THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 GIFT OF
 
 i- EDIT 
 
 ADEI/ 
 j 
 
 X 
 
 *
 
 IF 
 
 V. 

 
 MEDICAL INQUIRIES 
 
 AND 
 
 UPON 
 
 THE DISEASES OF THE MIND. 
 
 BY BENJAMIN RUSH, M. D. 
 
 PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE, AND OF CLINICAL 
 PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA. 
 
 FIFTH EDITION. 
 
 PHILADELPHIA: 
 
 PUBLISHED BY GRIGG AND ELLIOT 
 
 NO. 9 3TOHTH FOURTH STREET. 
 
 1835.
 
 Eastern District of Pennsylvania, to wit : 
 
 Be it remembered, that on the first day of December, A. D., 1825, in the 
 fiftieth year of the Independence of the United States of America, William 
 Rush, of the said district, has deposited in this office ^he title of a Book, the 
 right whereof he claims as proprietor in the words following, to wit : 
 
 "Medical Inquiries and Observations upon the Diseases of the Mind. 
 By Benjamin Rush, M. D., Professor of the Institutes and Practice of 
 Medicine, and of Clinical Practice, in the University of Pennsylvania." 
 
 In conformity to the Act of the Congress of the United States, entitled 
 " An act for the encouragement of learning, by securing the copies of maps, 
 charts and books, to the authors and proprietors of such copies, during the 
 times therein mentioned :" and also to an act entitled, " An act supple- 
 mentary to an act, entitled, An act for the encouragement of learning, by 
 securing the copies of maps, charts and books, to the authors and proprietors 
 of suchcopies, during the times therein mentioned'; and extending the bene- 
 fits thereof to the arts of designing, engraving, and etching historical and 
 
 0therprintS '' D. CALDWELL. 
 
 Clerk of the Eastern District of Pennsylvania. 
 
 Printed by J. Crissy & G. Goodman, 4 Minor St.
 
 College 
 Library 
 
 CONTENTS, 
 
 CHAPTER I. PAGE 
 
 Of the Faculties and Operations of the Mind, and on the Proximate 
 Cause of Intellectual Derangement 7 
 
 CHAPTER II. 
 Of its Remote, Exciting and Predisposing Causes 
 
 CHAPTER III. 
 
 Of Partial Intellectual Derangement, and particularly of Hypochon- 
 driasis, or Tristimania -----,-- 72 
 
 Of the Remedies for Hypochondriasis or Tristimania 96 
 
 CHAPTER IV. 
 
 Of Amenomania, or Partial Intellectual Derangement accompanied 
 with Pleasure, or not accompanied with Distress 133 
 
 CHAPTER V. 
 
 Of General Intellectual Derangement 139 
 
 Of the symptoms of Mania 140 
 
 Of the different forms of Mania - - 160 
 
 Of the Influence of the Moon on Mania - 1G8 
 
 CHAPTER VI. 
 Of the Remedies for Mania ... 174 
 
 CHAPTER VII. 
 Of Manicula - - 212 
 
 CHAPTER VIII. 
 
 Of Manalgia - - 214 
 
 Of the Remedies for Manalgia - - - - - - 219 
 
 Of the Means of Improving the Condition of Mad People - - 239 
 
 Signs of a Favourable and Unfavourable Issue of all the Forms of In- 
 tellectual Derangement - - .._... 246 
 TJsual Modes of Death from them - 254
 
 
 IV CONTENTS. 
 
 CHAPTER IX. PAGE 
 
 Of Demence, or Dissociation .---------.-- 257 
 
 CHAPTER X. 
 Of Derangement in the Will 261 
 
 CHAPTER XI. 
 Of Derangement in the Principle of Faith, or the Believing Faculty - 269 
 
 CHAPTER XII. 
 
 Of Derangement of the Memory 274 
 
 Of the Remedies for it 281 
 
 CHAPTER XIII. 
 Of Fatuity 289 
 
 CHAPTER XIV. 
 Of Dreaming, Incubus, or Night Mare, and Somnambulism - - - 298 
 
 CHAPTER XV. 
 Of Illusions 304 
 
 CHAPTER XVI. 
 Of Reverie, or Absence of Mind 308 
 
 CHAPTER XVII. 
 
 Of Derangement of the Passions 
 
 Of Love - 312 
 
 Of Grief 316 
 
 Of Fear - - - 322 
 
 Of Anger - - 331 
 
 Of the morbid Effects of Envy, Malice and Hatred ..... - 338 
 Of the Torpor of the Passions - .... 343 
 
 CHAPTER XVIII. 
 Of the morbid State of the Sexual Appetite ... 345 
 
 CHAPTER XIX. 
 
 Of the Derangement in the moral Faculties - - - - 355
 
 
 PREFACE. 
 
 AGREEABLY to a promise made to the public some years 
 ago, and in compliance with the solicitations of the author's 
 pupils, he now offers to them a volume of Medical Inquiries 
 and Observations, upon the Diseases of the Mind. 
 
 The views which he has taken of the proximate cause, forms, 
 and symptoms of those diseases, have obliged him to employ a 
 new nomenclature to designate some of them. This becomes 
 no less necessary where new opinions are proposed, or new 
 symptoms described in the history of diseases, than an increase 
 in the number of words, and new combinations of them, become 
 necessary to accompany the increase of the wants and objects 
 of civilized society. 
 
 Some of the facts contained in the following pages are of an 
 old date, and will be familiar to the medical reader, but the 
 publication of them, it is hoped, will be excused, when it is 
 perceived, that they are placed under the direction of new 
 principles, and that new inferences of a practical nature are 
 deduced from them. An apology may seem necessary like- 
 wise for the large number of recent facts that have been added 
 to them. Upon subjects so interesting as the present, more 
 than common testimony is necessary to produce conviction. 
 Besides, facts, or precedents, have the saine effects in reason- 
 ing in medicine, that examples have in morals. They compel 
 the reader to admit the practice they are intended to establish, 
 provided they are applied in a proper manner.
 
 V PREFACE. 
 
 4 
 
 The author has omitted referring to the books from which 
 he has obtained some of his facts. His reason for doing so 
 was, when he began to collect them, he did not expect to pub- 
 lish them, and of course did not mark the volumes and pages 
 from which they were extracted. Since he formed that design 
 he has faithfully preserved references to them both. He has 
 suppressed them, only because their partial publication would 
 have destroyed the uniformity of the work. He commits his 
 imperfect labours, now before the reader, to his fellow citizens, 
 with a hope that they may serve as a supplement to materials 
 already collected, from which a system of principles may be 
 formed that shall lead to general success in the treatment of the 
 diseases of the mind. Experience -has exhausted herself in 
 abortive efforts for that purpose, and should the following 
 attempt to co-operate with her by principles be alike unsuccess- 
 ful, it must be ascribed to their being erroneous, for the author 
 believes those diseases can be brought under the dominion of 
 medicine, only by just theories of theiv seats and proximate 
 cause. 
 
 BENJAMIN RUSH. 
 
 PHILADELPHIA, OCTOBER, 1812.
 
 1 
 
 * ' ' % 
 
 MEDICAL 
 INQUIRIES AND OBSERVATIONS 
 
 Olf 
 
 I 
 
 THE DISEASES OF THE MIND. 
 
 CHAPTER I. 
 
 Of the Faculties and Operations of the Mind, and on 
 the Proximate Cause and Seat of Intellectual De- 
 rangement. 
 
 IN entering upon the subject of the following 
 Inquiries and Observations, I feel as if I were 
 about to tread upon consecrated ground. I am 
 aware of its difficulty and importance, and I thus 
 humbly implore that BEING, whose government 
 extends to the thoughts of all his creatures, so to 
 direct mine, in this arduous undertaking, that no- 
 thing hurtful to my fellow citizens may fall from 
 my pen, and that this work may be the means of 
 lessening a portion of some of the greatest evils 
 of human life.
 
 ON THE DISEASES 
 
 Before I proceed to consider the diseases of the 
 mind, I shall briefly mention its different faculties 
 and operations. 
 
 Its faculties are, Understanding, Memory, Im- 
 agination, Passions, the principle of Faith, Will, 
 the Moral faculty, Conscience, and the sense of 
 Deity. 
 
 Its principal operations, after sensation, are 
 Perception, Association, Judgment, Reasoning 
 and Volition. All its subordinate operations, 
 which are known by the names of Attention, Re- 
 flection, Contemplation, Wit, Consciousness, and 
 the like, are nothing but modifications of the five 
 principal operations that have been mentioned. 
 
 The faculties of the mind have been called, very 
 happily, internal senses. They resemble the exter- 
 nal senses in being innate, and depending wholly 
 upon bodily impressions to produce their specific 
 operations. These impressions are made through 
 the medium of the external senses. As well might 
 we attempt to excite thought in a piece of marble 
 by striking it with our hand, as expect to produce 
 a single operation of the mind in a person de- 
 prived of the external senses of touch, seeing, 
 hearing, taste and smell.
 
 OF THE MIND. 9 
 
 All the operations in the mind are the effects of 
 motions previously excited in the brain, and every 
 idea and thought appears to depend upon a mo- 
 tion peculiar to itself. In a sound state of the 
 mind, these motions are regular, and succeed im- 
 pressions upon the brain with the same certainty 
 and uniformity that perceptions succeed impres- 
 sions upon the senses in their sound state. 
 
 In inquiring into the causes of the diseases of 
 the mind, and the remedies that are proper to re- 
 lieve them, I shall employ the term derangement, 
 to signify the diseases of all the faculties of the 
 mind. 
 
 As the understanding occupies the highest rank 
 of those faculties, and as it is most frequently the 
 seat of derangement, I shall begin by considering 
 the causes, and all the states arid forms of its dis- 
 eases. 
 
