  she had
entirely recovered her  former/ health."!  Nothing could be more
judicious than this treatment, and the  result corresponded with the
views of the enlightened practitioner.  There can be no doubt that
in this  case  a vessel  had suddenly been  ruptured : the labour in
which  the patient was occupied was  violent, the season was that of
the surnmor, and the  temperature probably  very  hot; the stupor
and state of the pulse  equally indicated compression of the brain.
  Thus far  bleeding may be allowed, and indeed, ought to be im-
peratively enjoined.   But there are some cases in  which it is alto-
gether a venture, and others in which it is  allowed on all hands to
be  injurious.  Even  Mr. Hunter himself recoils from the practice
where  hemiplegia is apparently a result of  retrocedent gout:  and
if we follow up the spirit  of this forbearance, we shall be induced to
abstain equally in all  instances where there  is a  like  diminution of
sensorial power—in all instances of atonic paralysis, let the  exciting
* Thomson's Annals of Philosophy, No. XLiv. p. 121.
t Treatises, &c. p. 15. 
 OK. VIIl.-SP. VI.]     NERVOUS FUNCTION.                427

 cause be what it may, where there is no stertor, no stupor, or ver-
 tigo, no convulsion or other irregular nervous action, and the pulse,
 instead of being firm,  is feeble and intermittent.  For it  should
 never  be  forgotten that, if many  patients have recovered after
 bleeding, in suspicious circumstances, others have  died after it, and
 probably in consequence of it, while great numbers have  derived
 no benefit whatever.   The advice of Dr. Cooke upon this subject
 is therefore founded in the truest wisdom, and cannot be too exten-
 sively  committed  to  memory: "  Each individual  case must  be
 viewed in all  its circumstances, and by a  careful consideration of
 them our practice should be regulated.   Before we prescribe blood-
 letting in hemiplegia, we must investigate the age, strength, gene-
 ral constitution and habits of the patient, and above  all the actual
 symptoms of the disease.  In early  or even in somewhat advanced
 life, if plethora  and  the various symptoms tending to apoplexy be
 present I should not  scruple to bleed freely  both generally and
 topically.  On  the  contrary, in great age, debilitated, leucophleg-
 matic  habit, dropsical  tendency, &c. I should think it right  to ab-
 stain altogether from this and from every other powerful mode of
 depletion, unless there be  an evident determination  to the head,
 marked by  flushing  in the countenance, throbbing of the arteries,
 redness of the eyes."*
  In purging we may proceed with less restraint: for even in de-
 bilitated and dropsical habits, stimulating the bowels is almost uni-
 formly found useful: should there  be  serous, or even  sanguineous
 effusion, absorption  is hereby powerfully promoted ; and if there
 be none, a beneficial revulsion will  often be produced, and the sti-
 mulus  will always be one of the most  useful we  can  adopt.  In a
 very debilitated state of the constitution, however, we should chuse
 the warmer in  preference  to  the colder purgatives ; and hence ja-
 lap, colocynth,  or even aloes in preference  to neutral  salts :  and it
 will also be serviceable to combine them with some distilled  water
impregnated with an essential oil, as mint,  penny-royal, juniper, or
 rosemary.
  The next reducent remedy, worthy  of notice, is emetics.   If we
 have strong reason  to apprehend a sanguineous effusion, this class
 of medicines ought  not  to  be employed for  a  few days, and will
 hence always be doubtful in the first attack of entonic hemiplegia, as
 we have already observed they are in entonic apoplexy.  But if we
 have no ground of such suspicion, they cannot be had recourse to
 too soon.  In  a certain sense they weaken, but they  are at the
 same time among the most powerful indirect  tonics that can enter
into  our practice.   They rouse the system generally,  solicit the
 torpid fibres to a resumption of activity, stimulate  all the excreto-
 ries, and especially those of the surface of the body, and thus pro-
mote absorption in every quarter and in every way.
  In low or atonic hemiplegia the practice of Stoll was founded on
* On Nervous Diseases, Vol. ii. Par. i. p. 141. 
428                     NEUROTICA.            [CL. 1V.-OR. IV.

the most rational principles.   He first  checked the hemiplegia by
emetics, and then carried it off by external and local  stimulants, as
cantharides, in conjunction with pills of gum ammonia, myrrh, and
aloes.*
  Such, under  different modifications, is the reducent course it
seems proper to pursue in  the general  train of paralytic  attacks
when they first make  their appearance.  If this course succeed,
the patient will soon recover, and,  with a  view  of  preventing a
relapse, a further reducent or tonic  regimen, according to  the na-
ture of  the  case  as we have already noticed in the treatment of
apoplexy, is all that we shall have further to prescribe.
