Body: | A Treatise on Madness
William Battie
1758 AD
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William Battie
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Monro, 1758 AD
A Treatise on Madness, William Battie, 1758 AD
"Battie's Treatise was a turning point in the medical approach to mental
illness. His division of madness into `original' and `consequential'
illnesses are forerunners to the `organic' and `functional' terms used to
this day, and his promotion of therapeutic optimism through engagement with
the patient, rather than restraint and other physical affronts, prefigured
the `moral therapy' of the Tukes at the York Retreat later in the 18th
century." (William Battie's Treatise on Madness (1758) and John Monro's
Remarks on Dr Battie's Treatise (1758) - 250 years ago, Andrew Morris,
British Journal of Psychiatry, 2008)
"William Battie (1703-76) A Treatise on Madness (1758), A: pp. 41-44, B:
pp. 68-77, C: pp. 93-99. Battie's work was the most important influence on
the treatment of madness in the eighteenth century before the founding of
the York Retreat in 1792. He trained at Cambridge, became a governor of
Bethlem Hospital in 1742, and in 1750-51 was a leading figure in the
founding of St Luke's Hospital for Lunaticks, serving as its first
physician until his retirement in 1764. Battie's achievement stands out
clearly in his short, pointed, and controversial Treatise on Madness. He
was among the first to try to dispense with the multiplication of labels
for madness- melancholy, spleen, vapours, and so on-and preferred two
simple categories: 'Original Madness', where there was some physical defect
from birth, and which was generally incurable, and 'Consequential Madness',
which followed upon some injury or external cause, and which would usually
respond to treatment. This distinction, together with his insistence on the
root cause of madness as 'deluded imagination', which allowed the patient
to judge right on wrongly perceived evidence, had profound implications.
Madness could now be seen as individual: it was brought about by something
specific in the individual's life or personality, and its form and progress
derived from the nature of the individual imagination. Battie therefore
demanded confinement as a prerequisite for cure. The patient was to be
removed entirely from the context wherein he or she had become mad,
including family, friends and external pressures. Only in such a state of
asylum could treatment have a chance of success. Moreover, Battie dismissed
a wide range of conventional treatments, as in extract C below, asserting
that management, by which he meant a temperate and ordered mode of living
within the regimen of the asylum, would do more than medicine, and that any
application of medicine should be judged according to the needs and
constitution of the patient. He also took in pupils, including Sir George
Baker, who became physician to George III, thereby stimulating the
development of a professional line of psychiatric practice which Bethlem,
with its father-to-son tradition, had always deliberately eschewed. The
example of St Luke's itself instigated the asylum movement throughout the
provinces, with hospitals opening in the north east in 1765, in Manchester
in 1766, York in 1777 and Liverpool in 1790. Ironically, Battie published
no case histories and included no examples in his Treatise, yet did more to
make attitudes towards the mad more open and less prejudiced than any other
physician of the period." (Patterns of Madness in the Eighteenth Century, A
Reader, Allan Ingram, 1998 AD, p112)
A Treatise on Madness William Battie, 1758 AD
Scanned text from the original book:
proofreaders Note: In the 18th century, an "f" was used in place of an "s".
"fs" was used in place of "ss".
Copyright 1969 by Brunner/Mazel, Inc.
80 East 11th Street, New York, N.Y. 10003
Library of Congress Catalog Card Number 68-56287
Manufactured in the United States of America
INTRODUCTION
The delight of medical historians is to unearth "firsts" the first time a
hypodermic needle was used, the first case of arthritis reported, and so
on. Sometimes a first is not discovered until the one to whom the honor
belongs is dead. Such is the case with pr. William A. Battie, who lived in
England from 1704 to 1776. He, his medical accomplish-ments, and this book
form a remarkable series of firsts.
To begin with, Battle was the first teacher of psychiatry in Eng-land; some
authorities go so far as to say "in the world." Moreover he was more than a
rebel who differed with and defied accepted mid-18th century psychiatric
thinking-especially as pontificated by John Monro, the director of
Bethlehem. He was a pioneer in mental dynamics, in hospital care of the
insane, and in the writing of the first extensive book on psychiatry in
England. He abhorred the un-wholesome conditions at Bethlehem and this led
him to be one of the founders of St. Lukes' Hospital for Lunaticks in
London where he was superintendent until he left to head a large private
asylum.
Battie's Treatise on Madness is an especially important work in medical
history because it is "the first by a psychiatrist who could draw on his
experiences with a large number of patients . . ." (Hunter and MacAlpine,
300 Years of Psychiatry).
As the first psychiatrist to teach his specialty, Battie invites- nay,
implores-physicians to read his book, to study psychiatry, to visit his
institution (the first private one, incidentally, devoted exclu-sively to
the care and treatment of the insane), to accompany him on rounds, and to
make their own observations. This was the more novel because the students
were not bound by the centuries-old tradi-tion which prevailed in Bethlehem
and which was gospel for the profession.
Besides being a psychiatric first, A Treatise on Madness contains some
revolutionary (for that time) ideas, many of which are valid by today's
criteria. At least Battie sponsored "change"; to throw off the yoke of
antiquated and unproven isms and give thought to new concepts even if they
turn out to be wrong when given a clinical try-out. Today we call this
research. When one reads this book and appreciates how "modern" Battie's
medical reasoning is, it is understandable that he would be a minority of
one among his contemporary collectgues who, a dozen years after Battie's
death, advocated drastic purging, blistering of the skull, bleeding,
induction of vomiting, and other similar measures for George III in his
first attack of insanity in 1788. Certainly he treated his patients, both
at St. Luke's and at his own private hospital, more humanely than did Monro
at Bethlehem.
Among his tenets, many of them "firsts," are his (correct) antipathy
[opposition] for violent purging as treatment of the insane. He separates
each psychiatric symptom, and maintains that a definition must say what
madness is and is not. (Ask any contemporary psychiatrist to define
"psychosis" and watch his embarrassment!) . He points out that defective
sensation is not necessarily psychopathological, differentiates between
altered sensation in the normal, the somatically sick, and the insane (to
whom he correctly lends the word "delusion" to the perversion or other
change in sensation). He envisions sensory pathways and fibers dividing and
re-dividing "beyond human vision." Considering his era, Dr. Battie reveals
an astounding knowledge of neuro-anatomy. He wipes out the then current
misconception that the brain is a gland whose secretion makes sensation
possible. He recognizes exogenous and endogenous sources of sensation.
Amazingly, he preceded Freud by claiming that all sensation is, at first,
crudely received and inter-preted by the brain as either painful or
pleasurable; this is a faculty necessary "to preserve life." He points out
that if an animal holds its breath, anxiety (pain) compels him to exhale.
"Uneasy sensation leads to sickness"-certainly a clear description of
what we know as psychosomaticism.
He says that madness begins with "too active sensation" and ends with "too
languid sensation." Again, in madness, sensation is often dis-proportional
to the external stimulus (today's "over-valuation"). An unpleasant
"external object" may disrupt "natural sensation"; so may "nerve weakness."
(And Freud, W. W. Keen and others are credited as pioneers in
neurasthenia!). Precipitating causes of madness are "black November days,
unpleasant weather" and the "tempest of love, hate, and other passions."
Where protracted disease and pains persist, a reactive depression may lead
to suicide. Dr. Battie certainly proved that there is nothing new in
psychiatry.
There are many more "firsts" in this superb book. It is extremely
interesting and should be a reading reward for all who peruse it.
("A Treatise on Madness", William Battie, Introduction by James Brussel, p
v)
JAMES A. BRUSSEL, M.D., F.A.C.P., F.A.P.A.
Assistant Commissioner, N. Y. State Department
of Mental Hygiene
Director, Bureau of Historical Research
New York, November 1968
A Treatise on Madness
William Battie
1758 AD
By WILLIAM BATTIE M. D.
Fellow of the College of Physicians in LONDON,
And Physician to St. Luke's Hofpital.
LONDON;
Printed for J. WiuSroN, and B. WHITE, in Fleet-ftreet. M,DCC,LVIII. dal
c-JT
[Price Two Shillings and Six-Pence.]
T
THE MOST NOBLE
GEORGE,
Earl of CARDIGAN,
Prefident of ST. LUKE'S HOSPITAL,
THIS
TREATISE ON MADNESS
IS HUMBLY DEDICATED
B Y
HIS LORDSHIP's
DUTIFUL AND OBLIGED SERVANT
W. BATTIE.
ADVERTISEMENT.
Am. N G the many good reasons offered to the Publick, for efta-blifhing
another Hofpital for the
reception of Lunatics, one, and that not the leaff considerable, was the
introducing
more Gentlemen of the Faculty to the
Study and PraRice of one of the moil
important branches of ribisick.
The attention of those worthy citizens of London, who first planned and
pro-moted this charitable work, was carried beyond its more immediate
object. Not content with giving relief to a few
indigent persons of their own age or'
country they interefted themselves in the
care of pofterity , and as far as they
were
[vi]
were able made a more ample and effeaual provifion for that help, which all
Lunatics of whatever nation or quality must at all times Band molt in need
of.
Agreeably to this their extenfive be-nevolence, they very soon by an
unani-mous vote signified their inclination of admitting young Physicians
well recom-mended to vifit with me in .the Hofpital, and freely to observe
the treatment of the patients there confined.
A command so conformable to my own fentiments I not only molt readily
obeyed ; but, that I might answer their expeIations in this as well as in
every other particular to the utmost of my power, I moreover offered to the
perufal of the Gentlemen who honoured me with their attendance the reasons
of those pre-fcriptions, which were fubmitted to their observation.
The
[ vii
The end proposed in committing my thoughts to writing on this fubject has
induced me to publilh. Those, for whole use these papers were originally
designed, having encouraged me to hope that the same hints may be of
fervice to other Students, who have not the same oppor-tunity of seeing
practice.
Lately Publifhed,
By JOHN WHISTON and BENJ. WHITE, in ONE VOLUME
Quarto, Price I2S. Bound,
DE PRINCIPIIS ANIMALIBUS Exercitationes viginti quatuor in Theatro Collegii
Medicorum Londinenfium habitat. A GULIELMO BATTIE, M. D.
Collegii ejufdem Socio.
Nunguam aliud Natura aliud Sapientia dicit.
TREATISE
O N
M A D N E S S.
SECT. I.
The Definition of Madness.
MADNESS, though a terrible and at present a very frequent calamity, is
perhaps as little underftood as any
that ever afflicted mankind. The names alone usually given to this disorder
and its several Species, viz. Lunacy, Spleen, Melancholy, Hurry of the
Spirits, ctc. may convince any one of the truth of this assertion, without
having recourse to the authors who have professedly treated on this
subject.
[ 2 I
Our defel of knowledge in this matter is, I am afraid, in a great meafure
owing to a defect of proper communication : and the disficulties attending
the care of Lunaticks have been at least perpetuated by their being
entrusted to Em-piricks, or at best to a few Idea Physicians, most of whom
thought it advifeable to keep the case as well as the patients to
themselves. By which means it has unavoidably happened that in this
inslance experience, the parent of me-dical science, has prosited little,
and every Prac-titioner at his first engaging in the cure of Lu-nacy has
had nothing but his own natural sense and fagacity to trust to ; except
what he may perchance have heard of Antimonial vomits, strong purges, and
Hellebore, as Specifically anti- maniacal : Which traditional knowledge
however, if indifcriminately reduced to pradice, a little experience will
soon make him with he had been an entire stranger to.
There is therefore reason to hope that an at- tempt to discover the causes,
effects, and cure of Madness, will meet with a favourable reception ;
lince, whatever may be the event, the intention is is right ; and it is
same comfort to think that no-thing of this nature, even though it should
fall short of what is aimed at, can in its consequences be entirely
useless. For the judicious reader will at least be hereby inclined to turn
his thoughts to the same subject, and may even receive instrution from the
mifcarriages of such an undertaking.
But the peculiar misfortune just now mention-ed, viz. want of proper
communication, though the chief, is not the only hindrance to our
know-ledge : for Madness hath moreover (hared the fate common to many other
diftempers of not being precisely desined. Inafinuch as not only several
symptoms, which frequently and acciden-tally accompany it, have been taken
into the ac-count as constant, necessary, and essential ; but also the
supposed cause, which perhaps never ex-hted or certainly never acted with
such effea, has been implied in the very names usually given to this
distemper. No wonder therefore is it, whilst several disorders, really
independent of Madness and of one another, are thus blended together in our
bewildered imagination, that a treatment, rationally indicated by any of
those disorders, should be injudicioufly directed againft Madness itself,
whether attended with such fyrnp-toms or not. Much lets can we blame the
Phyfician, who being prejudiced by the supposed cause couched in the name
of the distemper he has to deal with at every new or full Moon attenuates,
evacuates, or alters the peccant hu-mours by medicines peculiarly adapted
to the black or fplendid Bile, ctc.