 By derangement in the understanding, I mean 
 every departure of the mind in its perceptions, 
 judgments, and reasonings, from its natural and 
 habitual order; accompanied with corresponding 
 actions. It differs from delirium, whether acute, 
 or chronic, in being accompanied with a departure 
 from habitual order, in incoherent conduct, as well 
 
 2
 
 10 ON THE DISEASES 
 
 as conversation. The latter, however, is not ne- 
 cessary to constitute intellectual madness, for we 
 sometimes meet with the most incongruous ac- 
 tions without incoherent speech, and we now and 
 then meet with incoherent speech in mad people, 
 in whom the disease does not destroy their habits 
 of regular conduct. This is evinced by the cor- 
 rectness with which they sometimes perform cer- 
 tain mechanical and menial pieces of business. 
 Madness is to delirium what walking in sleep is to 
 dreaming. It is delirium, heightened and pro- 
 tracted by a more active and permanent stimulus 
 upon the brain.* 
 
 Let it not be supposed that intellectual derange- 
 ment always affects the understanding exclusively 
 in the manner that has been mentioned. Far from 
 it. Two or more of the faculties are generally 
 brought into sympathy with it, and there are cases 
 in which all the faculties are sometimes deranged 
 in succession and rotation ; and now and then they 
 are all affected at the same time. This occurs 
 most frequently in the beginning of a paroxysm of 
 
 * The reader will find several other distinguished marks be- 
 tween madness and delirium, applicable to legal purposes, in the 
 author's Introductory Lecture upon MedicalJurisprudence, pub- 
 lished in a volume of Lectures, by Bradford and Inskeep, in the 
 year 1810.
 
 OF THE MIND. 1 1 
 
 intellectual madness, but it rarely continues to 
 affect the other faculties of the mind after two or 
 three weeks, or after the liberal use of depleting 
 remedies. Thus fever, in its first attack, affects 
 the bowels and nervous system, and in a few days 
 settles down into a disease chiefly of the blood- 
 vessels. 
 
 Derangement in the understanding, has been 
 divided into partial and general. The causes of 
 both are the same. I should proceed immediately 
 to enumerate them, but as the seat or proximate 
 cause of a disease is generally the first object of 
 a physician's inquiry on entering a sick room, it 
 shall be the first -subject of our consideration in 
 the present inquiry. 
 
 1. The most ancient opinion, of the proximate 
 cause of intellectual derangement, or what has 
 been called madness, is, that it is derived from a 
 morbid state of the liver, and that it discovers 
 itself in a vitiated state of the bile. Hippocrates 
 laid the foundation of this error by his encomium 
 upon Democritus, whom he found employed in 
 examining the liver of a dumb animal in order to 
 discover the cause of madness.
 
 12 ON THE DISEASES 
 
 2. Madness has been said to be the effect of 
 a disease in the spleen. This viscus is supposed 
 to be affected in a peculiar manner in that grade 
 of madness which has been called hypochondria- 
 sis. For many years it was known in England 
 by no other name than the spleen, and even to 
 this day, persons who are affected with it are said 
 to be spleeny, in some parts of the New England 
 states. 
 
 3. A late French writer, Dr. Prost, in an inge- 
 nious work entitled " Medecine Eclairee par Ob- 
 servation et POverture des Corps," has taken 
 pains to prove that madness is the effect of a dis- 
 ease in the intestines, and particularly of their 
 peritoneal coat. The marks of inflammation 
 which appear in the bowels in persons who have 
 died of madness, have no doubt favoured this 
 opinion; but these morbid appearances, as well 
 as all those which are often met with in the liver, 
 spleen, and occasionally in the stomach, in per- 
 sons who have died of madness, are the effects 
 and not the causes of the disease. They are 
 induced either, 1st, by the violent or protracted 
 exercises of the mind attracting or absorbing the 
 excitement of those viscera, and thereby leaving 
 them in that debilitated state which naturally dis- 
 poses them to inflammation and obstruction.
 
 OF THE MIND. 13 
 
 Thus diseases in the stomach induce torpor and 
 costiveness in the alimentary canal. Thus too 
 local inflammation often induces coldness and in- 
 sensibility in contiguous parts of the body. Or, 
 2d, they are induced by the reaction of the mind 
 from the impressions which produce madness, be- 
 ing of such a nature as to throw its morbid excite- 
 ment upon those viscera with so much force as to 
 produce inflammation and obstructions in them. 
 That they are induced by one, or by both these 
 causes, I infer from the increased secretion and 
 even discharge of bile which succeed a paroxysm 
 of anger; from the pain in the left side, or spleen, 
 which succeeds a paroxysm of malice or revenge; 
 and from the pain, and other signs of disease in 
 the bowels and stomach which follow the chronic 
 operations of fear and grief. That the disease 
 and disorders of all the viscera that have been 
 mentioned, are the effects, and not the causes of 
 madness, I infer further from their existing for 
 weeks, months and years in countries subject to 
 intermitting fevers, without producing madness, 
 or even the least alienation of the mind. 
 
 4. Madness, it has been said, is the effect of a 
 disease in the nerves. Of this, dissections afford 
 us no proofs; on the contrary, they generally 
 exhibit the nerves after death from madness in a
 
 14 ON THE DISEASES 
 
 sound state. I object further, to this opinion, 
 that hysteria, which is universally admitted to be 
 seated chiefly in the nerves and muscles, often 
 continues for years, and sometimes during a long 
 life, without inducing madness, or if the mind be 
 alienated for a few minutes in one of its paroxysms, 
 it is only from its bringing the vascular system into 
 sympathy, in which 1 shall say presently the cause 
 of madness is primarily seated. The reaction of 
 the mind from the impressions which produce 
 hysteria, discovers itself in the bowels, in the kid- 
 neys, and in most of the muscular parts of the 
 body. 
 
 5, and lastly. Madness has been placed exclu- 
 sively in the mind. I object to this opinion, 1st, 
 because the mind is incapable of any operations 
 independently of impressions communicated to it 
 through the medium of the body. 2d, Because 
 there are but two instances upon record of the 
 brain being found free from morbid appearances 
 in persons who have died of madness. One of 
 these instances is related by Dr. Stark, the other 
 by Dr. De Haen. They probably arose from the 
 brain being diseased beyond that grade in which 
 inflammation and its usual consequences take 
 place. Did cases of madness reside exclusively 
 in the mind, a sound state of the brain ought to 
 occur after nearly every death from that disease.
 
 OF THE MIND. 15 
 
 I object to it, 3, because there are no instances 
 of primary affections of the mind, such as grief, 
 love, anger, or despair, producing madness until 
 they had induced some obvious changes in the 
 body, such as wakefulness, a full or frequent 
 pulse, costiveness, a dry skin, and other symptoms 
 of bodily indisposition. 
 
 I know it has been said in favour of madness 
 being an ideal disease, or being seated primarily 
 in the mind, that sudden impressions from fear, 
 terror, and even ridicule, have sometimes cured 
 it. This is true, but they produce their effects 
 only by the healthy actions they induce in the 
 brain. We see several other diseases, particu- 
 larly hiccup, headach, and even fits of epilepsy, 
 which are evidenly affections of the body, cured 
 in the same way by impressions of fear and terror 
 upon the mind. 
 
 Having rejected the abdominal viscera, the 
 nerves, and the mind, as the primary seats of mad- 
 ness, I shall now deliver an opinion, which I have 
 long believed and taught in my lectures, and that 
 is, that the cause of madness is seated primarily in 
 the blood-vessels of the brain, and that it depends 
 upon the same kind of morbid and irregular 
 actions that constitutes other arterial diseases.
 
 16 ON THE DISEASES 
 
 There is nothing specific in these actions. They 
 are a part of the unity of disease, particularly of 
 fever; of which madness is a chronic form, affect- 
 ing that part of the brain which is the seat of the 
 mind. 
 
 My reasons for believing the cause of madness 
 to be seated in the blood-vessels of the brain are 
 drawn, 
 
 I. From its remote and exciting causes, many 
 of which are the same with those which induce 
 fever and certain diseases of the brain, particu- 
 larly phrenitis, apoplexy, palsy and epilepsy, all of 
 which are admitted to have their seats in a 
 greater or less degree to the blood-vessels. Of 
 thirty-six dissections of the brains of persons who 
 had died of madness, Mr. Pinel says he could per- 
 ceive no difference between the morbid appear- 
 ances in them, and in the brains of persons who 
 had died of apoplexy and epilepsy. The sameness 
 of these appearances, however, do not prove that 
 all those diseases occupy the same parts of the 
 brain: I believe they do not, especially in their 
 first stage : they become diffused over the whole 
 brain, probably in their last stages, or in the pa- 
 roxysm of death. Dr. Johnson, of Exeter, in 
 speaking of the diseases of the abdominal viscera,
 
 OF THE MIND. 17 
 
 mentions their sympathy with each other, by what 
 he very happily calls " an intercommunion of sen- 
 sation." It would seem as if a similar intercom- 
 munion took place between all the diseases of the 
 brain. It is remarkable they all discover, in every 
 part of the brain, marks of a morbid state of the 
 blood-vessels. 
 
 II. From the ages and constitutions of persons 
 who are most subject to madness. The former 
 are in those years in which acute and inflamma- 
 tory arterial diseases usually affect the body, and 
 the latter, in persons who labour under the arte- 
 rial predisposition. 
 
 III. I infer that madness is seated in the blood- 
 vessels, 
 
 1. From its symptoms. These are a sense of 
 fulness, and sometimes pain in the head ; wake- 
 fulness, and a redness of the eyes, such as precede 
 fever, a whitish tongue, a dry or moist skin, high 
 coloured urine, a frequent, full or tense pulse, or a 
 pulse morbidly slow or natural as to frequency. 
 These states of the pulse occur uniformly in re- 
 cent madness, and one of them, that is frequency, 
 is seldom absent in its chronic state.
 
 18 ON THE DISEASES 
 
 I have taken notice of the presence of this 
 symptom in my Introductory Lecture upon the 
 study of Medical Jurisprudence, in which I have 
 mentioned, that seven-eighths of all the deranged 
 patients in the Pennsylvania Hospital in the year 
 1811, had frequent pulse,* and that a pardon was 
 granted to a criminal by the president of the 
 United States, in the year 1794, who was sus- 
 pected of counterfeiting madness, in consequence 
 of its having been declared, by three physicians, 
 that that symptom constituted an unequivocal 
 mark of intellectual derangement. 
 