  But this course may not succeed : the disease may prove obstinate
and become  confirmed; and the practitioner be called upon to
proceed further.
  Having removed, as far as we may be able, all pressure upon the
sensorium, and so far given an opportunity of healthful  play to its
function, our next  business is to re-invigorate its general energy,
and extend it to the parts which it has ceased in  a greater or less
degree  to actuate.
  Stimulants external  or internal, or both, have  been almost uni-
formly had recourse to for this purpose :  but I cannot avoid think-
ing that the practice  has  been too indiscriminate, and, in many
cases, far too precipitate.  We have observed that in  many cases of
hemiplegia there is not only great local inactivity, but great irre-
gularity of action ;  a tumultuous hurry of sensorial power to some
parts, v/ith an equal withdrawment of it from others.  In all such
cases we should proceed gently and palliatively rather than  rapidly
and forcibly :  and  to  do nothing is better  than  to  do  too mnch.
We should endeayour to allay the nervous commotion, and  restore
the agitated system to order by internal and external quiet of every
kind.  The patient should  be kept as still  as possible in a warm
commodious bed and a  well  ventilated  room.  His diet should be
plain, with the allowance of a moderate  quantity of  wine, or wine
and water.  Camphor, musk, valerian, and other warm sedatives, as
ammonia, neutralized with citric acid, are here to be  chiefly resort-
ed  to, if,  indeed, we resort to medicines  of  any kind, and to these
may be added the less stimulant metallic salts, and especially those
of zinc  and bismuth.  The  warm bath may be allowed two or three
times a week, and  if the nights  be  restless the inquietude  may be
subdued by hyoscyamus.  And as this form of the disease is  often
connected with great general debility and a  tendency to  hypochon-
drism or lowness of spirits,  cheerful and  exhilarating conversation,
and such  occasional exercise in a carriage  as may be indulged in
without fatigue, will form very serviceable auxiliaries.  In Pechlin!
is to be found the case  of a  person called Peyreske,  who is said to
have been cured of a palsy accompanied with aphonia, by  reading
* Rat. Med. Part n. p. 92.
t Lib. m. Ob?. 27. 
GE. VIII.-SP. VI.]      NERVOUS FUNCTION.                429

some  favourite  and agreeable  authors.  This may be an  over-
statement, or too much stress may be laid on this particular part of
the general plan of treatment: but there can be no doubt that, in
the form of the  disease we are now contemplating, a gentle and
insinuating amusement of this kind will not be without its effect.
  This tranquillizing and unostentatious plan I have found to answer
wonderfully in many cases of that tumultuous and irregular action
described in the preceding history of the disease before us.   But
where the case  seems  altogether confirmed and chronic, and an
entire side, or some other extensive  part of the body, shows a  fixed
loss of sense  and voluntary motion, while  every  other part has
resumed  its  healthy function,  we  may  then,  with safety,   have
recourse to the stimulant practice.
  This will consist of external and internal irritants,  and Dr. Cullen
has given a long and useful table of bolh.  Of the former, the  chief
are friction by the hand or a flesh-brush ;  stimulating liniments pre-
pared of the concentrated acids,  or the caustic alkalies inviscated in
oil or lard to render them less acrid and corrosive ; brine or a strong
solution of sea-salt;  the  essential oils of  turpentine, or other tere-
binthinate  substances;  and various  vegetable  acrids as mustard
garlic, and cantharides, or other blistering insects.   The object of
all these is the same :  it is that of acting  upon the origin of the
nervous chain by stimulating it at its extreme end, and as we  have
numerous instances of the production of such an effect in a  great
variety of cases, particularly in those of trismus and lyssa, or canine
madness, the principles of which we have endeavoured to elucidate
under these diseases, we have reason to expect a like influence, and
of a beneficial instead  of a morbid kind,  in the applications before
us.  Generally speaking, however, the irritation produced by  a use
of many of the  siliquose  and alliaceous or alkalescent plants, as
mustard,  horse-radish, and garlic, is  more uniformly  efficacious than
that  of cantharides; as the irritation excited is more  considerable
and of longer duration.   Dr. Cullen tells us that he has reason to
believe the use  of liquid styrax in  the proportion  of one part to
two of the  old  black basilicon, a favourite  empirical  composition,
" has been of remarkable service in paralytic cases, and particularly
in a debility of the limbs following rickets."*
  Many practitioners have, for the same purpose, been in the  habit
of burning moxa or cotton on different parts of the affected side.