In order therefore to avoid this mifchievous confusion of sentiment as well
as language, and that we may fix a clear and determinate mean-ing to the
Word Madnefr ; we must for some time at least quit the schools of
Philofophy, and content ourselves with a vulgar apprehenfion of things ; we
must reject not only every supposed cause of Madness, but also every
symptom which does not necessarily belong to it, and retain no one
phcenomenon but what is essential, that is without which the word Madness
becomes nuga-tory and conveys no idea whatever : or, in other words, no
desinition of Madness can be safe, which does not, with regard at least to
some particular symptoms, determine what it is not, as well as what it is.
[ 5 ]
First then, though too great and too lively a perception of objets that
really exist creates an uneasiness not felt by the generality of men, and
therefore discovers a prmternatural state in the instruments of Sensation,
and tho' such uneasiness frequently accompanies Madness, and is therefore
fore sometimes mistaken for it; nevertheless Anxiety is no more essentially
annexed to Madness, so as to make part of our complex idea, than Fever,
Head-ach, Gout, or Leprosy. Witness the many instances of happy Mad-men,
who are perfectly easy under what is esteemed by every one but themselves
the greatct misfortune hu-man nature is liable to.
Secondly, though too little and too languid a perception of things that
really exist and are ob-truded with force sufficient to excite sensation in
the generality of men, discovers as prxternatural a state or disorder in
the instruments of Sensation as uncommon Anxiety, and tho' it sometimes
at-tends Madness, and is likewise mistaken for it, eSpecially by the French
who call Mad-men and Fools by the same name; nevertheless such defect of
Sensation is no more essentially annexed to Madness than the former symptom
of Anxiety, which that very frequent symptom of Madness sufficiently
proves.
[ 6 ]
But-quiSpecies alias veris caplet, commotus babe- bitur --- And this by
all mankind as well as the Physician : no one ever doubting whether the
perception of objects not really existing or not really corresponding to
the senses be a certain sign of Madness. Therefore deluded imagination,
which is not only an indisputable but an essential character of Madness,
(that is without which, all accidental symptoms being removed from our
thoughts, we have no idea whatever remaining annexed to that found)
precisely discriminates this from all other animal disorders: or that man
and that man alone is properly mad, who is fully and unalterably perfuaded
of the Existence or of the appearance of any thing, which either does not
exit} or does not actually appear to him, and who behaves according to such
erroneous per-fuafion.
Madness, or false perception, being then a preternatural state or disorder
of Sensation; before we attempt to discover its causes effects and cure, it
will be necessary for us to inveiligate the seat the causes and the effects
of natural Sensation. For the consideration of the abuse or fault of any
thing necessarily brings that very thing into comparifon with what it was
when found and perfect ; and 'tis impofsible for us rationally to amend or
restore what never was the object of our thoughts.
Be it therefore our first endeavour to contem-plate natural Sensation : if
haply this moll guishing property of animal life may supply us with actual
and pofitive knowledge of some mat-
ters
X71
ters that relate to the present subject ; or at least may point out to us
what it is that herein fur-passes our impedect understandings. A science
negative indeed, and by no means so satisfactory to the pride and
speculative curiofity of man as the former, but very often as useful and as
con-ducive to the attaining practical truth.
[8]
SECT. II.
the Seat of natural Sensation.
WHoever is confcious that he hears, fees, or feels, and beholds all animals
he is converfant with acting just in the same manner as he does when he
hears, fees, or feels, must acknowledge that his own and every other animal
body is as really endued with Sensation as that it exists.
Whoever attentively contemplates in what manner he and every other animal
is affeted by external impulse, must acknowledge that some parts of the
same body, however animated, are quite insensible, some endued with a less
degree of Sensation than others.
Whoever is moreover sufficiently verified in Anatomical researches, and has
learnt to separate those parts of an animal body, which, however contiguous
or closely conneted, are nevertheless really distinct from each other, very
readily discovers several soft fibres, each of which is actually divisible
into many smaller of the same kind, as far as his eye can trace ; and he by
analogy justly concludes that each of those smaller fibres is as capable of
being still farther and farther divided beyond the reach of vision, and
even of human imagination.
[9j
These soft fibres are all connected with the contents of the cranium, and
in different parts of the body they are collected into fasciculi ; every
one of which is enveloped by a continuation of those very membranes which
within the cranium contain the substance of the brain and its medullary
appendages.
Every such fafciculus as well as the several fibres it is refolveable into
is called a Nerve : a name borrowed indeed from the ancients, but used by
them in a very different signification. For by veL7po and nervus neither
the Greeks nor La-tins meant any thing soft and medullary, but on the
contrary the hard and elastic subslance of a tendon or ligament ; as the
word fill retained by the moderns to signify the fafcia or membrane
expanded over and conneting the muscular fibres, sufficiently shews.
[ 10 ]
Every nerve, which is within the reach of our observation, is extended
between the medulla oblongata (base of brain) or its appendage the medulla
spinalis (spinal cord) and the place of such nerve's destination. But every
such nerve is thus extended in a manner very different from the disposition
of the blood-vessels, and indeed of all other portions of the same body
which are called familiar. For in its passage it neither is split into
ramifications, nor is it at all connected with any contiguous parts of the
body, except with some substances equally nervous called ganglions chiefly
observable in the mefentery.
If a nerve in a living body be distracted by external force, there
immediately arises an exquisite sensation called pain. Which sensation is
always in a direct proportion to the quantity of such distrading force ;
and which never ceafes either untill the distrading force is removed or is
become unadive, or untill the material par-ticles which constitute the laid
nerve are by this diftraction irrecoverably difunited.
If to a nerve in a living body be applied any acrimonious objects, that is
such portions of matter whole surfaces are full of angles, and which when
affisted with proper impulse are therefore capable of distracting the
particles that constitute the nervous substance, there immediately arises
the same painful sensation : which is always in a direct proportion to the
quantity and acuteness of such acrimonious angles, and to the impulse with
which they are impacted, and which continues as long as in the former case
of vifible diftraction occasioned by external force. Those parts of an
animal body, in which the greatest quantity of nervous fibres is manifesily
contained, and in which such nervou,; sibres lie the most exposed and
undefended by any other matter that constitutes the same body, are the
soonest and the most affeted whenever any ex-ternal objects are applied
with force sufficient to excite sensation.
Those membranes, which not only within the cranium surround the brain, but
which also serve as sheaths to the several appendages of the brain,
collecting them into nervous fafciculi all over the body as far as the eye
can trace, are indeed every where contiguous to and seem intimately
connected with the medullary fubflance they contain: nevertheless upon the
application of any external objects they all discover no extraordinary
signs of sensibility, any more than several other membranes in the same
body, which are equally vascular and elastic. Witness the many well
attested case of erosions and other accidents of the dura mater unattended
with any degree of pain.
[ 12
All which constant and uncontroverted observations prove, I. That the
nervous or medullary substance derived from or rather communicating with
the brain is the seat or instrument of natural Sensation : 2. That no other
matter whatever, whether animated or not, is such seat or instrument,
SECT.
[ 13 i
SECT. HI.
the supposed Causes of natural Sensation.
TH A T the medullary or nervous fub-fiance continued from or rather con-
nested with the brain is the seat of Senfation, is a point now so
univerfally agreed upon, that perhaps it might have been sufficient barely
to have alerted it without any formal proof. Happy should we be, if the
causes of Sedation were as clearly and incontestably fettled.
But I am afraid before any right or satisfactory notion can be formed
concerning this matter, we must get rid of some opinions, which how-ever
absurd have of late passed upon many fox real knowledge.
The reason of this difference, which at pre- fent subsists between the
discovery of the seat, and the discovery of the causes of Sensation, is not
in the things themselves that have been en- quired after, but in the manner
of enquiry. Because in fixing the seat of Sensation we have been content
with facts that are apparent to all men, and which if any one should
controvert, he must difclaim the evidence of his own senses:
But in assigning the causes of Sensation several things have been assumed
as matters of fact, which have never been discovered, and which may at
least with equal probability be denied as admitted.
For here the Hypothetical Genius, forgetful that he hath Nature's works for
his contemplation, and defpifing that poor pittance of know-ledge which the
real appearance of things flip- plies every one with as well as himself,
hath dared without any warrant to coin new ideas; hath made free with air,
water, ?ether, nay even electrical fire ; and imagining that to he
pro-bable which is barely possible, and then heighten-ing this assumed
probability up to matter of fact, he takes one large stride more and
roundly af-ferts that the brain is a gland; that its cortical portion is a
convolution of secretory vessels deigned to separate from the blood one or
other of thole ele-mentary .1a:fiances, which he bath by wars un-known
introduced into the carotid arteries for this Lis pretext purpose; that the
medullary portion of the brain and nerves is nothing else but a colleElion
of excretory dugs ferving to convey this elemen-tary matter to all the
fenlible parts of the body : which matter either by undulation or
retrograde. motion imparts to the Sell°. rium commune all thole impulses
it receives from such external objeRs affeat the extremities of the nervous
filaments.
C 15
This excrement therefore of the brain tho' invisible is the necessary cause
of sight, tho' impalpable the sufficient cause of feeling, and tho' an
animal Spirit the material cause of animal Sensation.
Now, as the secretion of such a nervous fluid and consequently its very
existence depends entirely upon the analogy that is supposed to lie between
the brain and every glandular substance, in case the brain is very unlike a
gland in any material circumstance, this whole machinery is immediately
destroyed.
Admitting therefore, what has never yet been proved, that the cortical
portion of the brain resembles the secretory organ of a gland, yet the
medullary or nervous fubifance is different from all excretory ducts
whatever : inasmuch as no excretory duct is ever found but what is
immediately detached from the gland whence it issues ; whereas on the
contrary the supposed glandular or secretory substance of the brain is
continued to every part supplied with nerves, and these nerves the supposed
excretory duds, after that they have left the cranium and their glandular
origin the brain, wherever they are capable of being examined, remain as
closely connected not
c16]
only with the cortical or secretory portion of the brain, but even with the
productions of the dura and pia mater, as the medullary substance itself
whilst contained within the cranium.
This observation alone would be sufficient to destroy the very foundation
of a nervous fluid, if any Hypothesis whatever could deserve a serious
consideration. But it may be feared that a solemn confutation of chimaeras
[mythical creatures] will appear equally ridiculous as an attempt to
establish them ; and he may perhaps incur the suspicion of insanity which
these theorists have deserved, who shall fight in earnst with shadows, and
mispend his time in offering reasons, why the solid constituent parts of
the medullary fubilance con-tained in every nerve bid fairer for supplying
us with the material cause of Sensation, than a fluid never yet discovered,
and which its very authors confess was once foreign to the body, and even
extracted from dead and putrefcent matter spirited up, we know not how,
into animality.
Let us therefore quit this enchanted ground to those, if such there be, who
are fill inclined to dispute upon it ; and in order to clear our way a
little more to the real causes of Sensation, let us divert our attention to
a very common phrase, viz. weakness of nerves, which tho' not professedly
systematical, like the former scheme of animal spirits, is nevertheless
extremely delusive ; inasmuch as it seems indiretIy to offer another
solution of the phenomenon in question, and to ascertain the cause of
Sensation.
17
For since the word weakness, when joined with material substances, can
convey no idea but a lax cohesion of such particles as constitute those
substances ; therefore the phrase weakness of nerves, which denotes a
morbid excels of Sensation, seems to imply that Sensation itself is owing
to the loose cohesion of those material particles which constitute the
nervous substance, inasmuch as the quantity of every effect must be
proportional to its cause.
By this inaccurate manner of talking, the most distinguishing property of
animal nature is in danger of being blended with inanimate matter. For, if
the case really were what these words seem to import, all bodies whose
particles do not cohere with too great a degree of proximity would be
nervous, that is endued with Sensation. But, since no portion of matter,
however loosely compacted, is nervous except it is part of an animal body,
therefore the medullary substance of a nerve is endued with Sensation not
because its constituent particles are loosely united [ie weakness of
nerves] and every nervous filament, tho' it consists of parts extended and
not too closely cohering, is confessedly as distinct from every other
material substance consisting of parts extended and equally cohering, as a
man from a carcass, or an horse from an equestrian statue.
[ 18 ]
S E T..
[ 19 ]
S E C T. IV.
the real Causes of natural Sensation.
SE N S AT ION, however perplexed it may seem to those who too curioufly
enquire into its nature, is to the model+ observer
as clear in idea and as fully to be accounted for, at leaf} to all useful
intents and purposes, as any phcenomenon whatever.