 The connection of this disease with the state 
 of the pulse, has been further demonstrated by a 
 most satisfactory experiment, made by Dr. Coxe, 
 and related by him in his Practical Observations 
 upon Insanity. He gave digitalis to a patient 
 who was in a furious state of madness, with a 
 pulse that beat 90 strokes in a minute. As soon 
 
 * This fact was ascertained, at my request, with great ac- 
 curacy, by Dr. Frederick Vandyke. It is probable the pulsa- 
 tions of the arteries in the brain were preternaturally frequent 
 in the brain in the few cases in which they were natural at the 
 wrists. Dr. Cox, of Bristol, informs us that he had found the 
 carotid artery to be full and tense, when the radial artery was 
 weak and soft.
 
 OF THE MIND. 19 
 
 as the medicine reduced his pulse to 70, he be- 
 came rational. Upon continuing it, his pulse fell 
 to 50, at which time he became melancholy. An 
 additional quantity of the medicine reduced it to 
 40 strokes in a minute, which nearly suspended 
 his life. He was finally cured by lessening the 
 doses of the medicine so as to elevate his pulse 
 to 70 strokes in a minute, which was probably 
 its natural state. In short, there is not a single 
 symptom that takes place in an ordinary fever, 
 except a, hot skin, that does not occur in the acute 
 state of madness. 
 
 IV. From its alternating with several diseases 
 which are evidently seated in the blood-vessels. 
 These are consumption, rheumatism, intermitting 
 and puerperal fever, and dropsy, many instances 
 of which are to be met with in the records of me- 
 dicine. 
 
 V. From its blending its symptoms with several 
 of the forms of fever. It is sometimes attended 
 with regular intermissions, and remissions. I 
 have once seen it appear with profuse sweats, 
 such as occur in certain fevers, in a madman in 
 the Pennsylvania Hospital. These sweats, when 
 discharged from his skin, formed a vapour resem- 
 bling a thick fog, that filled the cell in which he
 
 20 ON THE DISEASES 
 
 was confined, to such a degree as to render 
 his body scarcely visible. 
 
 Again, this disease sometimes appears in a 
 typhus form, in which it is attended with cold- 
 ness, a feeble pulse, muttering delirium, and in- 
 voluntary discharge of faeces and urine. But it 
 now and then pervades the whole country in the 
 form of an epidemic. It prevailed in this way in 
 England in the years 1355 and in 1373, and in 
 France and Italy in the year 1374, and Dr. Win- 
 tringham mentions its frequent occurrence in 
 England in the year 1719. 
 
 A striking instance of the union of madness 
 with common fever is mentioned by Lucian. He 
 tells us that a violent fever once broke out at 
 Abdera, which terminated by hemorrhages, or 
 sweats, on the seventh day. During the conti- 
 nuance of this fever the patients, affected with it, 
 repeated passages from the tragedy of Andro- 
 meda with great vehemence, both in their sick- 
 rooms and in the public streets. This mixture of 
 fever and madness continued until the coming on 
 of cold weather. Lucian ingeniously and very 
 properly ascribes it to the persons affected, having 
 heard the famous player Archilaus act a part in 
 the above tragedy in the middle of summer in so
 
 OF THE MIND. 21 
 
 impressive a manner, that it excited in them the 
 seeds of a dormant fever which blended itself 
 with derangement, and thus produced, very natu- 
 rally, a repetition of the ideas and sounds that 
 excited their disease. 
 
 VI. From the appearances of the blood which 
 is drawn in this disease being the same as that 
 which is drawn in certain fevers. They are, 
 inflammatory buff, yellow, serum and 'lotura car- 
 nium. 
 
 VII. From the appearances of the brain after 
 death from madness. These are nearly the same 
 as after death from phrenitis, apoplexy, and other 
 diseases which are admitted to be primary affec- 
 tions of the blood-vessels of the brain. I shall 
 briefly enumerate them; they are, 1, the absence 
 of every sign of disease. I have ascribed this to 
 that grade of suffocated excitement which pre- 
 vents the effusion of red blood into the serous 
 vessels. We observe the. same absence of the 
 marks of inflammation after several other violent 
 diseases. Dr. Stevens, in his ingenious inaugural 
 dissertation, published in 1811, has called this 
 apparently healthy appearance, the "airnatous" 
 state of inflammation. Perhaps it would be more 
 proper to call it the " aimatous" state of disease.
 
 22 ON THE DISEASES 
 
 * 
 
 It is possible it may arise in recent cases of mad- 
 ness which terminate fatally, from the same re- 
 trospection of the blood from the brain, which 
 takes place from the face and external surface 
 of the body just before death*. But, 
 
 2. We much oftener discover in the brain, after 
 death from madness, inflammation, effusions of 
 water in its ventricles, extravasation and intrava- 
 tion of blood, and even pus. After chronic mad- 
 ness, we discover some peculiar appearances 
 which have never been met with in any other dis- 
 ease of the brain, and these are a preternatural 
 hardness, and dryness in all its parts. Lieutaud 
 mentions it often with the epithets of " durum," 
 " praedurum," "siccum," and " exsuccum." Mor- 
 gagni takes notice of this hardness likewise, and 
 says he had observed it in the cerebrum in per- 
 sons in whom the cerebellum retained its natural 
 softness. Dr. Baillie and Mr. John Hunter have 
 remarked, that the brain in this state discovered 
 marks of elasticity when pressed by the fingers. 
 Mr. Mickell ,says a cube of six lines of the brain 
 of a maniac, thus indurated, weighed seven 
 drachms, whereas a cube of the same dimension 
 of a sound brain weighed but one drachm, and 
 between four and six grains. I have ascribed this 
 hardness, dryness, elasticity and relative weight of
 
 OF THE MIND. 23 
 
 the brain to a tendency to schirrus, such as suc- 
 ceeds morbid action or inflammation in glandular 
 parts of the body, and particularly that early grade 
 of it which occurs in the liver, and which is 
 known by the name of hepitalgia. The brain in 
 this case loses its mobility so as to become inca- 
 pable of emitting those motions from impressions 
 which produce the operations of the mind. 
 
 3. We sometimes discover preternatural soft- 
 ness in the brain, in persons who die of madness, 
 similar to that which we find in other viscera from 
 common and febrile diseases. This has been 
 observed to occur most frequently in the kidneys 
 and spleen. The brain in this case partakes of 
 its texture and imbecility in infancy, and hence 
 its inability to receive and modify the impressions 
 which excite thought in the mind. 
 
 4. and lastly. We sometimes discover a pre- 
 ternatural enlargement of the bones of the head 
 from madness, and sometimes a preternatural 
 reduction of their thickness. Of 216 maniacs 
 whose heads were examined after death, Dr. 
 Creighton says, in 160 the skull was enlarged, 
 and in 38 it was reduced in its thickness. Now 
 the same thing succeeds rheumatism, and many
 
 24 ON THE DISEASES 
 
 other febrile diseases which exert their action in 
 the neighbourhood of bones. 
 
 I might add further, under this head, that the 
 morbid appearances in the spleen, liver, and sto- 
 mach, which are seen after death from madness, 
 place it still more upon a footing with fevers from 
 all its cases, and particularly from koino-mias- 
 matic exhalations, and in a more especial manner 
 when they affect the brain, and thereby induce 
 primary, or idiopathic phrenitis. In short, mad- 
 ness is to phrenitis, what pulmonary consumption 
 is to pneumony, that is, a chronic state of an 
 acute disease. It resembles pulmonary consump- 
 tion further, in the excitement of the muscles, and 
 in the appetite continuing in a natural, or in a 
 preternatural state. 
 
 VIII. I infer madness to be primarily seated in 
 the blood-vessels, from the remedies which most 
 speedily and certainly cure it, being exactly the 
 same as those which cure fever or disease in the 
 blood-vessels from other causes, and in other 
 parts of the body. They will be noticed in their 
 proper place. 
 
 I have thus mentioned the facts and arguments 
 which prove what is commonly called madness to
 
 OF THE MIND. 25 
 
 be a disease of the blood-vessels of the brain. All 
 the other and inferior forms of derangement, whe- 
 ther of the memory, the will, the principle of faith 
 the passions, and the moral faculties, I believe to 
 be connected more or less with morbid action in 
 the blood-vessels of the brain or heart, according 
 to the seats of those faculties of the mind. 
 
 In placing the primary seat of madness in the 
 blood-vessels, I would by no means confine the 
 predisposition to it exclusively to them. It ex- 
 tends to the nerves, and to that part of the brain, 
 which is the seat of the mind, both of which, 
 when preternaturally irritable, communicate more 
 promptly deranged action to the blood-vessels of 
 the brain. I have called the union of this diffused 
 morbid irritability, the phrenitic predisposition. 
 It is from the constant presence of this predispo- 
 sition, that some people are seldom affected with 
 the slightest fever, without becoming delirious ; 
 and it is from its absence, that many people are 
 affected with fevers and other diseases of the 
 brain without being affected with derangement. 
 I am aware that it may be objected to the proxi- 
 mate cause or seat of madness, which has been 
 delivered, that dissections have sometimes dis- 
 covered marks of arterial diseases in the brain, 
 
 4
 
 26 ON THE DISEASES 
 
 similar to those that have been mentioned, which 
 were not preceded by the least alienation of mind. 
 In these cases, I would suppose the diseases may 
 have existed in parts of the brain which are not 
 occupied by the mind, or that the mind may have 
 been translated to another, and a healthy part of 
 the brain. The senses of taste and hearing, we 
 know, when impaired by disease, are often trans- 
 lated to contiguous, and sometimes to remote 
 parts of the body. But did we admit the objec- 
 tion that I have met, to militate against madness 
 being an arterial disease, it would prove too much, 
 for we sometimes discover the same morbid ap- 
 pearances, which produced apoplexy and palsy, 
 to be present in the brain after death, without any 
 of the common symptoms of those diseases hav- 
 ing been preceded by them. 
 