Dupuytren employed the  former, and Pascal! the latter; and  both,
as they tell us,  with great advantage.  Others have thought they
derived more  service from a  repeated  use  of sting-nettles.   Some
again have employed issues, others  setons, and others  the potential
or even the actual cautery.  This last mode  of treatment, however,
is best calculated for that form of hemiplegia produced by a diseased
spine.  Mr. Pott found the use of caustics applied on each side of

              * Mat. Med. Vol. n. Part n. Cap. v.
              t  Journ. de Med. Tom. lxvi. 
430
NEUROTICA.
[CL. IV.-OR. IV
 the  spine peculiarly serviceable,  and they have  been in common
 employment ever since.
   In the rank of external stimulants we are to arrange electricity
 and  voltaism.  From the approach which these subtile lluids seem
 to make to the  nature of the nervous power, as we have already
 observed in the  Physiological Proem to the present class, and more
 particularly from  their well known  and extraordinary  power of
 re-exciting1 irntabil:ty  in the muscular fibres of animals that have
 been for some time dead, it was  very  reasonable to suppose that
 either of these  stimuli might be employed with very great advan-
 tage : and accordingly  we  meet with them in  very extensive  and
 popular use from the earliest periods of their  having been, if not
discovered,  at least reduced to scientific management;  and have
 numerous reports  of cases in which the former was tried,  and in
 many instances with advantage, rather before the  middle of the last
 century.*  In various experiments there can be no doubt that both
 have been found highly beneficial, but in various cases also both
 have been made use of in vain,  and in a few instances,  with appa-
 rent disadvantage.   To run over the  list of those  who have  chiefly
 espoused, and those who  have chiefly opposed their employment,
 would  be useless.   It is of  more  importance to  know that a very
 great number of physiologists and pathologists who employed them
 most extensively, and particularly in the form of electricity,  for the
 fluids are most probably one and the same, and who were at first
 most sanguine of  success, gradually lost  their confidence  as they
 proceeded, and confessed their general failure ;  and candidly owned
 that, where  for a time  they promised fair and seemed to be  of use,
 the  benefit  was  delusive  and merely temporary.   And the  author
 now alludes to the distinguished names of Franklin, Percival, Cavallo,
 Falconer, Quarin, Stoll, and  Saus.
   The fact seems  to be that, even at this late period of trial, we
 are greatly in the dark  upon the subject, and have  not learned to
 discriminate the exact  modifications of the disease, or the exact
 modifications of  electric power in which alone this active stimulus
 may be employed with advantage :  for that in both forms it  has
 been occasionally of very high benefit is by no means to be disputed :
 and even at times when communicated by the gymnotus electricus or
 electric eel itself, of  which a singular example  is given  in  the
 Haerlem Transactions;! the patient having  recovered the  use of
 the affected side after  a hundred strokes from the fish.   Upon the
 whole, as it is a  direct stimulus, it appears better adapted  to  the
 atonic than the entonic character of paralysis.
   Hot and cold bathing are the  next external stimulants we are to
 notice as applicable to the disease before us.  The stimulus of hot
  *  Memoirs del'Acarlemie des Sciences, 1749, p. 40.
    Jallabert, Experience sur l'Electricill. Gener. 1749.
  +  Abhandlungen aus den Scriftcn der Harlemer und  anderer Hollandisrhei
H^l'sdinften.  13nnd. i. p. 109. 
GE. VIII.-SP. VI.]     NERVOUS FUNCTION.                 431

water alone is often serviceable in local palsy, and especially when
produced by cold or  damp ;  and in conjunction  with the rubefa-
cients and vesicatories we have just enumerated, or with friction to
the part affected by means of the hand or a flesh-brush, and parti-
cularly when  aided  by terebinthinate  or other essential oils,  will
usually succeed in restoring to  the  affected muscles their wonted
power.  But where the  palsy is more  extensive, as in hemiplegia
and many cases of paraplegia, it has been more usual to recommend
the stimulus of hot water in conjunction with various active mineral
corpuscles held in solution by it; and hence the  common resort of
paralytic patients in our own  country to the waters at Bath, Buxton,
and Leamington.  Hot baths of this kind are also a direct stimulus;
and as such are found more efficacious in paralytics of atonic or di-
lapidated constitutions, than in those who have suffered from  ple-
thoric or entonic fulness, or at least till they have  been  lower-
ed to  the  proper standard by a long course of some reducent re-
gimen.