For is not what we feel a plain matter of fact, of which we are not only
certain and confcious ourselves, but which we are likewise capable of
communicating to others by words or ligns ? And are we not perfectly well
acquainted with many things, which when impelled with force sufficient will
make us feel ; and which it is frequently in our power to apply, remove, or
avoid, as best fuits our interct ?
It is the heedless or rather the wilful neglect of precisely feparating
these many evident and external causes of Sensation as well from their
unknown and internal operations as from their in-termediate and equally
unknown effects, that has created such difficulties in contemplating this
phcenomenon.
D 2 For
C20
For the mutual colnefion of material particles, as essential to our idea of
an animal body as sense itself, but not better accounted for, hath however
been looked upon as a thing much less my steriou s.
Which seeming diversity can be owing to no-thing else, but because the
generality of man-kind have contented themselves with the useful and the
attainable knowledge of such external objects, as will harden or soften
those bodies they are applied to, without enquiring too nice-ly why the
conslituent particles of those bodies, are more or less united upon such
application, or indeed why they are united at all : whereas the philofopher
in his contemplation of sensible matter is not content with knowing
certainly like other men what objects externally applied to a nerve will
create, increafe, or deaden sensation, but moreover conjectures why ; and
attempts by any means whatever to afsign the manner in which these external
objects act upon, and the changes they produce in the nervous substance
previous to sensation their last effect ; which ef-fect, for reasons bell
known to himself, seems to demand a more explicit solution than the
co-INefion of material particles.
r 21
In endeavouring therefore to afsign the causes of Sensation, be it one of
our chiefest cares to distinguish them from one another as effectually in
our mind, as they are really different in their nature, and to separate
what we actually and usefully know from what we are, and perhaps shall
always be without any great damage, en-tirely ignorant of.
For which purpose, it may not be amifs to premife a few considerations on
causes in gene-ral ; which will illustrate the fubject of our present
enquiry and at the same time be confirmed thereby.
First then, by observing that any one phenomenon frequently follows
another, we conclude that the second is owing to the first ; and hence we
get the ideas of cause and effect.
Secondly, by observing that any one phenomenon never fails to follow
another, we conclude that the first is not only a cause but alto a
sufficient cause of the second.
Thirdly, by observing that the second phenomenon never occurs but in
consequence of the first, we further conclude that the first is not only a
cause but a necessary cause of the second, which is therefore called the
carfa fine qua non.
Fourthly, by observing that the second phenomenon follows the first without
either the evident or the demonstrated intervention of any other phenomenon
as necessary or at least accessory to its existence, we conclude that the
first phenomenon is moreover the immediate cause of the second.
Fifthly, by observing either that the first phenomenon is not always
succeeded by the second, or that the second is not always preceded by the
first, we conclude that the first phenomenon is either not a sufficient or
not a necessary, but merely an accidental cause of the second.
Sixthly, by observing or by admitting as undeniable that any one or more
phenomenon intervene between the first and the last in question, we plainly
discover that the first is remote, and that the several other intervening
phenomenon in their order approach nearer and nearer to the immediate
cause.
Seventhly, a very little reflection upon causes and effects as thus stated
will make us conclude that the remote and accidental causes of any effect
may be many, but that the sufficient and necessary as well as the immediate
cause can be but one. Since either of two causes supposed sufficient will
render the other unnecessary ; and either cause supposed necessary will
render the other insufficient. Which unavoidable conclusion, by the way,
might be extended beyond secondary agents or instruments, improperly
cal-led causes, and would give an additional proof, if any was wanting, to
the unity of the first, the necessary, the sufficient, and indeed stri6tly
speaking the sole cause of all things.
Thus, to inftance in our present fubjea ; fight, hearing, taste, fmell,
Fee.. which frequently succeed the application of external objects, are
look-ed upon by us as the effects of finch external ob-jects ; and we in
common difcourse refer our ideas back to thole objects as to their causes,
as when we fay we fee the fun, we hear the drum, ctc.
But, forafmuch as the external objects of sense, however forcible their
application may be, do not always and in all animal bodies create fight,
ctc. And moreover, as the very same perceptions do sometimes, at least in
disordered subjects, arise without any external object that really affects
them ; it is impofsible but every filch external object must be meerly
accidental, and by no means
E24
means the sufficient or the necessary cause of filch its nervous effect. :
Which sufficient and ne-cessary cause is therefore internal, that is it
in-haeres in the very frame and constitution of the nervous substance
itself; whereby alone such substance is rendered capable of being asfeted
by any external object so as to create Sensation ; and without which
internal cause no thing what-ever would actually become an objea of our
senses
For the same reason all such external causes are not only accidental but
likewise remote. Since the necesfary and sufficient cause at leas} must
intervene ; and betides, before an external objea can create any sensation
whatever, it must produce several intermediate effects, viz. motion,
impulse, and pressure : all which pre-cede not only fight, eec. thereby
excited, but also precede that particular internal asfection of the nerve
itself, whatever it is, which is the im-mediate, the necessary, and the
sufficient cause of such perception.
The accidental and remote causes of Senfa- tion, as also their intermediate
effects, provided such effects are external to the nervous fub- stance,
very readily discover themselves, and are clearly comprehended. For indeed
they are all bodies
1 25 I
bodies that lye within our observation (many of which are within our reach)
and the motion and impulse of those bodies, or of particles emit-ted
therefrom, upon the organs of sense : which every one not only has a clear
idea of, but is moreover certain of their existence, motion, and impulse.
Now, as no body whatever can be capable of creating Sensation in
consequence of its motion and impulse, without pressing upon the nerve
af-fected by such impulse ; therefore pressure of the medullary substance
contained in the nervous filaments approaches nearer in order to the
im-mediate cause of Sensation, than the motion and impulse of any external
objet.
Pressure of the medullary fubilance contained in the nervous filaments
cannot indeed be ima-gined without some alteration in the former
ar-rangement of thole material particles which con-ftitute that fulltance.
But we have no idea whatever, either vifible or intelle±ual, how and in
what manner those particles are by such pressure differently juxtapofited,
previously to Sensation thereby excited.
Whence it undeniably follows that pressure upon the medullary fubilance
contained in the
[ 26 ]
nervous filaments is the last in order of all thole causes of Sensation,
which we have any idea of. Thus far and no farther our knowledge in these
matters reaches, limited by the outfide of the seat of Sensation ; what
passes within being meer conjecture. For if a new pofition of medullary
particles, which is an immediate and unavoidable effect of external
pressure, does not discover it-self any more than their confitutional
arrange-ment ; what account can we with any the leaf degree of modefy
pretend to give of all the alterations in the nervous substance fill
fubfe-quent to such pressure and to change of place thereby occasioned ; a
regular feries of which may, for any thing we know to the contrary, precede
the immediate cause of sensation.
SECT.
SECT. V.
The salutary Effects of natural Sensation.
SENSAT ION is always accompanied with some degree of pleasure or uneasiness
; no animal being indifferent to what he sees, hears, or feels. These
additional and in some degree infeparable assections demonstrate the
di-rect tendency of Sensation to the prefervation of life; inasmuch as
every one fpontaneoufly flies from those objects which hurt and are at
enmity with him, and covets such as create satisfation and are fuitable to
his interef.
But, tho' no one at first fight would doubt whether the perception of
pleasure is agreeable to his nature, and conducive to its prefervation ; it
may with great reason be doubted by those who reflect a little whether such
perception, however convenient it may seem to animal life, is alone
instrumentai in its prefervation, and without the intervention of the
contrary affection ever conduces to health.
For uneasiness is so interwoven in the very frame of mortals, that even the
greatest present
C28
satisfaction implies the removing or flifling the greaten uneasiness which
before difquieted. And a sense of future pleasure, as it excites desire, in
that very defire implies a present uneasiness adequate to the supposed
enjoyment of the pleasure in expectation. By which present uneasiness,
according to Mr. Locke's just observation, the will is determined.
However paradoxical therefore it may seem, nothing is more true than that
Anxiety, a real evil, is nevertheless productive of real good ; and, tho'
seemingly disagreeable to Nature, is absolutely necessary to our
preservation, in such a man-ner, that without its fevere but useful
admoni-tions the several Species of animals would fpeedily destroyed. For
sirli, are not hunger and thirft very falu-tary Anxieties ? By which the
nerves of the mouth cefophagus and stomach excite all ani-mals from the
first moment of their birth to feize on such objects, as are capable of
relieving those natural and healthy but agonizing sensations.
Now the real good produced by the gratifica-tion of these appetites is by
no means to be pla-ced in their present gratification alone. What-ever he
may imagine, who being ignorant of the animal
f29J
animal eaconomy looks no farther than the actual pleasure which accompanies
the stiffing such sensations. For the end herein proposed by the Author of
Nature is undoubtedly the refection of that very body which hungers and
thirsts ; whole constituent particles by the inevitable effects of vital
action are in a continual flux and decay ; whereas the efficient or
coercive causes of eating and drinking are those sensations alone, which
torment every animal to a very good purpose. Who perhaps would not
otherwise give himself the trouble of opening his mouth, much less by hard
labour earn food wherewith to sill it ; even tho' he should be assured that
the loss of meat and drink today, tho' not at all inconvenient to him at
present, will be sensibly felt to-morrow by his distempered body, and that
his idleness and fasting will be soon attended by fatal consequences.
Secondly, the introducing fresh air into the lungs being as necessary for
the immediate con-tinuance of life, as it is for other purposes of the
animal ceconomy which are more remote, and at present unknown ; therefore
every ani-mal provided with organs of respiration, whether awake or
sleeping, draws into his breast and ex-pels a quantity of external air
sufficient to dif-tend them from the firsi moment of his birth
[ 30 ]
till the last period of life. Which alternate anion, if he either
carelessly or obstinately omits it, he is very soon compelled to perform by
that inexpressible Anxiety which attends a long de-tention of air once
admitted as well as the re-fufing admiflion to any air at all.
Thirdly, forafinuch as voluntary exercise of the body is no less requisite
to the due circula-tion and secretions of the animal fluids, and the
salutary consequences thereon depending, than the propulfive action of the
heart and the refi-lition of the arterial tubes ; which the ill effects of
a fedentary life sufficiently prove ; therefore the uneasy sensation that
is always occasioned by fatiety and the wearisome condition of idleness
determine all animals, to whom aUivity is thus necesfary, frequently to
alter their place of resi-dence, and to remove from those objects they have
long been converfant with, however plea-fing and eagerly fought for they
might once have been.
Fourthly, all the afore-mentioned instances of uneasy sensation, however
nearly allied to and often ending in sickness, are nevertheless the natural
effects of perfect health. But be- fides these there occur several other
anxieties, which are the unavoidable effects of real sickness
and
[ 31
and moreover frequently determine the will of the patient to such things as
are capable either of relieving the present disorder or of prevent-ing its
mifchievous consequences. Thus, to in- ,fiance in one particular, feaverish
heat threatens putrid obstructions, and at the same time occasions intenfe
thirst and an almost infatiable crav-ing for acidulated water. Which
defire, if not contradicted- by the osficious and ill-tim'd care of the
by-handers, procures a remedy that is both diluting and antifeptic.
Lahly, tho' the nervous energy be neither absolutely necesfary nor alone
sufficient to excite muscular action, yet such is the connection be-tween
the nervous and muscular sibres, however really distina from each other,
that animal sensation often instantaneously precedes animal ac-tion, so as
to have confounded these two qua-lities, or at leas} to have made the one
appear the immediate and only cause of the other. And, what chiefly
deserves our notice whilst we are considering the salutary effects of
Sensation, Convulsion itself, a distempered excess of animal motion, which
is a frequent effect of uneasy Sensation, sometimes becomes its sudden and
ef-ficacious remedy, by removing the material cause of such uneasy
Sensation, and that without
any
[ 32
any determination or interpofition of the will whatever.
All which nervous appetites as well as milieu-lar motions, that either
preserve or restore health, and are seemingly excited by somewhat
rational-ly forecasting their salutary ends, have given rife, I suppose, to
some modern metaphorical expressions, viz. Nature, and the Anima invented
by Willis and deifyed by Stahl. Which figurative words, tho' not quite
philosophical, are innocent and even useful, in case they are applied only
to avoid periphrases in relating medical matters of fait. But young
Practitioners, who are often told that they are to imitate and aslist
Nature, must take great care not to be misguided by the literal sense of
words, or fancy any thing like personal consciousness and intellectual
agency in the animal ceconomy. For in such case of misapprehension these
and the like expressions become as absurd as all the exploded Faculties of
the Ancients, and, what is much worse, may be as mischievous as an
instrument of death in the hands of a Madman.
SECT.
( 33 I
SECT. VI.
The Causes and Effects of Anxiety and Insensibility, two species of
Sensation disordered tho' not delusive.