 Many other organic diseases are occasionally 
 devoid of their usual characteristic symptoms. 
 Neither vomiting, nor want of appetite, have 
 taken place in stomachs in which mortification 
 has been discovered after death : and abscesses 
 have been found in the livers of persons, who have 
 died without any one of the common symptoms 
 of hepatitis. By allowing the same latitude to the 
 confused and irregular operations of nature." in
 
 OF THE MIND. 27 
 
 the brain, in the production of madness, that we 
 observe in the production of all the other dis- 
 eases that have been mentioned, we can reconcile 
 its occasional absence, with the existence of all 
 the organic affections in the brain which usually 
 produce it 
 
 In reviewing the numerous proofs of madness, 
 being seated primarily in the blood-vessels, and 
 its being accompanied so generally with most of 
 the symptoms of fever, we can not help being 
 struck with the histories of the disease that have 
 been given by many ancient and modern physi- 
 cians. Galen defines it to be "delirium sine 
 febre." Aritaeus says it is " semper sine febre." 
 Dr. Arnold quotes a group of authors, who have 
 adopted and propagated the same error. Even 
 Dr. Heberden admits and reasons upon it. The 
 antiquity and extent of this error should lead us 
 never to lose sight of the blood-vessels in investi- 
 gating the causes of diseases. They are, to a 
 physician, what the meridian sun is to a mariner. 
 There are but few diseases in which it will be 
 possible for him to preserve the system in a heal- 
 thy course, without daily, and often more frequent 
 observations of the state of the blood-vessels, as 
 manifested by the different and varying states of 
 the pulse.
 
 28 ON THE DISEASES 
 
 CHAPTER II. 
 
 OF the remote and existing causes of intellectual 
 derangement. 
 
 I have combined both these classes of causes, 
 inasmuch as they most commonly act in concert, 
 or in a natural succession to each other. In en- 
 umerating them, I shall include such as act alike 
 in producing partial and universal madness. 
 
 They have been divided, l,into such as act, 
 directly upon the body; and, 2, such as act indi- 
 rectly upon the body, through the medium of the 
 mind. 
 
 To the first head belong, 1, all those causes 
 which act directly upon the brain. These are, 1, 
 malconformation and Isesions of the brain. Be- 
 tween the latter, and the existence of madness, 
 there is sometimes an interval of several years. 
 A young man died in the Pennsylvania Hospital 
 in the year 1809, who became deranged at twenty-
 
 OF THE MIND. 29 
 
 one, in consequence of a contusion on his head 
 by a fall from a horse in the fifteenth year of his 
 
 age. A Mr. died of madiess in the same 
 
 place, from an injury done to his brain by being 
 thrown out of his chair, between two and three 
 years before he discovered any signs of derange- 
 ment. It is remarkable that injuries show them- 
 selves more slowly in the brain than in other parts 
 of the body. Dr. Lettsome mentions a case, in 
 the Memoirs of the London Medical Society, of a 
 disease in the brain, induced by a fall from a 
 horse, which did not discover itself until two and 
 twenty years after its occurrence. 
 
 2. Certain local disorders, induced by enlarge- 
 ment of the bone, tumours, abscesses, and water 
 in the brain. 
 
 3. Certain diseases of the brain, particularly 
 apoplexy, palsy, epilepsy, vertigo, and head- 
 ach. It occurs but rarely from the last of these 
 causes. 
 
 4. Insolation. Two cases of madness from 
 this cause occurred under my care between July 
 1807, and February 1808. 
 
 5. Certain odours. There is a place in Scot-
 
 30 ON THE DISEASES 
 
 land where madness is sometimes induced by the 
 fumes of lead. Patients who are affected with it 
 bite their handsf| and tear their flesh upon the 
 other parts of their bodies. It is called by the 
 country people mill-reck. Dr. Prost describes a 
 furious grade of madness in Peru, brought on by 
 a mineral exhalation, but he does not mention the 
 metal from which it is derived. From among 
 many other facts that might be mentioned, to 
 show the connection of odours with a morbid 
 state of the mind, I shall mention one more. An 
 ingenious dyer, in this city, informed me that he 
 often observed the men who were employed in 
 dying blue, of which colour indigo is the basis, to 
 become peevish, and low-spirited, and never even 
 to hum a tune, while engaged at their work. 
 
 There are certain causes which induce mad- 
 ness, by acting upon the brain in common with 
 the whole body. These are, 1, gout, dropsy, con- 
 sumption, pregnancy, and fevers of all kinds. 
 
 2. Inanition from profuse evacuation, or from a 
 defect of nourishment. Famine induces it in part 
 from the latter cause. 
 
 3. The sudden abstraction of the stimulus 
 of distention. When madness follows parturi-
 
 OP THE MIND. 31 
 
 tion, it is most commonly derived from this 
 cause. 
 
 4. The excessive use of ardent spirits. During 
 the time Dr. Nicholas Waters acted as resident 
 physician and apothecary of the Pennsylvania 
 Hospital, he instituted an inquiry, at my request, 
 into the proportion of maniacs from this cause, 
 who were confined in the Hospital. They 
 amounted to one-third of the whole number. 
 
 5. Inordinate sexual desires and gratifications. 
 Several cases of madness from this cause have 
 come under my notice. 
 
 6. Onanism. Four cases of madness occurred, 
 in my practice, from this cause, between the years 
 1804 and 1807. It is induced more frequently by 
 this cause in young men, than is commonly sup- 
 posed by parents and physicians. The morbid 
 effects of intemperance in a sexual intercourse 
 with women are feeble, and of a transient nature, 
 compared with the train of physical and moral 
 evils which this solitary vice fixes upon the body 
 and mind. 
 
 7. The transfusion of blood from one animal 
 into the blood-vessels of another. This practice
 
 32 ON THE DISEASES 
 
 was employed in France many years ago, in 
 order to discover a method of restoring health, 
 and renovating life, in sick and aged people. All 
 the persons, Dionis tells us, who were the sub- 
 jects of it, died in a state of derangement. The 
 practice was founded in error; for old age and 
 sickness are occasioned by exhausted or diseased 
 solids, and not by any unfitness in the quality of 
 the blood, to support animal life. 
 
 8. Great pain. 
 
 9. Unusual labour or exercise. 
 
 10. Extremely hot and cold weather. 
 
 3. Madness is induced by corporeal causes, 
 which act sympathetically upon" the brain. These 
 are, 1, certain narcotic substances, particularly 
 opium, hemlock, night-shade, hen-bane, and acco- 
 nitum, taken into the stomach. 
 
 2. The suppression of any usual evacuation, 
 such as the menses, lochia, milk, semen or blood 
 from the hemorrhoidal vessels. 
 
 3. Worms in the alimentary canal.
 
 OF THE MIND. 33 
 
 4. Irritation from certain foreign matters re- 
 tained in irritable parts of the body. 1 once knew 
 some small shot which were lodged in the foot of a 
 school-boy, induce madness several years after he 
 became a man. It has been brought on in one 
 instance by decayed teeth, which were not ac- 
 companied with pain. 
 
 4. Madness is sometimes induced by what is 
 called a metastasis of some other disease to the 
 brain. These diseases are, 1, dropsy. A case of 
 madness from this cause is related by Dr. Mead. 
 2. Consumption. All the symptoms of this dis- 
 ease sometimes suddenly disappear, in conse- 
 quence of the translation of morbid excitement to 
 the brain. 
 
 3. St. Vitus's dance. I attended a young lady 
 some years ago, in whom this disease was sus- 
 pended by an attack of madness. Her madness 
 passed out of her brain, through the same chan- 
 nel by which it entered it, that is, in convulsions 
 in the limbs of one side, which gradually yielded 
 to the power of medicine. 
 
 4. Hysteria. The morbid commotions in the 
 nervous system are sometimes transferred to the
 
 34 ON THE DISEASES 
 
 blood-vessels and the brain, where they induce 
 transient or chronic madness. 
 
 5. Certain cutaneous eruptions. The son of 
 Dr. Zimmerman became deranged in consequence 
 of an eruption being repelled from his skin. I 
 attended a private patient in the Pennsylvania 
 Hospital, in whom madness was induced by the 
 same cause. The healing of an old and habitual 
 ulcer has sometimes produced the same effect. 
 
 6. The measles. A young man, of sixteen 
 years of age, was admitted into the Pennsylvania 
 Hospital, in June 1812, in a high state of derange- 
 ment, which followed this disease. 
 
 II. The causes which induce intellectual de- 
 rangement, by acting upon the body through the 
 medium of the mind, are of a direct and indirect 
 nature. 
 
 The causes which act directly upon the under- 
 standing are, 
 
 1. Intense study, whether of the sciences or of 
 the mechanical arts, and whether of real or im- 
 aginary objects of knowledge. The latter more
 
 OP THE MIND. 35 
 
 frequently produce madness than the former. 
 They are, chiefly, the means of discovering per- 
 petual motion ; of converting the base metals into 
 gold, of prolonging life to the antediluvian age ; 
 of producing perfect order and happiness in mo- 
 rals and government, by the operations of human 
 reason ; and, lastly, researches into the meaning 
 of certain prophecies in the Old and New Testa- 
 ments. 1 think I have observed madness from the 
 last cause, to arise most frequently from an at- 
 tempt to fix the precise time in which those pro- 
 phecies were to be fulfilled, or from a disappoint- 
 ment in that time, after it had passed. 
 
 2. The frequent and rapid transition of the 
 mind from one subject to another. It is said 
 booksellers have sometimes become deranged 
 from this cause. The debilitating effects of these 
 sudden transitions upon the mind, are sensibly 
 felt after reading a volume of reviews or maga- 
 zines. The brain in these cases is deprived of 
 the benefit of habit, which prevents fatigue to 
 a certain extent, from all the exercises of the 
 body and mind, when they are confined to single 
 objects. 
 
 It is worthy of notice, that this cause of mad- 
 ness accords exactly with a symptom of one of its
 
 36 ON THE DISEASES 
 
 forms, and that is, a constant and rapid transition 
 of the mind to a variety of unrelated subjects. 
 But the understanding is affected chiefly in an 
 indirect manner. 
 
 "r 
 
 1. Through the medium of the imagination. 
 It is conveyed into the understanding from this 
 faculty, in all those people who became deranged 
 from inordinate schemes of ambition or avarice. 
 Mad-houses in every part of the world, exhibit 
 instances of persons who have become insane 
 from this cause. The great extent and constant 
 exercises of the imagination in poets, accounts 
 for their being occasionally affected with this 
 disease. 
 
 2. The understanding is sometimes affected 
 with madness through the medium of the me- 
 mory. Dr. Zimmerman relates the case of a 
 Swiss clergyman, in whom derangement was in- 
 duced by undue labour in committing his sermons 
 to memory. 
 