   Cold bathing is also a stimulant as well  as hot bathing, but a  sti-
mulant of a different kind, for it  acts indirectly instead of directly.
The intention with which it is used is  that  of forcibly urging  the
mouths of the cutaneous vessels into a general  entastic  or rigid
spasm in order hereby to excite a general re-action, as in the case
of the first and second stages  of an ague-fit, and  thus to draw  the
torpid muscles into the common  range  of association.  Dr.  Cullen
seems favourable to  this  practice  under a prudent management.
" Cold," says  he, " applied to the body for any length of time is al-
ways hurtful to paralytic persons: but if it be not  very intense,  nor
the application long continued, and if at the same time the body be
capable of a brisk re-action, such an application of cold is a power-
ful stimulant of the whole system, and has  often been useful in cur-
ing palsy.  But if the  power of re-action in the body be  weak, any
application of cold may prove hurtful."*  It is hence only necessa-
ry to add that while the  hot  mineral baths appear best adapted to
cases of atonic paralysis, cold affusion or the cold bath may be  em-
ployed with most promise of success  in accidental palsies  of  the
plethoric and  the vigorous.
   The ordinary internal stimulants are the mineral waters  we have
just adverted to, camphor and other terebinthinate substances, many
of the  siliquose  and alliaceous plants as  mustard, horse-radish, gar-
lic, and onions, and a temperate use of wine: the  whole of which,
however, are  proscribed in all cases by many writers of great emi-
nence,  and particularly  Dr.  Cullen and  Mr.  John Hunter:  and
which, if allowed at all, should be confined to the  atcnic form of
paralysis, or never be commenced in any instance  of entonic  palsy,
till the system has been  sufficiently reduced for the purpose.  And
where this has been  accomplished, such a class of remedies  has
often been found of essential service.
* Pract. of Phys. Vol. iv. mclxvi. p. 190. 
432                    NEUROTICA.           [CL. IV.-OR. IV.

  Independently of these there is, a tribe of medicines entitled al-
so to the name of stimulants, though  operating in  a very  different
manner, which have long been boldly ventured upon  by some phy-
sicians ; and, after having for many years sunk into disrepute, have
again been brought into favour, and are now in  a pretty extensive
scale of employment.   I mean several of the acrid poisons, as arnica
montana or leopard's-bane, rhus vernix, varnish-sumach, and strych-
nos nux vomica.
  All these  excite the nervous system to great agitation and spas-
modic action ; and if the dose be increased, violent convulsions, al-
ternating with tetanus, are sure to ensue:  and  hence it has been
supposed that they may be rendered  effectual in  a  restoration of
motivity to paralytic limbs.  The flowers of the arnica, or doroni-
cum, as it was once  called, were chiefly employed, though some-
times the leaves were preferred.  Dr. Collin was much attached to
the former in palsies of all kinds, and affirms that he has found them
very generally successful.  He gave them in an  infusion or decoc-
tion, in the proportion of from a drachm to half an ounce,  to a pint
of the liquid :* and, from his  recommendation, they  were, at  one
time, very generally  adopted, were  countenanced hy Plenck,  and
Quarin,  and experimented  upon by Dr.  Home.!  The  last tried
them in six  cases but  without much  success; and they  have  not
been able to maintain their  reputation : nor,  from  the  violence
and uncertainty of their effects, it is hardly worth while to revive
them.
  The rhus vernix, or varnish-sumach, is chiefly indebted  for what-
ever degree of fame it has acquired in paralysis to.the experiments
and recommendation of Dr. Fresnoi.   The  milky juice of  this plant
is so acrid as to blister the hands of those who gather ils leaves, so
that they are obliged to wear gloves.  The leaves are employed in
decoction, and in extract: and appear not only to act  powerfully
upon the nervous system, but by urine and perspiration; and hence
the plant has a claim to be considered as an active promoter of ab-
sorption as well as revellent, which may, perhaps, render it service-
able in some cases of paralysis from serous compression of the brain.