HAVING contemplated the seat causes and effects of natural and true
Sensation ;- before we proceed to consider delusive Sensation, the only
subject of this enquiry, it may be not improper to take some notice of
those two other disorders of the same quality, which were excluded from our
definition of Madness, viz. preternatural Anxiety or Sensation too greatly
excited by real objects, and its contrary Insensibility or Sensation not
sufficiently excited by real objects, tho' acing with their usual force and
tho' capable of engaging the attention of all other healthy animals of the
same Species.
For, although Madness in its proper sense be clearly distinct from the too
lively or the too lan-guid perception of things really existing, it
how-ever very often is preceded by or accompanied with the first and as
often terminates in the fe-cund of these two disorders. Befides the being
too much affected by external impulse, tho' it
F does
34
does by no means imply Sensation materially delusive, inasmuch as the ideas
excited by filch im-pulfe are referred to true and correfponding ob-jeds ;
yet the quantity of concomitant affection not being proportionate and
therefore not in all reSpects correfponding to the natural quantity of its
real cause hath apparently some deviation from absolute truth, and from the
natural and usual circumstances of this animal function. And Sensation not
proportionate to real impulse, tho' it is not strictly speaking delusive,
hath however as great a deviation from absolute truth as excessive
Sensation itself.
Now Sensation, which in its most natural and perfect state is sooner or
later attended with some degree of uneasiness, may with very little
addition be heightened into Anxiety either by the too great or too long
continued force of external ob-jects, or by the illconditioned Rate of the
nerve itlelf, whereby it is rendered liable to be too much affeded with the
usual action of such ex-ternal objects.
This illconditioned Rate of the nerve may be inhaerent in the internal
proper and unknown constitution of the medullary substance, or it may be
external to that substance, and arise from the loss or defed of thole
membranes which en- velope
[35]
and sheathe the seat of Sensation, and are designed to protect it from such
rude attacks and impreflions as might otherwife endanger the dif-solution
of so loft a matter.
For, whenever those integuments are quite re-moved from a nerve which is
endued with no more than a common share of fensibility, An-xiety must enfue
the application of any external objects that are capable of exciting
natural Sensation. And in fad we find that the laying bare any sensible
part and exposing it to the common air, which usually refreshes the body
whilst cloathed with 'kin, immediately distrads us with intolerable
torment.
For the same reason Anxiety, which follows an entire removal of the nervous
sheaths, will in some degree arise whenever those sheaths are not strong
and sufficiently compacted so as to answer the purpose of defence. That is
the sensation of the nervous or medullary fibres, tho' they con-tinue the
same, will be in a reverse proportion to the cohesion of those minute
particles which constitute the solid and elastic fibres. And in fact we
find that Anxiety is almost always the consequence of morbid laxity, except
where the intervention of fat, lymph, or vifcid congestions
F 2 owing
[ 36 I
owing to such laxity subsiitute an occasional de-fence.
No wonder is it then that the straining or loosening the solid parts of
human bodies should frequently render those bodies liable to be violently
affected by such objects as are scarce felt or attended to by other men,
who enjoy a natural or artificial strength and compactness of fibres.
And from hence we are enabled to annex a true and intelligible meaning to
that expression before taken notice of, viz. weakness of nerves. Which word
weakness would not have been so improper, if it had been joined in idea not
to that substance which is strictly nervous, but to its integuments and
contiguous membranes; and if laxity, an accidental and remote cause of
excessive and therefore uneasy Sensation, had not been thereby made liable
to be mistaken for its immediate necessary and sufficient cause.
Whatever may be the cause of Anxiety, it chiefly discovers itself by that
agonizing impatience observable in some men of black November days, of
easterly winds, of heat, cold, damps, etc. Which real misery of theirs is
sometimes derided by duller mortals as whimsical affectation.
And
[37]
And of the same nature are the perpetual tempests of love, hatred, and
other turbulent passions provoked by nothing or at most by very trifles. In
which state of habitual diseases many drag on their wretched lives ; whilst
others, unequal to evils of which they see no remedy but death, rashly
resolve to end them at any rate. Which very frequent case of suicide,
though generally ascribed to Lunacy by the verdict of a good-natured Jury,
except where the deceased hath not left assets, are no more entitled to the
benefit of passing for pardonable acts of madness, than he who deliberately
has killed the man he hated deserves to be acquitted as not knowing what he
did.
Among the morbid effects of Anxiety or the praeternatural excess of
Sensation one, which frequently attends upon it and more particularly
demands our attention, is Spasm or the praeternatural excels of muscular
adion. Which state of morbid motion, tho' sometimes salutary as has been
before observed, is often occasioned by this nervous disorder to no good
purpose whatever ; and, when very violent or of long continuance, is
necessarily productive of numberless evils and of acute and chronical
distempers, which if not relieved in time almost always end in death.
[38]
Another area of Anxiety or of the preternatural excess of Sensation is the
nervous disorder directly contrary to it, viz. Insensibility, that is a
prxternatural defect or total loss of Sensation.
Whether this entire change from one extreme to the other is owing to the
material instruments of Sensation having been strained by Anxiety or rather
by some of its causes, cannot perhaps, be determined with any degree Of
certainty. But thus much is clear in reason that any distraction, which is
sufficient to disunite or break in pieces the medullary substance, must be
sufficient to make it unfit for its function ; and it is as undeniable in
fact that Anxiety is frequently either attended with such spasmodic
disorders or occasioned by such external injuries as must necessarily
distract the nerves thereby affected.
Not that Insensibility is owing to no other cause except Anxiety. For it is
at least as often occasioned by the internal and unknown con-stitution of
the nervous or medullary fulastance itself, which was either formed
impellect at first or bath since degenerated.
[39]
And, besides the internal and unknown defect in the seat of Sensation,
Insensibility may as often be ascribed to another cause external to the
nerve and sufficiently understood. For, since the nervous integuments or
neighbouring membranes do sheathe the medullary subslance, and thereby
prevent the morbid excess of its energy ; whenever the fibres that compote
those integuments or membranes are preternaturally compacted and of too
close a texture, instead of moderating they undoubtedly mutt deaden or
destroy Sensation. And for the same reason those nerves that are pillowed
with fat, foaked in lymph, or Rifled by obstructed vessels, cannot and in
fad do not receive a proper that is a fen-fible impulse from external
objects, altho' such objects are rightly and forcibly applied, and
al-though the nervous substance itself is perfectly found, and in its
internal constitution sitted for the efficacious reception of such external
impulse.
But, whatever may be the cause of Infenfibility, its ill effects are many
and as obvious as they are unavoidable, and need not be here enumerated.
For they are all those disorders in the animal economy, which Sensation in
its natural vigour was designed to prevent. The
[40)
defect therefore or loss of this salutary and vital quality must either
hurry on or fuller the sickly body to approach nearer and nearer to the laD
period of animal life.
VII The Causes of Madness
Whoever is satisfied with our account of the seat and causes of natural and
true Sensation, will acknowledge that the one immediate necessary and
sufficient cause of the preternatural and false perception of objects,
which either do not exist, or which do not in this instance excite such
sensation, must be some disorder of that substance which is medullary and
strictly nervous. And moreover, as he cannot discover the natural and
internal constitution of this medullary substance, which renders it fit for
the proper perception of real and external impulse or rather of the ideas
thereby excited; he must for the same reason own that he is unable to
discover wherein consists that preternatural [above or beyond the normal
course of nature] and internal state of the same nervous matter, which
disposes it to be without any such impulse affected by those very ideas,
that would have been presented to the imagination, if the same nervous
matter had been acted upon by something external. Or, to speak more
technically, forasmuch as the one immediate necessary and sufficient cause
of the perception of real objects is unknown, we must likewise remain
entirely ignorant of the one immediate necessary and sufficient cause of
the perception of Chimaeras, which exist no where except in the brain of a
Madman.
But, altho' the immediate and internal cause of delusive as well as of true
Sensation is absolutely hid, many remoter and external causes thereof
frequently discover themselves to the by-stander, notwithstanding that the
idea thus excited is not by the patient himself referred to any one of
those true causes, but to something else, which may or may not exist, and
which certainly does not in this particular case act upon the affected
organ.
Thus, to instance in a very common accident, the eye that is violently
struck immediately sees flames flash before it; which idea of fire
presented to the imagination plainly shews that those material particles
which constitute the medullary substance of the optic nerve are affected by
such blow exactly in the same manner, as they are when real fire acts upon
the eye of a man awake and in his senses with force sufficient to provoke
his attention. Thus variety of sounds disturb the ear that is shocked by
the pulsation of vessels, by the inflammation or other obstruction of those
membranes which line the meatus auditorius, by the intrusion of water, and
in short by any material force external to the medullary portion of the
seventh pair of nerves; which force hath no connection with any sonorous
body, that by its elastic vibration communicates an undulatory motion to
the intermediate air.
Now suppose that any one perfectly awake without the accident of such a
blow sees fire, or without the pulsation of vessels, inflammation, or any
obstruction in the meatus auditorius, ctc. hears sounds; or suppose that
the idea of flame really excited by a blow is by him referred to an house
on fire, or the idea of sound excited by the pulsation of vessels, ctc. is
referred to a musical instrument, which is not near enough to be heard, or
is not really played upon; the man who is so mistaken, and who cannot be
set right either upon his own recollection or the information of those
about him, is in the apprehension of all sober persons a Lunatic.
From whence we may collect that Madness with respect to its cause is
distinguishable into two species. The first is solely owing to an internal
disorder of the nervous substance: the second is likewise owing to the same
nervous substance being indeed in like manner disordered, but disordered ab
extra [from outside]; and therefore is chiefly to be attributed to some
remote and accidental cause. The first species, until a better name can be
found, may be called Original, the second may be called Consequential
Madness.
The internal disorder of the medullary substance, or the cause of Original
Madness, for the same reason as the immediate necessary and sufficient
cause of true Sensation, can be but one : but the external and accidental
causes of Confequential Madness, as well as of true Sensation, may be many.
Now no external cause whatever can be supposed capable of exciting delusive
any more than true perception, except such cause aas materially upon the
nerve thereby disordered, and that with force sufficient to alter the
former arrange-ment of its medullary particles. Which force necessarily
implies impulse and pressure in cielu-five Sensation, in the same manner
and order as it does in the perception of objects really corref-ponding
thereto.
Pressure therefore amongst all the external and discoverable causes of
false as well as of true perception is in our apprehension the nearest to
such its apparent effect. As to the intermediate alterations
145
of the medullary substance, that may really precede delusive Sensation,
they are all as much unknown as are the nervous effects which intervene
between the pressure made by any external objet and the true and adequate
idea of that very object.
But, altho' Consequential Madness cannot be supposed without some sort and
degree of pressure upon the nerves, nevertheless every sort and degree of
pressure does not always and unavoidably produce Consequential Madness. For
the nerves may suffer external impulse, and yet the pressure thereby
occasioned either may not have force sufficient to excite any idea at all ;
or it may act with too great a force and in so shocking a manner as to
dissolve or greatly difunite the medullary matter ; in which case
Sensation, which can never exist but whilll that matter does properly
cohere, instead of being perverted will be abolished, or at least fuspended
untill the con= stituent particles are reunited.
What this particular fort and degree of pref- fure is, which is capable of
creating delusive Sen- fation, we are not able to afcertain ; because the
different circumstances of the unknown fubject aced upon will make-the
nervous effects variable and oftentimes contrary, notvvithsianding the ac-
tion
[46]
of the known cause considered per fi is in all refpe1s the same.
But, altho' we cannot exaaly defcribe the particular flrength of that
external impulse which excites, any more than we can discover why it
excites delusive ideas ; thus much we may reasonably conclude in general
that all material ob-jects, which by their action or refinance occasion a
sufficient but not too great a pressure upon the medullary substance
contained in the nerves, may be the remoter causes of Consequential
Madness.
Which conclufion is not only agreeable to reason, but is moreover confirmed
by matter of fact and almost every day's experience. Witness the internal
exostofes of the cranium, the indu-rations of the finus's and processes of
the Dura Mater, which have frequently been found in those who died mad ;
witness the intrapression of the skull or concusfion of the head, which if
not apciplectic is almost always attended with a delirium. And indeed every
one, who contem-plates several case of Consequential Madness and those
accidents which precede the same, will find that pressure of the medullary
substance somewhere or other collected intervenes between such accidents
and these their delirious effects.
[47]
One case of Consequential Madness that proves the intervention of such
pressure is an etrect of Infolation or what the French call coup du soleil.