 3. But madness is excited in the understanding 
 most frequently by impressions that act primarily 
 upon the heart. I shall enumerate some of these 
 impresssions, and afterwards mention such in- 
 stances of their morbid effects as I have met with
 
 OP THE MIND. 37 
 
 in the course of my reading and observations. 
 They are joy, terror, love, fear, grief, distress, 
 shame from offended delicacy, defamation, ca- 
 lumny, ridicule, absence from native country, the 
 loss of liberty, property, and beauty, gaming, and 
 inordinate love of praise, domestic tyranny, and 
 lastly, the complete gratification of every wish of 
 the heart. 
 
 Extravagant joy produced madness in many of 
 the successful adventurers in the South-Sea spe- 
 culation in England, in the year 1720. 
 
 Charles the Sixth, of France, was deranged 
 from a paroxysm of anger. 
 
 Terror has often induced madness in persons 
 who have escaped from fire, earthquakes and 
 shipwreck. Two cases, from the last cause, have 
 occurred under my notice. 
 
 Where is the mad-house that does not contain 
 patients from neglected, or disappointed love f 
 
 Fear often produced madness, Dr. Brambilla 
 tells us, in new recruits in the Austrian army.
 
 38 ON THE DISEASES 
 
 Grief induced madness, which continued fifty 
 years, in a certain Hannah Lewis, formerly a 
 patient in the Pennsylvania Hospital. 
 
 Distress often produced this disease, Mr. How- 
 ard tells us, in the prisoners of the town of Liege. 
 
 An exquisite sense of delicacy, Dr. Burton says, 
 produced madness in a school-master, who was 
 accidentally discovered upon a close-stool by one 
 of his scholars. 
 
 The Bedlams of Europe exhibit many cases of 
 madness from public and private defamation, and 
 history informs us of ministers of state and gene- 
 rals of armies having often languished away their 
 lives in a state of partial derangement, in conse- 
 quence of being unjustly dismissed by their sove- 
 reigns. 
 
 A player destroyed himself in Philadelphia, in 
 the year 1803, soon after being hissed off the 
 stage. 
 
 The Swiss soldiers sometimes languish and die 
 
 o 
 
 from that form of madness which is brought on 
 by absence from their native country.
 
 OF THE MIND. 
 
 39 
 
 An ingenious modern poet mentions this dis- 
 ease, as well as its exciting cause, with peculiar 
 elegance. 
 
 " The intrepid Swiss that guards a foreign shore, 
 " Condemn'd to climb his mountain-clifFs no more, 
 " If chance he hear the song, so sweetly wild, 
 " Which, on those cliffs, his infant hours beguil'd, 
 " Melts at the long lost scenes, that round him rise, 
 " And sinks a martyr to repentant sighs." 
 
 It is remarkable, that this disease is most com- 
 mon among the natives of countries that are the 
 least desirable for beauty, fertility, climate, or the 
 luxuries of life. They resemble, in this respect, 
 in their influence upon the human heart, the arti- 
 ficial objects of taste which are at first disagreea- 
 ble, but which from habit take a stronger hold 
 upon the appetite than such as are natural and 
 agreeable. 
 
 The Africans become insane, we are told, in 
 some instances, soon after they enter upon the 
 toils of perpetual slavery in the West Indies. 
 
 Hundreds have become insane in consequence 
 of unexpected losses of money. It is remarkable 
 this disease occurs oftener among the rich, who 
 lose only a part of their property, than among
 
 40 ON THE DISEASES 
 
 persons in moderate circumstances, who lose 
 their all. 
 
 An American Indian became deranged, and 
 destroyed himself, in consequence of seeing his 
 face in a looking glass soon after his recovery 
 from a violent attack of the small-pox. The 
 loss of one eye, by an affray in a country tavern, 
 which materially affected the beauty of the face, 
 produced derangement in a young man who was 
 afterwards my patient in the Pennsylvania Hos- 
 pital. There are other facts, which show the 
 depth of this attachment to beauty in the human 
 mind, and the poignancy of the distress occa- 
 sioned by its loss or decay. The once beautiful 
 lady Mary Wortley Montague tells a friend, in 
 one of her letters, that she had not seen herself 
 in a looking glass for eleven years, solely from 
 her inability to bear the mortifying contrast be- 
 tween her appearance in the two extremes of her 
 life. 
 
 A clergyman in Maryland became insane in 
 consequence of having permitted some typo- 
 graphical errors to escape in a sermon which 
 he published upon the death of general Wash- 
 ington.
 
 OP THE MIND. 41 
 
 The son of a late celebrated author in England 
 became deranged in consequence of the severe 
 treatment he received from his father in the 
 course of his education. Several instances of 
 madness, induced by the cruel or unjust conduct 
 of schoolmasters and guardians to the persons 
 who were the subjects of their power and care, 
 are to be met with in the records of medicine. 
 
 Sir Philip Mordaunt shot himself immediately 
 after succeeding to a great estate, and to the fa- 
 vour of his prince, and while he appeared to be 
 in possession of every thing that could constitute 
 the plenitude of human happiness. The eldest 
 son of a Scotch nobleman, of high rank and large 
 fortune, destroyed himself in the same way, a few 
 weeks after the consummation of all his worldly 
 prospects and enjoyments, by his marriage to a 
 most accomplished and amiable young lady. 
 
 Two instances are upon record, of persons who 
 destroyed themselves immediately after drawing 
 high prizes in a lottery. In all these cases death 
 was the effect of derangement. 
 
 4. The understanding is sometimes deranged 
 
 6
 
 42 ON THE DISEASES 
 
 through the medium of the moral faculties. A 
 conscience burdened with guilt, whether real or 
 imaginary, is a frequent cause of madness. The 
 latter produces it much oftener than the former. 
 
 An instance of insanity occurred in a married 
 woman in this city some years ago, of the most 
 exemplary character, from a belief that she had 
 been unfaithful to the marriage bed. An accident 
 discovered that the supposed criminal connection 
 was with a man whose very person was unknown 
 to her. There is further a morbid sensibility in 
 the conscience in some people, that predisposes 
 to madness from the most trifling causes. A 
 young man, of great piety, died of this disease in 
 our Hospital a few years ago, in consequence of 
 his believing that he had offended his Maker by 
 refusing to say grace at the table of a friend. 
 
 The most distressing grade of derangement un- 
 der this head is, where real guilt, and a diseased 
 imagination concur in producing it. The occa- 
 sional act of self-mutilation which deranged pa- 
 tients sometimes inflict upon themselves, and the 
 painful and protracted austerities voluntarily im- 
 posed upon the body in Catholic countries, ap-
 
 OF THE MIND. 43 
 
 pear to be the effects of the combined operation 
 of these two causes upon the understanding. 
 
 But we sometimes observe intellectual de- 
 rangement to occur from the moral faculties be- 
 ing unduly excited by supposed visions and 
 revelations, instances of which will be mentioned 
 in another place. 
 
 Let not religion be blamed for these cases of 
 insanity. The tendency of all its doctrines and 
 precepts is to prevent it from most of its mental 
 causes ; and even the errors that have been 
 blended with it, produce madness less frequently 
 than love, and many of those common and neces- 
 sary pursuits, which constitute the principal en- 
 joyments and business of life. 
 
 To the history of the causes of derangement 
 which has been given, I shall add, that that form 
 of it which has been called hypochondriasis, is 
 sometimes induced without either the patient or 
 his friends being able to ascribe it to any cause. 
 Dr. Nicholas Robinson, a physician who lived in 
 the beginning of the last century, complains, in a 
 treatise which he has published upon melancholy, 
 of his sufferings from it in the following words :
 
 44 ON THE DISEASES 
 
 "When no air has blown across my affairs, and 
 no shade obscured my sun, then am I most mis- 
 erable." I have heard similar declarations from 
 several of my patients, and particularly from a 
 clergyman of the most exemplary life and con- 
 versation. In all such cases, it would be absurd 
 to suppose the disease existed without a cause. 
 Many diseases take place in the body from causes 
 that are forgotten, or from sympathies with parts 
 of the body that are supposed to be in a healthy 
 state. In like manner, depression of mind may 
 be induced by causes that are forgotten ; or by 
 the presence of objects which revive the sensa- 
 tion of distress with which it was at one time 
 associated, but without reviving the cause of it 
 in the memory. The former pupils of the author 
 will recollect several instances of mental plea- 
 sure, as well as pain, from association, mentioned 
 by him in his physiological lectures upon the 
 mind, in which the original causes of both had 
 perished in the memory. 
 
 Intellectual derangement is more common from 
 mental than corporeal causes. Of 113 patients 
 in the Bicetre Hospital in France, at one time, 
 Mr. Pinel tolls us 34 were from domestic misfor- 
 tunes, 24 from disappointments in love, 30 from 
 the distressing events of the French Revolution,
 
 OF THE ftflND. 45 
 
 and 25 from what he calls fanaticism, making in 
 all the original number. I have taken pains to 
 ascertain the proportion of mental and corporeal 
 causes which have operated in producing mad- 
 ness in the Pennsylvania Hospital, but I am sorry 
 to add, my success in this inquiry was less satis- 
 factory than I wished. Its causes were con- 
 cealed in some instances, and forgotten in others. 
 Of fifty maniacs, the causes of whose diseases 
 were discovered by Dr. Moore and his assistant, 
 Mr. Jenny, in the month of April, 1812, 7 were 
 from disappointments, chiefly in love; 7 from 
 grief; 7 from the loss of property; 5 from er- 
 roneous opinions in religion; 2 from jealousy; 1 
 from terror; 1 from insolation; 1 from an injury 
 to the head ; 2 from repelled eruptions ; 5 from 
 intemperance ; 3 from onanism ; 2 from pregnan- 
 cy; and 1 from fever; making in all 34 from 
 mental, and 16 from corporeal causes. A pre- 
 disposition to the disease was hereditary in but 
 five of them. 
 
 I shall now mention all those circumstances in 
 birth, certain peculiarities of the body, age, sex, 
 condition and rank in life, intellect, occupation, 
 climate, state of society, forms of government, 
 revolutions, and religion, which predispose the
 
 46 ON THE DISEASES 
 
 body and mind to be acted upon by the remote 
 and exciting causes that have been mentioned, so 
 as to favour the production of madness. 
 