Of its benefit in  some other diseases  of  a  spasmodic or nervous
character,  and especially in  hooping  cough,  we  have already
spoken.!
   Most of the species of the rhus or sumach, contain a like pungent
acridity in their milky juices,  and hence several others of them have
occasionally been  employed for the same  purpose.   Dr.  Alderson,
of Hull, has of late preferred the leaves of the rhus Toxicodendrum,
poison-sumach, or poison-oak, as it  is sometimes, but  improperly
called: and, in many cases, of trial,  he has thought it of considera-

       * Obsetv. circa morbos acutos et chronicos. Tom. v. p. 108.
       t Clinical Experiments, Histories, &c. Edin. 8vo. 1780.
        X Vol. I. p. 358. 
GE. VIII.-SP. VI.]      NERVOUS  FUNCTION.
433
ble benefit.  He commences with  half a  grain of the powdered
leaves which he gives three times  a-day,  and  gradually increases
the dose to four or five grains till he finds a sense of tingling pro-
duced in the paralytic part, accompanied with some degree of sub-
sultus or a twitching or convulsive motion.
  The effect, therefore, produced on the nervous system by the poi-
son-sumach is weak or clonic spa«m : but there are other acrid poi-
sons which  have a tendency to produce strong, entastic  or rigid
spasm, most of which  possess an intensely bitter principle, and, per-
haps derive  this difference of effect from  the tonic power of this
very quality.  Of these the chief are the stychnos Nux  Vomica, and
the ignatia amara.  Both have hence been  employed in paralysis,
and the virtues of both seem to be  nearly alike, the former, how-
ever, has of late taken the lead  upon the  recommendation  of Dr.
Fouquier, of the Hospital de la Charity, at Paris, who has tried it upon
a very  extensive scale, and apparently with a perfect restoration  of
health in many cases.   He gives it in the  form of powder,  or alco-
holic extract: four grains of the first, and two of the last are a dose,
and may be taken from two to six times a day.  He also employs it
in injections.   In half an hour after administration the paralyzed
muscles  have,  in various cases, begun to evince contraction: and,
what is  peculiarly singular, while a  spastic  contraction  is determin-
ed to these, the sound parts remain  unimplicated in the action.   A
frequent effect, unquestionably dependent on  the bitter principle of
the plant, is that of increasing the appetite, and diminishing the
number of the alvine  evacuations when in excess.  Sometimes it
produces  a  temulent  effect, and occasions stupor and a sense of in-
toxication, and, when  rashly administered, general tetanus with all
its train of distressing and frightful symptoms.
  Like all other powerful medicines in their first and indiscriminate
use, the nux vomica appears sometimes to  have been highly bene-
ficial, sometimes mischievous,  and  sometimes to have  produced
violent effects on the  nervous system without an important change
of any kind.   Dr. Cooke has collected a variety of cases in which
it has been tried in our own country as well as in France, and this
seems to be the general result.   The present author has tried it in
various  instances, but has never been able, from its  tendency to
termulency to  proceed much more than half as  far as some practi-
tioners have gone, who have gradually advanced it from four grains
of the  powder to twenty-four three or four times  a-day.   In the
case of the late E. Sheffield, Esq.,  of the  Polygon, Somers-Town,
Mineralogist to the estates of the Duke of  Devonshire, and  who is
well known  to have been one of the best practical geologists of his
day, the author commenced with two  grains alone of  the  powder
given three times daily, as this was a hemiplegia following upon a
second  fit of atonic  apoplexy,  with a  general  debility  both of
the mental  and corporeal powers, the patient  being,  at the time,
rather  upwards  of sixty years  of age.  This  dose occasioned
no  manifest effect, and on the third day,  August '21. 1819, it was
  vol. i"-                  r>5 
434
NEUROTICA.
[CL. IV.-OR. IV.
 gradually  increased  to six grains.   It now produced  a powerful
 sense of intoxication, but with clonic agitation instead of a tetanic
 spasm, of the paralyzed leg and arm, and great heat down the whole
 of the affected side.  The powder was continued in this proportion
 for three or four days, but the stupor and  vertigo were so conside-
 rable and afflictive that the patient  could not be persuaded to pro-
 ceed with it any longer, and it was in consequence suspended.  On
 the  ensuing September 1,  he was  evidently getting weaker,  and
 recommenced the medicine at his own desire ; the dose was gradu-
 ally raised from four  to six grains three times a-day:  the same clonic
 effect was produced  with  the same sensation of heat through  th&
 whole of the affected side, but without a sense of intoxication.  The
 dose  was  advanced to  eight  grains, when  the head again became
 affected, but without any permanent return of muscular power or
 sensation in the palsied limbs, or any other effect than a few occa-
 sional twitches and involuntary movements. Mr.  Sheffield  could
 not be  persuaded to  persevere any farther, and the medicine was
 abandoned.  He continued in the same feeble state  for about three
 months, when he  fell a sacrifice to  a third apoplectic attack  appa-
 rently of a much slighter kind.