An instance of which I lately met with in a Sailor, who became raving mad
in a moment while the Sun beams darted perpendicularly upon his head. Which
maniacal effect of heat could be attributed to no assignable cause, except
either to the violent impression of the Sun's rays, upon the medullary
substance of the brain, which the cranium in this case was not able to
defend, or to the intermediate rarefaction of blood contained in the
vessels of the Dura or Pia Mater, which vessels being suddenly distended
compressed the same medullary substance. Of the same nature and owing to
the same rarefaction of fluids in the brain are those delirious fevers
called Calentures ; one of which was, I suppose, mistaken for the plague by
the Author [Dr. Dover] of the Physicians laft Le-gacy, and treated with
bleeding ufque ad aniini deliquium, which indeed is its only cure.
:
[ 48
Another case of Consequential Madness is a sudden inflammation arising in
those membranes which surround and therefore when thus distended compress
the contents of the cranium and its nervous appendages. This Esate of
inflammation whilst the patient lives discovers itself by the sudden
redness of the eyes external coat, which is a part or rather a production
of the Dura Mater : and that membrane after death is frequently upon
dissection found turgid and difcoloured with a red bloody suffufion, just
in the same manner as if it had been artificially injected.
Another case of Consequential Madness is a gradual congestion of ferum or
other fluid mat-ter upon the same membranes which envelop the medullary
fubftance ; whereby those membranes, tho' not with equal danger as when
they are fud,-7 denly inflamed, yet with the same delirious ef-fects
compress their nervous contents. This fe-rous congestion is discoverable by
the opaque and cloudy appearance of the cornea, for the same reason as an
inflammatory tumor in the Dura Mater is betrayed by the external coat of
the eye being tinged with blood.
Pressure of the medullary substance, the nearest in our apprehension to
Madness of all its known and remoter causes, most frequently and most
effectually produces this its nervous effect, whilst it acts upon the
contents of the cranium, as is evident from the case above-mentioned. But,
altho' the brain is undoubtedly the principal seat of delusive sensation,
nevertheless it is not
c 49
the only one : forafmuch as the same fangui-nary or ferous obflrudions are
capable in any other nervous part of the body of exciting false ideas as
well as in the brain, at lean to some degree and in proportion to the
quantity of medullary matter there collected so as to be sufficiently
compressed by such obstructions. Thus the stomach, intestines, and uterus,
are frequently the real seats of Madness, occasioned by the contents of
these viscera being slopped in such a manner as to compress the many
nervous filaments, which here communicate with one another by the
mesenteric ganglia, and which enrich the contents of the abdomen with a
more exquisite sensation. Thus the glutton who goes to bed upon a full
stomach is hagridden [torment] in his sleep. Thus Men prove with child as
powerful fancy works: And patients truly hypochondriacal or hysterical
refer that load of uneasiness they feel in their bellies to some imaginary
object, which if it really existed and ailed upon their senses would excite
the very same idea.
p 50
SECT. VIII. The causes of Madness
FOrafmuch as prxternatural pressure upon the nerves is in human
apprehension the nearest to delusive sensation thereby excited ; whatever
injury creates such pressure must be a remoter cause of Consequential
Madness.
Under this head therefore of remoter causes are to be ranked the internal
exostoses of the cranium, the induration of the Dura Mater, the fracture
and intropression of the skull and concussion of the head, as also, if it
were of any service in the cure of madness to enumerate them, the many and
various accidents these delirious injuries may be owing to.
To the same number of remoter causes we must add morbid distensions of the
vessels contiguous to the medullary fubflance. And, as several case
mentioned in the foregoing section are clearly refolvable into such
distenfions, whole re-moval or diminution will frequently be sufficient to
answer our intention and is almost always ne-cefftry and serviceable in the
cure of this distemper; it may be of use to spend a little time in
examining into the nature and origin of those vascular distensions which
end in Consequential Madness.
Whoever has attended to the accidents that animal bodies are liable to must
have observed that several membranes, which in their natural state appear
smooth and even, are sometimes suddenly at other times gradually elevated
beyond the surface or plane they before helped; to compose. To the first of
these two case wri-ters on Surgery have given the name-of Tumors by
Fluxion, to the second that of rumors by Congeflion thereby ascribing the
quick or slow ap-pearance of these fwellings to the different mo-tion of
the fluids themselves, which materially formed them, and which according to
the me-dical philofophy then in fashion contained all the refources of life
health and sickness.
Now, altho' the discovery of the blood's cir-culation hath demonstrated
that the fluids are paffive in every circumstance of animal life whe-ther
found or distempered, it will however be very useful in profecuting the
present enquiry to take into our account the case themElves as
dif-tingislaed from one another by their different manner of appearance
which cannot be contro-
H 2 verted,
[ 52 ]
verted, and then endeavour to afsign other reasons for such their
appearance, which not only really exist, but which also are sufficient to
pro-duce either Species of tumor.
Tumors then by Fluxion ending in Madness are either vessels distended by
the rarefaaion of their proper and natural contents, as in the case of
Infolation ; or, which is the most frequent ac- cident, they are the same
vessels obstructed by the sudden intrufion of improper fluids into finaller
canals which were never designed to give either a pasrage or admittance to
such contents, as in the case of Inslammation. Now this change of place and
forcible propulsion of :fluids from their natural ducts into improper
receptacles must apparently be owing to some power external to the fluids
so propelled, which power either was not excited or did not effectually act
the moment before filch delirious obstructions took place. But the
spasmodic constridion of those muscular fi- bres which furround the
extremities of arteries and veins, and are at res} till rusfled by some
ac,-, cident, is a power occasionally excited, and when ailing with
sufficient force is capable of driving the blood out of its natural
channels into vessels not originally fitted for its reception. And it is
moreover a repeated observation that Madness frequently succeeds or
accompanies Fever, Epilepfy, Child-birth, and the like muscular disorders ;
and that the tumultuous and visibly spasmodic passions of joy and anger are
all at least for a time maniacal. But these passions constringe the muscles
of the head and neck, and therefore like a ligature force the blood that
was descending in the jugular veins back upon the minutest vessels of the
brain. Spasm therefore, when it is productive of tumors by Fluxion or of
sudden distensions in the vessels contiguous to the nervous substance,, as
also spasmodic passions such as joy and anger are to be reckoned amongst
the remoter causes of Madness. Not but that the same muscular constric-tion
is often excited by the application of several external objets ; which
objects are therefore to be added to the same class. For befides the ma-ny
well attested case of poifons or medicines, which as soon as fwallowed
convulfe the body and intoxicate the understanding, such as Hem-loc, and
the root lately mistaken for Gentian, filch as Opium when administered to
some par-ticular patients, eec. The many bottle-companions whole pulses
beat high and quick, whose faces are flushed with blood in the same manner
as if they were strangled, who are first wild and then stupid, who drink
till they fee double, and then drink on till they cannot fee at all, as
well as the crowds of wretches that infest our streets and fill our
hospitals, evidently prove to the vulgar as well as to the Physician that
vinous spirits inflantaneously provoke an irregular action of the muscles
succeeded by temporary delirium ; and that, if the same noxious draughts
are taken in too large doses or frequently repeated, they be-come a very
common tho' remoter cause of continual madness.
If any one rather supposes that such external objects, which produce
Madness, act immediately upon the nerves thereby affected, and that spasm,
tho' an undoubted effect of the same objects, is the companion and not the
intervening cause of their delirious effect : However probable the contrary
opinion may fill appear to those, who consider that spasm never fails to
precede or to accompany the nervous disorders subsequent to such
application, and moreover that spasm is sufficient to produce maniacal
symptoms ; nevertheless the nearest known cause of Madness re- mains
exactly the same, and these external objects are fill to be reckoned among
its remoter causes, which ever opinion is the more probable. Since it is
impossible for any one of them to act at all upon the nerves without motion
impulse and pressure in the same manner and order, as if they had
previously occasioned muscular constriction
[ 55
friction and vascular obstruCtion its most usual effect.
As for Tumors by Congestion ending in Madness, that is to say those loads
of fluids which gradually overcharge the vessels contiguous to the nerves,
and by compressing a sufficient quantity of medullary matter create
delusive sensation as effectually as does inflammation or any sudden
distension of the same vessels : such gradual or chronical congestions are
frequently, tho' not al-ways, an effect of a very different fort of
muscular constriction, easily distinguishable from the former by its manner
of invasion and continuance. For this spasmodic action of the muscular
fibres is very gentle at first, and so far from alarming either the patient
or his friends, that for Tome time it is very little attended to or even
discernable. But what it wants in violence is more than made up by its
obstinate duration and encreafe : inasmuch as it seldom remits, and is with
great difficulty relieved by art. This Species therefore of spasm must
likewise be added to the remoter causes of Consequential Madness.
[ 56
To such constant muscular constriction, and to the gradual or chronical
congestions in the brain or mefenteric vifcera thereby occasioned, the
despairing bigot, incapable in his own apprehension of being pardoned by
infinite mercy, or predefined by infinite justice to eternal misery before
he had a being, the moping lover, the motionless widow or mother bereft of
her children, may at fiat view be afcribed. Who all wear contractae feria
frontis, and discover the fixed muscular marks of passions flower indeed in
their operation than the turbulent forms of joy or anger, but which in
consequence of pref-lure upon the nerves are as much the remoter causes of
Madness, and indeed sooner or later are as destructive to every animal
power.
The same Tumors by Congestion, capable with intervening pressure of
creating Consequen-tial Madness, are indeed oftentimes an eifea of laxity
in the overloaded vessels themselves. But even this weakness, if traced to
its original, will frequently be found owing to one of the two
aforementioned Species of muscular conflridion.
To such vascular laxity arising from muscular spasm may be referred the
many instances of Madness occasioned by praemature, excesfive, or unnatural
Venery, by Gonorhceas ill cured with loads of Mercury and irritating Salts,
by fevers, and other such like convulsive tumults. And from hence we may
account for the chimaerical dreams
57 3
dreams of infirm and shattered Philofophers, who after having fpent many
days and nights without cloling their eyes in unwearied endea-vours to
reconcile metaphysical contradictions, to fquare the circle, to discover
the Longitude or grand Secret, have at WI fallen half afleep, and who by
excesfive attention of body have strained every animal fibre, and may
without a metaphor be faid to have cracked their brains.
But, altho' laxity arising from spasm is most commonly the cause of gradual
obstruelions end-ing in delusive Sensation, nevertheless the same delirious
tumors by Congeslion, more eSpecially thole that act upon the nervous
matter contain-ed in the abdomen, are formed sometimes without laxity or
any fpafinodic disorder whatever, either by excess of eating or by defect
of voluntary motion : which motion is just as necessary to a due propulsion
of the fluids thro' the uterine and hemorrhoidal vessels, and thro' the
many and intricate ramisications of the vena porta', as is the action of
the heart or the refilition of the vessels themselves. Gluttony therefore
and idleness are both to be added to the remoter causes of Consequential
Madness. To the first [Gluttony] is owing the meagrim of the Epicure
[inclined to pleasure]. To the second [idleness, sloth, laziness], perhaps
more than to a spirit of lying, may be ascribed the temptations of St.
Anthony and the lazy Monks his followers, the ecstasies of sedentary [slow
paced life] and chlorotic [iron-deficiency anemia, primarily of young
women, characterized by a greenish-yellow discoloration of the skin. Also
called greensickness] Nuns, and their frequent conversations with Angelic
ministers of grace. Not to mention what now and then happens to the senior
Recluses in our Protestant Monasteries at Oxford and Cambridge.
SECT.
[ 59
SECT. IX.
The Diagnollic Signs of Original and Colfepen- tial Madness ; and the
PrognoJlic al-Ong there-from.
AVIN G in the two preceding Sections discovered most of the causes of
Madness that deserve our attention, and thereby divided this disorder into
two Species, viz. Original and Consequential : It will be ne-cessary to
mention some particular circumslances attending either Species, which will
enable the Physician not only to diftinguish Original Madness from
Consequential, but also the better to fettle his prognostic and method of
cure.
First then, there is some reason to fear that Madness is Original, when it
neither follows nor accompanies any accident, which may justly be deemed
its external and remoter cause.
Secondly, there is more reason to fear that, whenever this disorder is
hereditary, it is Ori-ginal. For, altho' even in such case it may now and
then be excited by some external and known cause, yet the striking oddities
that characterife
[ 6o ]
whole families derived from Lunatic ancestors, and the frequent breaking
forth of real Madness in the offspring of such illconcerted alliances, and
that from little or no provocation, strongly intimate that the nerves or
instruments of Sensation in such persons are not originally formed perfea
and like the nerves of other men.