 I. A peculiar and hereditary sameness of or- 
 ganization of the nerves, brain and blood-ves- 
 sels, on which I said formerly the predisposition 
 to madness depended, sometimes pervades whole 
 families, and renders them liable to this dis- 
 ease, from a transient or feeble operation of its 
 causes. 
 
 Application was made some years ago for the 
 admission of three members of the same family 
 into the Pennsylvania Hospital on the same day. 
 I have attended two ladies, one of whom was the 
 fourth, and the other the ninth, of their respective 
 families, that had been affected with this disease 
 in two generations. 
 
 The following letter to the author, from Dr. 
 Stephen W. Williams, of Deerfield, in Massachu- 
 setts, contains the history of two cases ol here- 
 ditary madness, which, from the singular resem- 
 blance in their subjects, symptoms, and issue, 
 have seldom perhaps been met with in the re- 
 cords of medicine.
 
 OP THE MIND. 47 
 
 JunelGth, 1812. 
 DEAR SIR, 
 
 " Believing that i the science of medicine is re- 
 lated to every thing,' I am induced to transmit to 
 you the following incidents which have lately oc- 
 curred in the vicinity of this place, hoping that 
 some useful inductions may be drawn from them, 
 for the benefit of our profession. 
 
 " Captains C. L. and J. L. were twin brothers, 
 and so great was the similarity in their coun- 
 tenances and appearance, that it was extremely 
 difficult for strangers to know them apart. Even 
 their friends were often deceived by them. Their 
 habits and manners were likewise similar. Many 
 ludicrous stories are told of people mistaking one 
 for the other. 
 
 " They both entered the American revolution- 
 ary army at the same time. Both held similar 
 commissions, and both served with honour during 
 the war. They were cheerful, sociable, and in 
 every respect gentlemen. Thoy were happy in 
 their families, having amiable wives and children, 
 and they were both independent in their proper- 
 ty. Some time after the close of the war, cap- 
 tain J. removed to the state of Vermont, while
 
 48 ON THE DISEASES 
 
 captain C. remained in Greenfield, in the vicini- 
 ty of Deerfield, and 200 miles from his brother. 
 Within the course of three years, they have both 
 been subject to turns of partial derangement, but 
 by no means rising into mania, nor sinking into 
 melancholy. They appeared to be hurried and 
 confused in their manners, but were constantly 
 able to attend to their business. About two years 
 ago, captain J, on his return from the general as- 
 sembly of Vermont, of which he was a member, 
 was found in his chamber, early in the morning, 
 with his throat cut, by his own hand, from ear to 
 ear, shortly after which he expired. He had been 
 melancholy a few days previous to this fatal ca- 
 tastrophe, and had complained of indisposition 
 the evening previous to the event. 
 
 " About ten days ago, Captain C. of Greenfield, 
 discovered signs of melancholy, and expressed a 
 fear that he should destroy himself. Early in the 
 morning of June fifth he got up, and proposed 
 to his wife to take a ride with him. He shaved 
 himself as usual, wiped his razor, and stepped 
 into an adjoining room, as his wife supposed, 
 to put it up. Shortly after she heard a noise, like 
 water or blood running upon the floor. She hur- 
 ried into the room, but was too late to save him.
 
 OF THE MIND. 49 
 
 He had cut his throat with his razor, and soon 
 afterwards expired. 
 
 "The mother of these two gentlemen, an aged 
 lady, and their two sisters, the only survivors of 
 their family, have been subject, for several years, 
 to the same complaint." 
 
 There are several peculiarities which attend 
 this disease, where the predisposition to it is 
 hereditary, which deserve our notice. 
 
 1. It is excited by more feeble causes than in 
 persons in whom this predisposition has been 
 acquired. 
 
 2. It generally attacks in those stages of life in 
 which it has appeared in the patient's ancestors. 
 A general officer, who served in the American 
 army during the revolutionary war, once expressed 
 a wish to a brother officer, from whom I received 
 the information, "that he might not live to be 
 old, that he might die suddenly, and that if he 
 married, he might have no issue." Upon being 
 asked the reason for these wishes, he said, he was 
 descec-ded from a family in which madness had 
 sometimes appeared about the fiftieth year of life, 
 and that he did not wish to incur the chance of 
 
 7
 
 50 ON THE DISEASES 
 
 inheriting, and propagating it to a family of chil- 
 dren. He was gratified in all his three wishes. 
 He fell in battle between the thirtieth and fortieth 
 years of his age, and he left no issue, although he 
 had been married several years before his death. 
 A similar instance of the disease appearing at 
 the same time of life, in three persons of the 
 same family, occurred under my notice in the 
 Pennsylvania Hospital. It came on in a father 
 and his two sons between the sixtieth and seven- 
 tieth years of their lives. . 
 
 3. Children born previously to the attack of 
 madness in their parents are less liable to inherit 
 it than those who are born after it. 
 
 4. Dr. Burton, in his Anatomy of Melancholy, 
 remarks, that children born of parents who are in 
 the decline of life, are more predisposed to one 
 of the forms of partial insanity than children born 
 under contrary circumstances. 
 
 5. A predisposition to certain diseases seated 
 in parts contiguous to the seat of madness, often 
 descends from parents to their children. Thus 
 we sometimes see madness in a son whose father 
 or mother had been afflicted only with hysteria, 
 or habitual headach. The reverse of this remark
 
 OF THE MIND. 51 
 
 likewise sometimes takes place. I attended a 
 respectable mechanic in this city in two attacks 
 of madness, the last of which terminated his life. 
 All his children, six in number, and now all adults, 
 are afflicted with headach, but none of them have 
 ever discovered any sign of madness in their con- 
 duct or conversation. 
 
 6. There are instances of families in which 
 madness has existed, where the disease has pass- 
 ed by the understanding in their posterity, and 
 appeared in great strength and eccentricity of the 
 memory and of the passions, or in great perver- 
 sion of their moral faculties. Sometimes it passes 
 by all the faculties of the mind, and appears only 
 in the nervous system, in persons descended from 
 deranged parents ; again we see madness in chil- 
 dren whose parents were remarkable only for 
 eccentricity of mind. 
 
 There are several diseases which attack the 
 children of the same family, which did not exist in 
 their ancestors. I have called them filial dis- 
 eases. They are chiefly consumption and epi- 
 lepsy. I have attempted to discover whether 
 madness never appears in this way, and have 
 heard of but two instances of it. One of them 
 occurred in a family on the Island of Barbadoes,
 
 52 ON THE DISEASES 
 
 in which four children, descended from parents of 
 habitual sound minds, became deranged. Per- 
 haps in these cases the disease had existed in 
 their remote ancestors, or possibly it was trans- 
 lated from a disease in some of the contiguous 
 systems of the body. I have wished to discover 
 whether there be any peculiarity of shape in the 
 skulls of mad people that are predisposed to de- 
 rangement, for which purpose I requested Dr. 
 Vandyke, in the year 1810, to examine the dimen- 
 sions of the heads of all the insane patients in our 
 hospital, in several different directions, and after- 
 wards to measure in the same way the heads of a 
 number of patients belonging to the hospital, 
 with other diseases. The result of this inquiry 
 was a discovery that there was no departure but 
 in one instance from the ordinary and natural 
 shape of the head, in between sixty and seventy 
 mad people. 
 
 II. A predisposition to madness is said to be 
 connected with dark coloured hair. Mr. Haslam 
 informs us that this was the case in two hundred 
 and five out of two hundred and sixty-five patients 
 in the Bethlehem Hospital. He intimates that it 
 was possibly from their consisting chiefly of the 
 natives of England, in whom that colour of the 
 hair is very general ; but the same connection
 
 OF THE MIND. 53 
 
 between madness and dark colour has been dis- 
 covered in the maniacs in the Pennsylvania Hos- 
 pital, who consist of persons from three or four 
 different countries, or of descendants who inherit 
 their various physical characters. Of nearly 
 seventy patients, who were examined at my re- 
 quest, by Dr. Vandyke, in our Hospital, in the 
 year 1810, with a reference to this fact, all, 
 except one, had dark-coloured hair. In the 
 month of April, 1812, I requested Dr. Vandyke to 
 direct his inquiries more particularly to the colour 
 of the eyes in the maniacal patients in our hos- 
 pital. He executed my request with great care 
 and correctness, and discovered that fifty-six out 
 of seventy-nine of them had light-coloured eyes, 
 of which number but six had fair hair. 
 
 III. There is a greater predisposition to mad- 
 ness between twenty and fifty, than in any of the 
 previous or subsequent years of human life. Of 
 the correctness of this remark, Mr. Pinel has fur- 
 nished us with the following proof. Of 1201 per- 
 sons who were admitted into the Bicetre Hospital 
 in France, between the years 1784 and 1794, 955 
 were between the two ages that have been men 
 tioned, 65 were between fifteen and twenty, 131 
 were between fifty and sixty, and 51 between sixty 
 and seventy-one. Mr. Haslam has furnished ad-
 
 54 ON THE DISEASES 
 
 ditional evidence of the correctness of this re- 
 mark. Of 1664 deranged patients who were 
 admitted into the Bethlehem Hospital in London, 
 between the years 1784 and 1794, he tells us 910 
 of them were between the ages mentioned by Mr. 
 Pinel. But the proportion of maniacal patients, 
 above twenty and under fifty years of age, was 
 much greater in the Pennsylvania Hospital in the 
 month of April, 1812. It was ascertained by Dr. 
 Vandyke to be 68 out of 79, that is, nearly seven- 
 eighths of their whole number. From the state 
 of the body and mind within those periods, it is 
 easy to account for this being the case. The 
 blood-vessels and the nerves are then in a highly 
 excitable state, and the former readily assume 
 morbid or inflammatory action from the remote 
 and exciting causes of disease. The mind too, 
 within those years, possesses more sensibility, and 
 of course is more easily acted upon by mental 
 irritants, the sources of which, from family afflic- 
 tions, and disappointments in the pursuits of busi- 
 ness, pleasure and ambition, are more numerous 
 in those years, than in any of the previous or sub- 
 sequent stages of life. 
 
 Madness, it has been said, seldom occurs under 
 puberty. To the small number of instances of 
 it, that are upon record, I shall add four more.
 