   I have stated that this was  a case  of atonic affection, and hence,
 there was no  opportunity of  giving full play to the power of  the
 nux vomica.  But so  far as I have  seen, I think we may come  to
 the following conclusions: First, that when only small doses can be
 given without seriously affecting  the head,  as in  cases of  great
 general, or nervous  debility, the effect is a clonic instead of an
 entastic or tetanic spasm.   Secondly, that under this effect it  is  not
 calculated to do any permanent good, and  often produces mischief.
 And thirdly, that it is most serviceable in entonic hemiplegia, after
 the patient has been  sufficiently reduced from a state of high ener-
 getic  health, and  especially energetic plethora, to  a subdued and
 temperate state of pulse ;  in which state  it may very frequently be
employed in doses sufficient to excite strong or entonic instead of
 weak or clonic spasm.
   From this history of treatment, it is obvious that nervous agitation,
proportioned to the mode of  the  disease  and the strength of the
patient, has often  been of peculiar advantage ; and  hence, we are
the more  easily prepared for hearing that palsy has occasionally
been  carried  off  suddenly  and spontaneously by a violent fit of
mental emotion, as of anger* or fright,! of both which the examples
are very numerous ; by a stroke of lightning ;| and by fevers.§  Nor
* Camerar. Memorab. Cent. v. No. 30.
  Paulini, Cent. m. Obs. 89.
  Schenck, Observ. Lib. I. No. 182.
t Diemerbroeck, Observ. ut Cur. Med.
  Locffter, Beytrage zur Wundarzneykunst. Band. 1.
X Wilkinson's Case of Mrs. Winder, 8vo. 1765.
} Act. Nat. Cur. Vol. v. Obs. 64.
  Sarnrnl. Medicinischen Wahrnemungeii. Ban,d. vi.p. 152,. 
OE. VIH.-SP. VI.]        NERVOUS  FUNCTION.              435

can I do otherwise than think that  one of the most rational and
efficacious  means  of cure  in  many instances  of paralysis, and
especially where no great inroad has been made upon the general
strength  of  the constitution, would be a journey into the Hundreds
of Essex  or some other marshy district, for the purpose of obtaining
a sharp attack of a tertian ague, which  would most effectually, and
I apprehend at the least expense, give us all the advantage of en-
tastic spasm and reaction in regular and repeated tides,  that we
could wish for, and which have already appeared to be so desirable.
In treating of the tertian intermittent, we  observed from Dr. Fordyce,
that it has  often a  tendency to  carry off a variety of obstinate and
chronic diseases to which the constitution has  been long subject,
and to restore it to the possession of a better and  firmer degree  of
health.   And where paralysis is capable of removal, there seems to
be  few  complaints on which it is likely to  operate  with a more
favourable  issue.  The author has for some  time  been waiting for
an opportunity of  making  the  experiment, and at present merely
throws out the hint with much deference to  the medical world at
large.
   In a few cases hemiplegia is said to  have ceased spontaneously
by the mere remedial energy of nature, and  without any apparent
icause of cure ;  in  one instance after ten years standing, and  accom-
panied with loss of voice.*   And in a few cases  of paraplegia from
external  injury to  the spine, where only one or two vertebae have
in a  small degree been displaced from  their proper position,  the
same  instinctive or remedial power has alone produced a cure or
greatly alleviated  the mischief by so far thickening the growth of
the bones immediately above  and below that the chasm has been
filled up, and a line of support restored.
   It is only necessary to add further,  that  where local palsy has
been  produced  by the  fumes or  minute divisions of lead or other
noxious  metals, it is almost always accompanied with symptoms of
colica Rhachialgia, or Painter's colic, and is to be  remedied by the
treatment already  laid down under that disease.!
* Bresl. Samml. 1721.—p. 406. 503.
+ Vol. I. p. 132.
END OF VOL. III. 
 
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