Thirdly, we may with the greatct degree of probability asfirm that Madness
is Original, when it both ceafes and appears afrefh without any af-signable
cause. For, although we cannot guess why this difeafe of the nerves is ever
relieved without the real assistance of art, or why it at-tacks the patient
again without any new provo-cation, any more than we can account for the
fpontaneous intermisfion of convulsion, fever, head-ach, and such like
spasmodic disorders of the mufcles ; it is however impossible that any one
effect whatever can perfecly ceafe, so long as that cause which was capable
of producing it continues to act upon the same fubjet and in the same
manner. And it is as impofTible that the effect of any action can after a
total difcon-tinuance arise again, without its being regenerat-ed by the
same or at least by a fimilar aaion. Therefore that disorder, be it
muscular or ner-vous, be it convulsion or Madness, which fpon-taneoufly
ceafes and as fpontaneoufly invades
again,
[ 61
again, cannot be consequential to any external cause, which always exisis,
and whole anion al-ways continueth the same.
Original Madness, whether it hereditary or intermitting, is not removable
by any method, which the science of Physick in its present im-perfect Efate
is able to suggest.
But, altho' Original Madness is never radically cured by human art, its
illconditioned fate is however a little recompenfed sometimes by a per-
fect recovery, sometimes by long intervals of fa-nity, without our Alstance
and beyond our ex-pectation. Befides Original Madness is in itself very
little prejudicial to animal life. For it is. notorious that men really mad
live as long as those who are perfecly in their fenle:: ; and, whenever
they sicken or die, they like other mortals are most frequently attacked by
illnesses, which have no necesiary connection with or de-pendance upon
their old complaint of false per-
ception.
Madness, which is consequential to other dif- orders or external causes,
altho' it now and then admits of relief by the removal or correCtion of
such disorders or causes ; yet in proportion to the force and continued
anon of such causes, and according
[ 62
according to the circumstances of the preceding disorders, it is very often
complicated with ma-ny other ill effects of those causes and disorders ;
and, tho' it may not in itself be prejudicial to bodily health, any more
than Original Madness, yet by its companions it becomes fatal or greatly
detrimental to animal life.
Madness, tho' it may be Consequential at first, frequently becomes habitual
and in ellect the very same as Madness strictly Original. In which case the
internal frame and constitution of the nervous substance retains that ill
difpofition which was communicated to it ab extra, even after that the
cause of such communication is quite re-moved or ceafes to act : And the
same subslance, tho' formed originally as perfect as that of other men, yet
by the continual and forcible action of such external cause is at last
essentially vitiated in the same manner and to as great a degree, as if it
had been created impeded and of itself ca-pable of exciting delusive
sensation.
When internal exostoses of the cranium, or induration of the Dura Mater are
the causes of Consequential Madness, each of these case is apparently
incurable by art. Fracture or intro-pression of the cranium, and concuffion
of the head, or rather its effects, tho' very dangerous
[ 63 I
and difficult to be managed, have sometimes been relieved.
When Insolation by the intervening rarefaction of the blood contained in
the brain produces delirium, this its mischievous effect frequently yields
to the lancet, if not too late or too sparingly applied. But if Madness is
the more immediate consequence of the Sun's anion upon the nervous
substance, and if, however occasioned it is from want of care or from
obstinacy of the case pro- tracted after that the piercing darts of heat
its remoter cause are quite abated, it is generally of long duration and
very often incurable : for-afmuch as the medullary portion of the brain is
either (hocked by the continued distenfion of the contiguous vessels, or is
disiraded by the fiery impression in such a manner that its constituent
particles are quite deranged from that order, which is necessary to the
performing their natu-ral functions in a proper manner.
Madness consequential to the inflammation of those membranes that furround
the brain is very dangerous : because such obstruction is formed in minute
vessels which lie out of our reach, and which cannot be soon enough
relieved by the moll plentiful evacuation ; nor can the brain thus
overcharged endure any additional (hock of
[ 64
errhines, vomits, or rough purges : Since spasm thereby excited would
either endanger a rupture of the distended vessels, or heighten the
delirious pressure up to Apoplexy, or convert the inflam-matory matter into
mortification.
And indeed this 'late of Madness, called Phrenzy, let the Physician act
ever so fkilfully, frequently ends in one or other of the two laft
mentioned case. The first of which is plainly threatened by stupidity
succeeding to delirium ; and mortification of the brain may be declared
coming on, or rather formed, when the mania-cal symptoms ceafe without any
apparent reason, and when the patient who was raving be-comes calm and
sensible in an infant ; whilft greater debility and a pulfe hardly
perceivable, together with coldness in the extremities, foretell that this
unexpeected recovery of the understand-ing, however it may flatter, will be
fatal.
Madness consequential to a gradual or chroni-cal congestion of fluids
frequently admits of re-leif, if applied in time. And such congestion is
leis dangerous and more easily removed when-ever the mefenteric nerves
alone are thereby af-feected ; inasmuch as every difficulty and danger that
attends any injury must be less the fewer those nerves are that fuller the
same.
When
[6s3
When spasm is productive of obstructions upon the brain and nerves, and in
this case becomes a-nother and a fill remoter cause of Consequential
Madness, if such spasm is suddenly excited either by the tumultuous
passions of joy and anger, or by intoxicating drugs and vinous spirits, it
is indeed very violent and oftentimes fatal by its immediate effects. But
in case the patient is ca-pable of bearing the first shock, and has not
been weakened by frequent attacks of the same nature ; such sudden and
irregular action of the mufcles together with all its phrenetic or
mania-cal consequences is much sooner either fpontane-oufly abated or
relieved by art, than the gradual and continued muscular constriction,
which is occasioned by the more gentle pail-ions of love grief and despair,
or by long and uninterrupted attention to any one object however pleafing
and agreeable. For Madness consequential to such obstinate muscular
constriction must be as obsti-nate as its cause: and befides in this case
of con-tinual or increafed congestion, there is great reason to fear leaf
the internal frame of the nervous substance itfeif may at last be
essentially vitiated ; and Madness which is habitual or of the same nature
with that which is Original may succeed, and take the place of what at
first was only Consequential.
K Laxity,
[66]
Laxity, whenever it intervenes between spasm and delirious pressure and
thereby becomes a remoter cause of Consequential Madness, admits of cure if
timely and properly applied ; and very often the weakened membranes
spontaneously recover their former elastic tone, provided the spasmodic
impulse is abated, before their constituent fibres are distracted beyond
that natural tendency to approximation which was originally implanted in
them.
Madness consequential to gradual or chronical congestions occasioned by
gluttony or idleness easily yields to medical care, if seasonably and
properly applied.
Madness consequential to or accompanied with other disorders affords no
particular prognostic, but what arises from those disorders when considered
as primary distempers distinct and separate from Madness itself.
[67J
nal integuments which were given to the ner-vous substance for its defence,
in such case An-xiety however afflicting promifes better success.
Insensibility or Ideotifm, when it arises from an internal and
constitutional defect of the or-gans designed to excite sensation, or when
it is a symptom or consequence of Original Madness, like Original Madness
and for the same reason must be pronounced incurable by art. But, what is
very remarkable and much to be lamented, when Insensibility is the effecte
of Consequential Madness, or when it may be attributed to the
pr2eternatural clofeness and rigidity of the ner-vous integuments, or to
obstructions in the con-tiguous vessels ; tho' it may Teem as curable as
Consequential Anxiety, yet in fact (whatever is the reason of the
difference) it is very seldom re-lieved either by art or Nature.
Anxiety, when it arises from some fault in- ctwing in the internal frame
and constitution of the nervous substance, which is thereby rendered too
sensible, like Original Madness and for the same reason is not radically
curable. But when its only cause is a laxity or defect of those exter-
nal
K2 SECT.
[ 68 ]
SECT. X.
B. The Regimen and Cure of Madness.
The Regimen in this is perhaps of more importance than in any distemper. It
was the saying of a very eminent practitioner in such cases that management
did much more than medicine; and repeated experience has convinced me that
confinement alone is oftentimes sufficient, but always so necessary, that
without it every method hitherto devised for the cure of Madness would be
ineffectual.
Madness then, considered as delusive Sensation unconnected with any other
symptom, requires the patient's being removed from all objects that act
forcibly upon the nerves, and excite too lively a perception of things,
more especially from such objects as are the known causes of his disorder;
for the same reason as rest is recommended to bodies fatigued, and the not
attempting to walk when the ankles are strained.
The visits therefore of affecting friends as well as enemies, and the
impertinent curiosity of those, who think it pastime to converse with
Madmen and to play upon their passions, ought strictly to be forbidden.
On the same account the place of confinement should be at some distance
from home: and, let him be where he will, none of his own servants should
be suffered to wait upon him. For all persons, whom he may think he hath
his accustomed right to command, if they disobey his extravagant orders
will probably ruffle him to the highest pitch of fury, or if they comply
will suffer him to continue in a distracted and irresolute state of mind,
and will leave him to the mercy of various passions, any one of which when
unrestrained is oftentimes more than sufficient to hurry a sober man out of
his senses.
Every unruly appetite must be checked, every fixed imagination must if
possible be diverted. The patient's body and place of residence is
carefully to be kept clean: the air he breaths should be dry and free from
noisom steams: his food easy of digestion and simple, neither spirituous,
nor high seasoned and full of poignancy: his amusements not too engaging
nor too long continued, but rendered more agreeable by a well timed
variety. Lastly his employment should be about such things as are rather
indifferent, and which approach the nearest to an intermediate state (if
such there be) between pleasure and anxiety.
As to the cure of Madness, this like the cure of any other disease
consists, 1. In removing or correcting its causes: 2. In removing or
correcting its symptoms: 3. In preventing, removing, or correcting its ill
effects.
These three intentions are to be answered either by general and rational
science; or, if that is wanting, by particular experience alone collected
from plain and similar facts, which the history of practice supplies us
with.
Original Madness indeed deserves our first attention, as it is the least
complicated with any other disorder. But a very little reflection will
serve to convince that all our consideration will never enable us to treat
this first species of Madness in a rational manner. For it is impossible by
any thing like judgment or previous design to answer the first intention,
viz. to remove the immediate necessary and sufficient cause of Madness,
which cause lies out of the reach even of our imagination....
And as to the second and third intentions, they in Original Madness are as
little to be answered as the first. But that is not because either the
symptoms or the ill effects of Original Madness lye out of our reach, or
their causes are unknown; but because Original Madness when considered per
se is not accompanied with any symptoms or succeeded by any effects, which
if not prevented removed or corrected would endanger the life or health of
the patient .
Nor does experience, which oftentimes supplies the defer of rational
intention in many disorders that are hitherto inexplicable by general
science and the common laws of Nature, furnish us with any well attested
remedy for Original Madness. For, altho' several Specific Medicines have by
the merciful direction of Providence been of late successfully applied in
some distempers otherwise incurable by art, such as Mercury in the Venereal
infection, Opium in pain and watch-fullness, the Peruvian Bark in
mortification intermittent fevers and many other complaints ; and altho' we
may have reason to hope that the peculiar antidote of Madness is reserved
in Nature's store, and will he brought to light in its appointed time ; yet
such is our present misfortune, that either this important secret hath been
by its inventors withheld from the rest of man-kind, or, which is more
probable, hath never yet been discovered.
[72]
Since therefore the first species of [Original] Madness is incurable by any
remedy which reason or experience suggests, let us divert our attention to
the second species: And here to our great comfort we shall find that
Consequential Madness is frequently manageable by human art.
For, altho' delusive Sensation, by whatever external accident it may be
occasioned, when considered as a distempered state of the nerves
themselves, admits of no rational or specific relief any more than Madness
which is not consequential to any known cause; nevertheless the previous
disorders and external causes of delusive Sensation are frequently within
our reach. And this, as well as any other morbid effect, may in reason be
and in fact often is prevented or abated; provided the known cause is taken
care of in time, that is before its continued action hath altered the
nervous substance to such a degree as to have rendered it essentially or
habitually unsound.
Now, forasmuch as pressure of the nervous or medullary substance amongst
all the known and external causes of Consequential Madness appears the
nearest to its delirious effect, and indeed so necessary a cause, that
without its intervention nothing external can be supposed capable of
exciting delusive Sensation, this cause therefore must be the first object
of our care.
In the next place our endeavours are to be employed in preventing removing
or weakning those other external accidents before enumerated, which by
occasioning intermediate pressure are the remoter causes of Consequential
Madness.
Delirious pressure of the brain or medullary substance contained in the
nerves, which is the nearest of all the known causes of Madness and
therefore demands our first attention, is incapable of being effectually
relieved, except the compressing matter itself be lessened, diverted, or
dislodged from the part affected: or, to speak technically, the chief
intentions under this first article are 1. Depletion; 2. Revulsion; 3.
Removal; 4. Expulsion.
Not that all these intentions are to be answered in all cases and
circumstances of delirious pressure. For when internal exostoses,
induration of the Dura Mater [brain matter], fracture intropression and
concussion of the head occasion such pressure, Removal (which indeed
intropression does now and then admit) is apparently impracticable. Nor can
Expulsion in any one of these cases, or indeed in any oppression of the
brain that is similar to tumor by Fluxion, be attempted without imminent
danger to the patient's life.