 OP THE MIND. 55 
 
 Two boys, the one of eleven and the other of 
 seven years of age, were admitted into our Hos- 
 pital with this disease (the latter during the time 
 of my attendance in 1799) and both discharged 
 cured. I have since seen an instance of it in the 
 year 1803, in a child of two years old, that had 
 been affected with cholera infantum ; and another 
 in a child of the same age, in the year 1808, that 
 was affected with internal dropsy of the brain. 
 They both discovered the countenance of mad- 
 ness, and they both attempted to bite, first their 
 mothers, and afterwards their own flesh. The 
 reason why children and persons under puberty 
 are so rarely affected with madness, must be as- 
 cribed to mental impressions, which are its most 
 frequent cause, being too transient in their effects, 
 from the instability of their minds to excite their 
 brains into permanently diseased actions. It is 
 true, children are often affected with delirium, but 
 this is a symptom of general fever, which is always 
 induced, like the few cases of madness in children 
 that I have mentioned, only by corporeal causes. 
 
 From the records of the Bicetre Hospital, in 
 France, it appears that madness rarely occurs in 
 old age. Doleus and Dr. Greding, mention seve- 
 ral cases of it; the latter in a man of eighty-five. 
 I have attended two men between sixty and seven-
 
 56 
 
 ON THE DISEASES 
 
 ty, and one woman between seventy and eighty, in 
 the Pennsylvania Hospital, and a private patient in 
 the eighty-first year of his age, in this disease. It 
 has been said that maniacs seldom live to be old. 
 I have known but few exceptions to this remark, 
 and they were of persons in whom the extinction of 
 the mind, in idiotism, had protected the body from 
 being worn out prematurely by its constant and 
 preternatural excitement or depression. One of 
 the persons was Hannah Lewis, formerly men- 
 tioned, in whom the disease was induced by grief, 
 in middle life, from the loss of her husband. She 
 died in our Hospital in the year 1799, in the eighty- 
 seventh year of her age. A predisposition to 
 longevity, which she derived from her ancestors, 
 predominated over the tendency of her long pro- 
 tracted disease to destroy her life. She lost one 
 sister in the eighty-second year of her age, and at 
 the time of her death had another living who was 
 ninety-four, neither of whom had ever been affect- 
 ed with madness. There are two reasons why 
 this disease so rarely attacks old people. Their 
 blood-vessels lose their vibratility from age, and 
 hence they are less liable to fevers than in middle 
 life; and from the diminution of sensibility in their 
 nerves an'd brains, the causes of madness make 
 but a feeble and transient impression upon their 
 minds. In the latter condition of their bodies,
 
 OF THE MIND. 57 
 
 they revert to that state which takes place in chil- 
 dren, and which I have said protects them from 
 the frequent occurrence of this disease. 
 
 V. Women, in consequence of the greater pre- 
 disposition imparted to their bodies by menstrua- 
 tion, pregnancy, and parturition, and to their 
 minds, by living so much alone in their families, 
 are more predisposed to madness than men. A 
 woman was admitted into our Hospital many 
 years ago, who was deranged only during the 
 time of her menstruation, and who in one of those 
 periods, hung herself with the string of her petti- 
 coat. Of 1664 patients admitted into the Beth- 
 lehem Hospital, between the years 1784 and 1794, 
 eighty-four of them were women in whom mad- 
 ness followed parturition. I have been consulted 
 in two cases, and I have heard of a third, in which 
 madness was induced by the solitude of a coun- 
 try life, in women who had been accustomed to 
 live in a large social and domestic society. Of 
 8874 patients admitted into the Bethlehem Hos- 
 pital in London, between the years 1748, and 
 1794, four thousand eight hundred and thirty-two 
 were women; nearly a fifth more than men. In 
 St. Luke's Hospital in London, the proportion of 
 women to men who have been admitted in a given 
 number of years, is in the ratio of three to two. 
 
 8
 
 58 ON THE DISEASES 
 
 But this disproportion of women to men, who are 
 affected with madness, is by no rneans universal. 
 In a Hospital for mad people in Vienna, one hun- 
 dred and seventeen men were admitted in a given 
 number of years, and but ninety-four women. In 
 a Hospital of the same kind at Berlin, twice as 
 many males were admitted in a given time as fe- 
 males. More of the former than of the latter 
 have been admitted into the Pennsylvania Hospi- 
 tal. In all these cases accidental circumstances, 
 such as the want of accommodations suited to fe- 
 male delicacy, or deep rooted prejudices against 
 public mad-houses, and a preference of such as 
 are private, may have lessened the proportion of 
 women in the above instances, while the evils of 
 war, bankruptcy, and habits of drinking, which 
 affect men more than women, and which vary in 
 their influence upon the mind in different coun- 
 tries, may have produced more instances of mad- 
 ness in the former than in the latter sex. Perhaps 
 it would be correct to say, women are more sub- 
 ject to madness from natural causes, and men 
 from such as are artificial. 
 
 What has been said under this head, applies 
 more particularly to general madness; but, from 
 many facts, I am led to believe that men are more 
 subject to that grade of derangement, which has
 
 OF THE MIND. 59 
 
 been called hypochondriasm, than women. The 
 distressing impressions made upon the minds of 
 women frequently vent themselves in tears, or in 
 hysterical commotions in the nervous system and 
 bowels, while the same impressions upon the 
 minds of men pass by their more compact ner- 
 vous and muscular fibres, and descend into the 
 brain, and thus more frequently bring on hypo- 
 chondriac insanity. If this remark be correct, it 
 will confirm Dr. Heberden's assertion, that men 
 are more disposed to suicide than women, for it 
 necessarily follows their being most subject to 
 that state of madness. Where the instances of 
 suicide are more frequent among women than 
 men, it is in those cases only in which the former 
 are exposed to sudden paroxysms of vexation and 
 despair. 
 
 VI. Single persons are more predisposed to 
 madness than married people. Of seventy-two 
 insane patients in the Pennsylvania Hospital, 
 whose condition relative to this question was as- 
 certained by my young friends, Dr. Moore and Mr. 
 Jenny, in the month of April 1812, forty-two had 
 never been married, and five were widows and 
 widowers, at the time they became deranged. 
 
 The absence of real and present care, which 
 give the mind leisure to look back upon past, and
 
 60 ON THE DISEASES 
 
 to anticipate future and imaginary evils, and the 
 inverted operation of all the affections of the heart 
 upon itself, together with the want of relief in con- 
 jugal sympathy from the inevitable distresses and 
 vexations of life, and for which friendship is a cold 
 and feeble substitute, are probably the reasons why 
 madness occurs more frequently in single, than in 
 married people. Celibacy, it has been said, is a 
 pleasant breakfast, a tolerable dinner, but a very 
 bad supper. The last comparison will appear to 
 be an appropriate one, when we consider further, 
 that the supper is not only a bad quality, but 
 eaten alone. -No wonder it sometimes becomes 
 a predisposing cause of madness. 
 
 VII. The rich are more predisposed to madness 
 than the poor, from their exposing a larger surface 
 of sensibility to all its remote and exciting causes. 
 Even where mental sensibility is the same in both 
 those classes of people, the disease is prevented 
 in the latter, by the constant pressure of bodily 
 suffering, from labour, cold, and hunger. These 
 present evils defend their minds from such as are 
 past and anticipated ; and these are the principal 
 causes of madness. When it occurs in poor peo- 
 ple, it is generally the effect of corporeal causes. 
 
 VIII. " Great wit, and madness," are said by 
 Dryderi " to be nearly allied." If he meant by
 
 OP THE MIND. 61 
 
 this, affinity between wit and madness, the rapid 
 exercises of the mind in associating similar and 
 dissimilar ideas of words which are peculiar to 
 both, the remark is a correct one ; but if he meant 
 that great wits are more predisposed to madness 
 than other people, the remark is opposed by all 
 that is known of the solidity of understanding, and 
 correctness of conversation and conduct of Butler, 
 Chesterfield, Franklin, Johnson, and many other 
 distinguished men who possessed the talent of wit 
 in an eminent degree. Nor is the remark true if 
 the term wit be intended to designate men of great 
 understandings. Their minds are sometimes worn 
 away by intense and protracted study, but they 
 are rarely perverted by madness. The vigorous 
 mind of Dean Swift perished gradually only from 
 the former cause. Where madness has been in- 
 duced by intense and protracted application to 
 books, it has generally been in persons of weak 
 intellects, who were unable to comprehend the 
 subjects of their studies. 
 
 IX. Certain occupations predispose to mad- 
 ness more than others. Pinel says, poets, painters, 
 sculptors and musicians, are most subject to it, 
 and that he never knew an instance of it in a chy- 
 mist, a naturalist, a mathematician, or a natural 
 philosopher. The reason of this will be under- 
 stood by recollecting what was said under the
 
 62 
 
 ON THE DISEASES 
 
 preceding head. The ^studies of the former exer- 
 cise the imagination, and the passions, while the 
 studies of the latter interest the understanding 
 only. Dr. Arnold tells us, he has observed me- 
 chanics to be more affected with madness than 
 merchants and members of the learned profes- 
 sions. This may arise from the vague and dis- 
 tracting exertions of genius, unassisted by educa- 
 tion; or from corporeal causes, to which their 
 employments expose them more than the classes 
 of men that have been mentioned. Of the effects 
 of the former of those causes, I once saw an 
 instance in a house-carpenter, who became de- 
 ranged in consequence of an unsuccessful attempt 
 to contrive a new kind of staircase. More farmers, 
 it has been said, become deranged than persons 
 of the same grade of intellect and independence 
 in cities. If this be the case, it must be ascribed 
 to the greater solitude of their lives, more espe- 
 cially in the winter season, and to their being more 
 exposed from labour and accidents, to its corpo- 
 real causes. 
 