But the two first intentions are almost always to be pursued; and delirious
pressure of the brain or medullary substance contained in the nerves demand
Depletion and Revulsion, let its remoter causes or circumstances be what
they will. For, tho' neither of these intentions propose the removal of
exostoses or any one accident just now mentioned, yet unloading the vessels
contiguous to the brain or nerves, which are thereby aggrieved, will
certainly in all cases prevent or lessen the delirious effect. And, if the
pressure arises solely from the distension of the vessels themselves,
Depletion and Revulsion are apparently the apposite and necessary methods
of relief.
When pressure of the brain or nerves is sudden, both these intentions may
safely and effectually be answered by the lancet and cupping-glass again
and again repeated in proportion to the strength of the patient and the
greatness of the pressure; by neutral salts, which gently stimulating the
intestines and sensible parts contained in the abdomen provoke stools and
urine: of this sort are Nitre, Sal Catharticus amarus, Magnesia alba,
Tartar, and all its preparations, more especially the Sal Diureticus
deservedly recommended by Dr. Mead in Maniacal cases. And Revulsion in
particular may be successfully attempted by the oily and penetrating steams
arising from skins and other soft parts of animals newly slain, by tepid
fomentations and cataplasms applied to the head legs and feet, by oily and
emollient glysters; which are of very great service not only as they empty
the belly, but also and indeed chiefly because they serve as a fomentation
to the intestinal tube, and by relaxing the branches of the aorta
descendens, which are here distributed in great number, make it more
capable of receiving the blood; which will therefore according to the known
course of fluid matter be diverted from the head.
The same intentions of Depletion and Revulsion seem indeed to recommend
sinapisms [ointment made of mustard], caustics [burn the skin to create
blister of clear fluid], errhines [induce sneezing], and vesicatories
[induce blisters], as also the rougher cathartics [induce diarrhea],
emetics [induce vomiting], and volatile diaphoretics [induce sweat by
elevating body temperature]. But when we reflect that a spasmodic
constriction is by no means the least amongst the remoter causes of
Madness, we shall in every case of sudden pressure be fearful of any
powerful irritation that endangers constriction, and that cannot answer
either intention unless it previously excites an irregular action of the
muscles.
And indeed Phrensy or sudden pressure of the brain attended with
inflammation of the containing membranes, and intrusion of blood and serum
into improper vessels of the head, not only forbid sinapisms and every
powerful irritation, but incline us to be suspicious of cathartic salts in
too large doses, and even of Nitre itself, tho' it is reckoned specifically
antiphlogistic, and tho' it is successfully administered in many other
inflammatory tumors before they suppurate.
Delirious Pressure of the nervous substance contained either in the head or
abdomen, when gradual or chronical, tho' it is of a very different nature
from sudden pressure, and tho' it is similar to tumor by Congestion, yet in
robust and plethoric habits alike indicates Depletion and Revulsion. But,
if the subject is either naturally infirm or shattered and exhausted by
preceding illness, the lancet must be cautiously used or entirely
forbidden; and both these intentions can with safety be answered by nothing
except the mildest solutives, such as the neutral salts above-mentioned,
Cassia, Manna, ctc. and the Gumms quickened with a few grains of Aloes.
But, when delirious pressure of the nervous substance, more particularly
that contained in the abdomen, is gradual or chronical, if such gentle
evacuants, tho' often and properly repeated, prove unable to lessen or
relieve the stagnating matter, and in case the weakness of the patient does
not contraindicate, here the third and fourth intentions take place: and it
becomes absolutely necessary to shake with violence the head and
hypochondria [abdomen] by convulsing the muscular fibres with emetics
rougher purges and errhines. For such spasmodic action communicates a
vibrating motion to the solid fibres of the whole body; whereby the
overloaded membranes and integuments that compress the contiguous medullary
substance remove or expell their morbid contents, and the patient delivered
from his delirious incumbrances frequently recovers his former sanity of
mind as well as body.
C78]
SECT. XI. The Cure of Madness.
Pressure of the medullary matter contained in the brain and nerves, amongst
all the known causes of Madness the nearest to such its delirious effect,
and therefore the first objet of our attention, has been considered with
regard to such methods of cure as are indicated by reason and justified by
experience. In the next place therefore we are to turn our thoughts to
those other external accidents, which by occasioning intermediate pre ure
are the remoter causes of Consequential Madness.
Now the several remoter causes before enumerated, were
Internal exostoses of the cranium [formation of new bone on the
surface of the skull]
Induration of the Dura Mater [a deposit of altered blood pigment,
stroke]
Fracture or intropression of the skull and concussion of the head ;
[blow to the skull]
Insolation; [measure of solar radiation energy received, exposure to
sunlight]
One Species of spasm, or muscular constriction, sudden and impetuous
but sooner quieted ; which arises either from
Material objets external to the body, viz. poisons, medicines, and
vinous spirits, or from [substance abuse]
Tumultuous passions, viz. joy and anger; [it overworks the nerves]
Another Species of spasm or muscular constriction more gradual and
gentle in its attack, but frequently increasing, and almost always
obstinate in its duration ; which arises from
Unwearied attention of the mind to one object, or from the quieter
passions of love, grief, or despair;
Preternatural laxity of the membranes or vessels contiguous to the
nerves;
Gluttony;
Idleness [nerves out of shape due to lack of use like building
muscles]
Of all which in their order.
Internal [1] exosloses and [2] induration of the Dura Mater cannot be
prevented, nor does either case admit of any particular method of relief.
[3] Concussion may itself indeed be sometimes prevented, but its ill
effects can never be prevented or removed by any intention except that of
Depletion and Revulsion recommended under the first article of cure. In
fracture or intropreson of the skull the trepan is peculiarly adapted
either to give a vent to, or to remove the extravasated and stagnating
fluids.
[4] Infolation is quite out of our power ; but its subject we have to deal
with is not always so. For, altho' the fiery darts of heat are not capable
of being removed or lessened by human means, the patient may be removed;
or, when that cannot easily be done, the head may be secure by a proper
integument ; for which purpose a cap of thick paper has been successfully
recommended.
p 80
[5] Spasm or muscular constriction, as well the sudden and impetuous as the
more gradual and gentle, when considered by its self and as abstracted from
irritation or any external cause, admits of no method of cure suggested by
rational intention : Forasmuch as the immediate necessary and sufficient
cause of muscular action, be it natural or distempered, is absolutely
unknown. Whenever therefore nothing external to the muscular fibres can be
assigned which is capable of provoking their constriction, we have no hope
except in Specific remedies, that is in such drugs, whole antispasmodic
virtues experience alone has discovered.
Under this head of antispasmodics every one, I suppose, will readily place
Valerian, Castor, the Gumms, and Musk ; and, were I at liberty to indulge a
suspicion which has for some time occurred, I should be inclined to add
Nitre, the Magnesia, the Sal Diureticus, as also all alkaline substances
incorporated with acids, all neutral salts, and all alexipharmacs or
diaphoretics : whole sudden efficacy in appealing the paroxysms of feverish
disorders which are apparently spasmodic can be attributed to no other
known power, but such as hath an immediate influence upon the animal fibres
endued with motion. Not that any thing more than conjecture is hereby
proposed ; which is to be admitted or not, as the conclusions of others
arising from their own just reasoning and experience shall determine.
But, whatever class the virtues of Nitre and neutral salts shall hereafter
be ranked under, it may at present with great truth be asserted from
observations already made that they are the only Specific helps, which can
be depended on with any probability of success or even with safety in fits
of Madness attended with fury and violent spasmodic motions. And it is as
certain that those other anti-spasmodic drugs which are poignant and
irritating, viz. Valerian, Castor, and the gumms, are serviceable and
indeed harmless only in the second or gradual and gentler Species of
muscular constriction.
Which observations by the way not only serve to distinguish what Specific
remedies are proper for either case of spasmodic Madness ; but more over
suggest a caution to the Physician in the administering even Nitre and
other saline febrifuges in spasmodic disorders whether delirious or not
because such sharp bodies when over-dosed or when applied to subjects too
susceptible of irritation may sometimes aggravate every symptom they are
intended to relieve, and may become as mischievous as those other more
poinant anti-spasmodics have frequently proved, when prescribed in all
convulsive case under the general and improper title of Nervous Medicines.
p 82
[6] The same caution is likewise highly necessary when spasm is occasioned
by the sixth class of remoter causes, viz. poisons, medicines, vinous
spirits, or any assignable matter which actually excites an irregular
motion of the muscles. For it is almost self-evident that in such case all
additional irritation must increase every convulsive effect, and that even
the most gentle saline remedies will be hazardous or at best inefficacious,
until the material cause of spasm if superficial is removed by chirurgical
assistance, if it be in the stomach or intestines until it is discharged by
the force of vomits or purges, or if such means of expulsion be thought too
violent until the offending matter is sufficiently enervated by diluting
and absorbing medicines, or in case of extreme necessity until its effect
is prevented or Rifled by narcotics. All which different methods of cure in
such Consequential Madness must be left to the sagacity of the Physician ;
it being impossible to lay down any general direction in a matter attended
with so great a variety of unfore-feen accidents.
p 83
But, though the removal of the sixth class of remoter causes, viz. every
irritation which produces Madness, is not always feasible or even safe, and
though such terrible effect admits of no relief so long as the material
cause continues to ad, nevertheless prevention, at least with regard to
vinous spirits, is entirely in our power. For which reason it deserves the
serious consideration of our governors, how far it is their duty by a total
prohibition of the cause to prevent those frequent effects of temporary but
real Lunacy, for which many wretches are executed, who in reality are
guilty of debauchery alone, which has been rendered familiar by the custom
or rather the convenience of their country, and is allowed or commuted for
by the laws of the revenue.
[7] As to the seventh class of remoter causes, viz. tumultuous and
spasmodic passions, such as joy and anger, in case the patient is not in
immediate danger of his life, nothing of any great consequence is to be
done at first; in hopes that these passions and their muscular effects
will, as they are frequently known to do, subside of themselves. But,
whenever anceps remedium is the indication, after sufficient depletion and
diminution of maniacal pressure thereby occasioned, we must have recourse
to the Specific, that is to the unaccountably narcotic virtues of the
Poppy. And, if notwithslanding this temporary relief any one particular
passion seems to engross the man or continues beyond its usual period, in
such case the discretion of the Physician must determine how far it may be
advisable or safe to stifle it by a contrary passion. I say safe, because
it is almost impossible by general reasoning to foretell what will be the
effect of fear substituted in the room of anger, or of sorrow immediately
succeeding to joy.
[8] The eighth remoter cause of Consequential Madness, viz. Muscular
Constriction, gradual, gentler and uniform, but more obstinate, may
sometimes be relieved or as it were diverted by convulsion that is by an
alternate motion of muscular fibres artificially excited in some other part
of the body. On which account vesicatories, vomits, rough cathartics,
errhines, and the most poinant among the medicines called nervous, may in
this particular case of spasm become even antispasmodic. For, ignorant as
we are and perhaps shall always be of the reason, experience has shown
that, although many parts of the body may be convulsed together, one
Species of spasm however occasioned seldom fails to put an end to that
other which before subsisted.
[ 85 ]
[9] When the ninth dials of remoter causes demands our care, viz. unwearied
attention to any one object, as also love, grief, and despair ; any of
these affections will sometimes be annihilated by the tumultuous but less
dangerous and sooner subsiding passions of anger or joy. But, if such
instantaneous alteration from one extreme to the other appears either not
feasible or too shocking to be attempted with safety ; bodily pain may be
excited to as good a purpose and without any the least danger. It being a
known observation, though as much out of the reach of human reason as are
most others which occur in the animal economy, that no two different
perceptions can subsist at the same time any more than the two different
Species of morbid muscular anion, viz. the convulsive and the constrictive.
Therefore vesicatories, caustics, vomits, rough cathartics, and errhines,
may be and in fact often are as serviceable in this case of fixed nervous
Sensation as in obstinate muscular constriction, inasmuch as they all
relieve and divert the mind from its delirious attention, or from the
bewitching passions of love, grief; and despair.
[86]
[10] The tenth remoter cause of Consequential Madness, viz. Laxity of those
vessels or membranes that are contiguous to the nervous substance,
apparently indicates such remedies as have the experienced though
unaccountable efficacy of contracting the material particles which
constitute an animal body. Of this nature is iron, vitriol, and mineral
waters impregnated therewith : but above all, when nothing contraindicates,
the bathing in cold or rather sea water.
[11] As to the eleventh and twelfth remoter causes, viz. Gluttony and
Idleness, little is requisite for their particular cure : since, after
proper evacuations, temperance is undoubtedly the apposite remedy of the
one, and bodily exercise of the other. Both which means of present recovery
and of prevention for the future may be effectually prescribed to men of
either character, at least whilst they are actually mad and properly
confined. For the diet of the glutton in such case is absolutely in the
Physician's power. And, although it would be no easy talk to persuade or
even to force any person, whether a Lunatic or not, who has long indulged
in idleness, to put his body in motion ; nevertheless this state of
inactivity may be artificially broke through by vomits, rough cathartics,
errhines, or any other irritating medicines : which in this case therefore
answer more than one intention, and not only discharge or dislodge the
delirious load of stagnating fluids, but also by their convulsive influence
upon the muscles of the abdomen and indeed upon every animal fibre of the
agitated body crowd as it were a great deal of exercise into a small
portion of time, and that without the consent of the patient, or even the
trouble of contradicting his lazy inclinations.
Section XII The cure of the symptoms and consequences of Madness. And some
observations upon the whole.
IT may be recollected that the cure of Madness, as well as of all other
distempers, consists in 1. Removing or correcting its causes: 2. Removing
or correcting its symptoms: 3. Preventing, removing, or correcting its ill
effects.
A method of answering the first intention has been proposed in the two
foregoing Sections: the symptoms and ill effects of Madness should
therefore be our next care.
But Original Madness, as hath been before observed, is not necessarily
accompanied with any symptoms or succeeded by any effects, that are
strictly speaking insalubrious [not conducive to good health].
And indeed, with respect to Consequential Madness, whatever may accompany
it as a symptom or follow it as a seeming effect, every such accidental
disorder hath in reality no necessary connection with Madness itself: but
is either resolvable into other injuries quite foreign to Maniacal
affections ; or, if it is owing to any one remoter cause of Madness, it is
fill no more than another effect of the same cause ; which effect is just
as capable of being thereby generated, whether Madness is or is not
produced together with such symptom or before such consequence.
89 ]
For which reason every symptom and every seeming ill effect of Madness,
whether Original or Consequential, must be considered either as a primary
distemper, or as the effect of some primary distemper, to which a proper
method of cure is applicable separate and independent of Madness ; and
therefore it is not the subject of our present enquiry.
But, as Anxiety frequently precedes Madness like its cause or accompanies
it like its symptom, and as Insensibility sometimes succeeds Madness like
its effect ; tho' both these preternatural states of Sensation are as
distinguishable and actually separate from delusive sensation, as any other
animal distemper is or can well be : the same reasons however, which
required a more particular enquiry into the nature and origin of these two
nervous affections, will excuse our endeavouring to investigate what method
of cure the discovery of their causes may seem to indicate with any the
least probability of success.
[ 90]
Anxiety then is either Original or Consequential. For, as hath been before
observed, it may arise, I. From some ill-conditioned state of the internal
and proper substance of the nerves affected ; 2. From the intolerable
impulse of external objects, or from some defect in those integuments and
membranes that surround the medullary matter, and when they are perfect
defend it even from the natural anion of bodies which would otherwise
excite too lively a sensation.
Anxiety, when it is Original, resembles Original Madness, and for the same
reason seems as much out of the reach of medical assistance : But in fact
its case is more fortunate ; and, tho' Original Anxiety is just as
incapable as Original Madness of being relieved by rational intention, it
is however frequently palliated by more than one Specific remedy.
For wine, and even vinous spirits which are rightly forbidden to persons in
perfect health, when occasionally administered as medicines to animal
bodies agonizing with exquisite sensation, beguile the distresses of
mortals, and oftentimes procure them tranquillity and happiness, to which
they have long been strangers. And, altho' neither wine nor vinous spirits
are advisable in the vexatious symptom of watchfulness, which frequently
attends upon Anxiety, whether accompanied by Madness or not ; forasmuch as
such poignant stimuli must irritate before their narcotic virtues can take
effect ; yet I have often prescribed the Extraurn thebaicum [opium] from
one to five grains without any ill consequence to such mad patients as were
uneasy and raving all the night as well as day. And, where extreme weakness
or some approaches to stupor rendered this powerful narcotic not quite so
safe, Camphire and Sagapenum have afforded the same anodyne and soporific
virtues, tho' not to so great a degree.
Nor ought any one to reject such temporary expedients, as unworthy the
attention of a Physician in Original Anxiety, even tho' it should prove
incurable by art ; who considers that it is his duty to protract the misery
of his fellow creatures, if it be but for a moment ; and that anodynes [a
drug that allays pain or soothes] are absolutely necessary in every case of
Consequential Anxiety, until either the intolerable impulse of external
objects can be entirely removed or weakened by such methods as particular
circumstances require, or until the nervous integuments [something that
covers] can be restored to their natural firmness by the astringent virtues
of the Peruvian Bark, iron, vitriol [a sulfate of any of various metals:
copper, iron, or zinc], mineral waters, and cold bathing ; which are the
proper and often-times effectual remedies, whenever Anxiety arises from the
laxity or defect of those membranes that surround and defend the medullary
matter.
93 J
Insensibility, Idiotism, Folly, or whatever name it is usually known by,
is, as hath been observed, almost always beyond the power of rational or
Specific relief. Nevertheless, that nothing may be left untried, it seems
advisable to make general evacuations, and to contrive partial but constant
discharges of the fluids from the head and neck by perpetual blisters,
setons [thread, gauze, or other material passed through subcutaneous tissue
or a cyst to create a sinus or fistula], and issues. It may likewise be of
some service, if nothing contraindicates, to shake the whole solid frame by
vomits, cathartics, errhines, and all sorts of tolerable irritation. To
which may be added, but not without great caution, the subtle and
penetrating particles contained in mineral waters drank at the
fountain-head, and the concussive force of the cold-bath. or sea, water.
But if Insensibility is constitutional, or owing to the firm and healthy
structure of those solid membranes which sheath the nervous matter, such
natural defect or impediment is incurable by art. However this slate of
stupidity may, at lead by those who are endued with too lively a sensation,
be deemed a kind of negative happiness, and rather to be envied than
lamented.
And thus ends our inquiry into the causes effects and cure of Madness.
But, before we quit this subject, it may not be improper to subjoin a few
remarks, which will readily occur to every one who recollects the premises,
and is moreover satisfied of their reasonableness.
We have therefore, as Men, the pleasure to find that Madness is, contrary
to the opinion of some unthinking persons, as manageable as many other
distempers, which are equally dreadful and obstinate, and yet are not
looked upon as incurable: and that such unhappy objects ought by no means
to be abandoned, much less shut up in loathsome prisons as criminals or
nusances to the society.
We are likewise, as Physicians, taught a very useful lesson, viz. That,
altho' Madness is frequently taken for one species of disorder,
nevertheless, when thoroughly examined, it discovers as much variety with
respect to its causes and circumstances as any distemper whatever. Madness
therefore, like most other morbid cases, rejects all general methods, v.g.
bleeding, blisters, caustics, rough cathartics, the gumms and faetid
antihysterics, opium, mineral waters, cold bathing, and vomits.
p 94
For bleeding, tho' apparently serviceable and necessary in inflammation of
the brain, in rarefaction of the fluids, or a plethoric habit of body, is
how ever no more the adequate and constant cure of Madness, than it is of
fever. Nor is the lancet, when applied to a feeble and convulsed Lunatic,
less destructive than a sword.
And, altho' blisters, caustics, and sharp purges quickned with white
Hellebore [herb flower: purgative], and indeed all painful applications,
not only evacuate and thereby relieve delirious pressure, but also rouse
and exercise the body, and seem more peculiarly adapted to Insensibility
when it is a symptom or consequence of Madness; nevertheless these and all
pungent substances are to be tried with great caution, or rather are not to
be tried at all in fits of fury. Nor does even defect of sensation allow
their use, whenever such defect is occasioned by the preceding excess of
the nervous energy, or when it is accompanied with spasm. As to black
Hellebore [Black hellebore, Helleborus officianalis which is drastically
cathartic, was formerly regarded as a specific in mental illness. It is
native to Greece and Asia Minor, but was especially associated with the
town of Anticyra on the Greek coast near Delphi.], it is either not the
drug which was recommended by the Ancients and made Anticyra famous, or
else it did not really deserve such recommendation.' For after several
trials I have not the least reason to think it of any service in Madness.
For the same reason the gumms and all foetid antihysterics, which are
undoubtedly serviceable in Madness arising from or complicated with some
sorts of spasmodic disorders, are by no means even safe in all
prxternatural actions of the muscles: much less can such irritating objects
be proper in that particular case of Madness which is attended with
feaverish heat, which happens in a plethoric habit of body, or which
follows an inflammatory obstruction in the brain.
As to Opium, notwithstanding what hath been before said concerning the
great relief obtained by this powerful drug in some particular
circumstances, it is no more a specific in Madness than it is in the Small
Pox. For no good whatever can be expected but from its narcotic virtue, and
much harm may arise therefrom when improperly administered. For it is
almost self-evident that in Madness attended with debility and languor, or
which approaches towards stupor and insensibility, every thing that deadens
sensation must be highly detrimental when given in a sufficient quantity,
and may prove fatal when overdosed.
Mineral waters drank at the fountain head and bathing in the sea or cold
fresh water have been sometimes chiefly if not solely relied on in the cure
of Madness, more especially when attended with Anxiety and known by the
name of Melancholy. Nevertheless such methods of relief are all apparently
contraindicated, whenever there is sufficient reason to suspect that
irresoluble congestions of the fluids clog the membranes contiguous to the
nervous substance, or that the solids are strained beyond the possibility
of recovering their natural elasticity. For in case of irresoluble
congestions every drop of water, whether mineral or not, taken into the
circulation will be added to the obstructing matter ; and the contracting
force of cold or of sea-water applied externally will make the same matter
more incapable, if possible, of being resolved. And, when the solids are
irrecoverably strained, they will be in great danger of rupture or at least
of a farther disunion of their constituent particles by the expansive force
of mineral springs, as well as by the rude shock of cold or of sea-water,
which is very sensibly felt even by those bodies, whose solids are strong
enough to bear the fame without being hurt thereby.
Lastly with respect to Vomits, tho' it may seem almost heretical to impeach
their antimaniacal virtues; yet, when we reflect that the good effects
which can be rationally proposed from such shocking operations are all
nevertheless the consequences of a morbid convulsion, these active
medicines are apparently contraindicated, whenever there is reason to
suspect that the vessels of the brain or nervous integuments are so much
clogged or strained as to endanger a rupture or further disunion, instead
of a deliverance from their oppressive loads. The same objection equally
holds good against such muscular irritation, whenever the vessels are
contracted with excessive cold, or when their contents are rarefied by
heat, as also in constitutions that are lax and feeble or naturally
spasmodic, and in several other circumstances which need no particular
description ....
[98]
Besides, since the characters that distinguish Original from Consequential
Madness are not al-ways so clear and certain as to leave no room for error,
and since Original Madness is not cur-able by any method which human reason
or experience hath hitherto been able to discover; we should take great
care not to do harm where it is not in our power to do any good, and not
dwell too long on endeavouring to remove the causes of Madness, which
perhaps are only imaginary, more especially if the methods to be made use
of are by no means indifferent. For which reason, whenever upon sufficient
trial not only of vomits but even of rougher purges, tho' rationally
indicated at first, the patient grows worse or at least gains no ground,
they are all entirely to be laid aside. For, if in any case the juvantia
and laedentia supply us with medical knowledge, they most signally do so in
disorders, whose nature we are not thoroughly acquainted with, and where
reasoning a priori cannot certainly foretell the success of any one
application.
Nor let us immediately despair at being obliged to withhold that assistance
which seemed the most effectual, or conclude that, because the patient
cannot be relieved by art, he therefore cannot be relieved at all. For
Madness, like several other animal distempers, oftentimes ceases
spontaneously, that is without our being able to assign a sufficient
reason; and many a Lunatic, who by the repetition of vomits and other
convulsive stimuli would have been strained into downright Idiotism, has
when given over as incurable recovered his understanding.
To which remarks arising as just conclusions from reasoning upon the
unavoidable action of vomits and rougher purges, I shall beg leave to add
some cautions, which experience has suggested as necessary to be
communicated to the young practitioner, even when such active medicines are
proper. viz. 1. If the season of the year is in the choice of the
Physician, to prefer the Spring or Autumn, as being in neither extreme of
cold or heat : 2. Not to persist in their use at any one time for a longer
term than six or eight weeks: 3. Even during that term to give a respite
every other or at least every third week from all drugs except the gumms,
neutral salts, or gentle solutives : 4. As soon as the patient visibly
approaches to a state of sanity, entirely to discontinue these and all
other violent methods ; that the animal fibres, which have been strained
either by the causes of Madness or perhaps by the means of removing them,
may be at liberty to recover their natural firmness and just approximation
of particles, which a repeated concussion will certainly prevent.
FINIS.
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