 X. Certain climates predispose to madness. 
 It is very uncommon in such as are uniformly 
 warm. Dr. Gordon informed me in his visit 
 to Philadelphia in the year 1807, that he had 
 never seen nor heard of a single case of madness 
 during a residence of six years in the province of
 
 OF THE MIND. 63 
 
 Berbice. It is a rare disease in the West Indies. 
 While great and constant heat increases the irri- 
 tability of the muscles, it gradually lessens the 
 sensibility of the nerves and mind, and the irrita- 
 bility of the blood-vessels, and in these I formerly 
 supposed the predisposition to madness to be 
 seated. It is more common in climates alter- 
 nately warm and cold, but most so in such as are 
 generally moist and cold, and accompanied at 
 the same time with a cloudy sky. Instances of it 
 are said to be most frequent in England in the 
 month of November, at which time the weather 
 is unusually gloomy from the above causes. Even 
 the transient occurrence of that kind of weather 
 in the United States, has had an influence upon 
 this disease. In the month of May in the year 
 1806, it prevailed to a great degree, during which 
 time three patients in the Pennsylvania Hospital 
 made unsuccessful attempts upon their lives, and a 
 fourth destroyed himself. Two instances of sui- 
 cide occurred in the same month in Philadelphia. 
 
 XL Certain states of society, and certain opi- 
 nions, pursuits, amusements, and forms of govern- 
 ment, have a considerable influence in predis- 
 posing to derangement. It is a rare disease 
 among savages. Baron Humboldt informed me, 
 that he did not hear of a single instance of it
 
 64 
 
 ON THE DISEASES 
 
 among the uncivilized Indians in South America. 
 Infidelity and atheism are frequent causes of it in 
 Christian countries. In commercial countries, 
 where large fortunes are suddenly acquired and 
 lost, madness is a common disease. It is most 
 prevalent at those times when speculation is sub- 
 stituted to regular commerce. The mad-houses 
 in England were crowded with patients before, 
 and after the bursting of the South Sea bubble in. 
 the year 1720. In the United States, madness 
 has increased since the year 1790. This must be 
 ascribed chiefly to an increase in the number and 
 magnitude of the objects of ambition and avarice, 
 and to the greater joy or distress which is pro- 
 duced by gratification or disappointments in the 
 pursuit of each of them. The funding system, 
 and speculations in bank-scrip, and new lands, 
 have been fruitful sources of madness in our 
 country. Sixteen persons perished from suicide 
 in the city of New York, in the year 1804, inmost 
 of whom it was supposed to be the effect of 
 madness, from the different and contrary events 
 of speculation. 
 
 Even the profit and losses of regular trade and 
 agricultural labour, now and then pervert the 
 understanding. A respectable merchant died of 
 madness in the Pennsylvania Hospital, in the
 
 OP THE MIND. 65 
 
 year 1794, induced by a successful East India 
 voyage. A farmer, near Albany, who refused to 
 take twenty shillings a bushel for a large quantity 
 of wheat, in the year 1798, became insane from 
 the sudden reduction of its price. Suicide was 
 induced in a farmer of great wealth, in York 
 county, in Pennsylvania, in the spring of 1812, by 
 a similar disappointment, in obtaining a less price 
 than he had been previously offered for a quanti- 
 ty of clover seed. Gaming is an occasional 
 cause of madness in some countries. At Penang 
 in the East Indies, where men often stake their 
 wives upon the issue of a game, this disease is 
 very common. The unfortunate gambler often 
 rises from his seat in a fit of derangement, and 
 sallies out into the street with instruments of mur- 
 der in his hands ; a bell is rung at this time, which 
 drives people into their houses, to avoid being 
 killed. A late German writer has remarked, that 
 nervous diseases increase in the cities of Ger- 
 many in proportion to the fondness of their citi- 
 zens for seeing tragedies. It is easy to conceive 
 they may extend their effects a little further, so as 
 to excite morbid commotions in the blood-vessels 
 of the brain. I have heard the greater frequency 
 of madness in England, than in some other coun- 
 tries, ascribed in part to its inhabitants preferring 
 tragedy to comedy in their stage entertainments. 
 
 9
 
 66 ON THE DISEASES 
 
 The real emotions excited by these exhibitions of 
 imaginary distress, are never accompanied with 
 an effort to relieve it, by which means there is an 
 accumulation and reflux of sensation in the mind, 
 that cannot fail of affecting the nerves arid brain, 
 and thereby to predispose to, or induce madness. 
 Certain forms of government predispose to mad- 
 ness. They are those in which the people pos- 
 sess a just and exquisite sense of liberty, and of 
 the evils of arbitrary power, against which com- 
 plaints are stifled by a military force. The con- 
 flicting tides of the public passions, by their ope- 
 ration upon the understanding, become in these 
 cases a cause of derangement. The assassina- 
 tion of tyrants and their instruments of oppres- 
 sion, is generally the effect of this disease. That 
 madness is thus induced, I infer from its occurring 
 so rarely from a political cause in the United 
 States. I have known but one instance of it, and 
 that was in a gentleman who had been deranged 
 some years before from debt, contracted by ex- 
 travagant living. In a government in which all 
 the power of a country is representative and elec- 
 tive, a day of general suffrage, and free presses, 
 serve, like chimnies in a house, to conduct from 
 the individual and public mind, all the discontent, 
 vexation, and resentment, which have been gen- 
 erated in the passions, by real or supposed evils,
 
 OF THE MIND. 67 
 
 and thus to prevent the understanding being in- 
 jured by them. 
 
 In despotic countries, where the public pas- 
 sions are torpid, and where life and property are 
 secured only by the extinction of the domestic 
 affections, madness is a rare disease. Of the 
 truth of this remark I have been satisfied by Mr. 
 Stewart, the pedestrian traveller, who spent some 
 time in Turkey; also by Dr. Scott, who accom- 
 panied lord M'Cartney in his embassy to China; 
 and by Mr. Joseph Roxas, a native of Mexico, 
 who passed nearly forty years of his life among 
 the civilized but depressed natives of that coun- 
 try. Dr. Scott informed me that he heard of 
 but a single instance of madness in China, and 
 that was in a merchant who had suddenly lost 
 100,000/. sterling by an unsuccessful speculation 
 in gold dust. 
 
 Mr. Carr, in his Northern Summer, tells us, 
 that madness is an uncommon disease in Russia. 
 It is a rare thing, says this professional traveller, 
 to see a Russian peasant angry. He even per- 
 suades and reasons with his horse, when he wishes 
 him to quicken his gait. It is to the long pro- 
 tracted civil and ecclesiastical tyranny of the late 
 government of Spain, that we must ascribe the
 
 68 ON THE DISEASES 
 
 small number of maniacs in all the hospitals in 
 that country. They amounted, according to Mr. 
 Townsend, in the year 1786, to but 664, in a 
 population, which produces in Great Britain be- 
 tween 4,000 and 5,000; 2,600 of whom are in 
 the city and neighbourhood of London. Habits 
 of oppression in all those cases expend the ex- 
 citability of the passions, and prevent their re- 
 acting upon the brain. But in some instances 
 the understanding decays with the passions, in 
 despotic countries. This state of the mind has 
 been called fatuity. It is very common in Turkey 
 and China. The inirritable or non-elastic state 
 of the brain upon which this disorder depends, is 
 induced in those countries without previous mor- 
 bid excitement, in the same manner that the 
 disorder called hepatalgia is induced, without 
 previous hepatisis or obvious and sensible in- 
 flammation in the liver, in the East and West 
 Indies. 
 
 XII. Revolutions in governments which are 
 often accompanied with injustice, cruelty, and 
 the loss of property and friends, and where this is 
 not the case, with an inroad upon ancient and 
 deep-seated principles and habits, frequently mul- 
 tiply instances of insanity. Mr. Volney informed 
 me, in his visit to this city in the year 1799, that
 
 OF THE MIND. 69 
 
 there were three times as many cases of madness 
 in Paris in the year 1795, as there were before 
 the commencement of the French Revolution. 
 It was induced, I shall say hereafter, in several 
 instances, by the events of the American Revolu- 
 tion. 
 
 XIII. Different religions, and different tenets of 
 the same religion, are more or less calculated to 
 induce a predisposition to madness. Dr. Sheb- 
 beare says there are fewer instances of suicide 
 (which is generally the effect of madness) in 
 catholic, than in protestant countries. He as- 
 cribes it to the facility with which the catholics 
 relieve their minds from the pressure of guilt, by 
 means of confession and absolution. This asser- 
 tion, and the reasoning founded upon it, are ren- 
 dered doubtful by 150 suicides having taken place 
 in the catholic city of Paris in the year 1782, and 
 but 32 in the same year in the Protestant city of 
 London. It is probable, however, the greater 
 portion of infidels in the former, than in the latter 
 city at that time, may have occasioned the dif- 
 ference in the number of deaths in the two 
 places, for suicide will naturally follow small de- 
 grees of insanity, where there are no habits of mo- 
 ral order from religion, and no belief in a future 
 state. Dr. Shebbeare's assertion is rendered still
 
 70 ON THE DISEASES 
 
 less probable, by considering the usual effects of 
 solitude upon the human mind, and this we know 
 acts with peculiar force in the cells of monks and 
 nuns. This remark is not the result of reasoning 
 a priori. Of between 240 and 250 deranged peo- 
 ple, who were confined at one time in a mad-house, 
 in the city of Mexico, Mr. Roxas informed me, in 
 a great majority of them the disease had been 
 contracted in those recluse and gloomy situations. 
 
 There are certain tenets held by several pro- 
 testant sects of Christians which predispose the 
 mind to derangement. They shall be noticed in 
 another place. 
 
 I shall conclude the history of the remote excit- 
 ing and predisposing causes of madness by the 
 following remarks. 
 
 J. Its remote causes generally induce predis- 
 posing debility. Its exciting causes more com- 
 monly induce that morbid excitement in the blood- 
 vessels of the brain in which madness is seated, 
 but the sudden and violent action of a remote 
 cause is often sufficient for that purpose without 
 the aid of an exciting cause. 
 
 2. Both the remote and exciting causes of mad-
 
 OF THE MIND. 71 
 
 ness produce their morbid effects more certainly, 
 promptly or slowly, according as the system is 
 more or less predisposed to the disease by the 
 causes formerly mentioned. 
 
 3. The predisposing causes of madness some- 
 times act with so much force, as to induce it 
 without the perceptible co-operation of either a 
 remote or an exciting cause. The remote causes 
 of madness likewise act with so much force in 
 some instances, as to induce it without the per- 
 ceptible co-operation of a predisposing or ex- 
 citing cause. 
 
 4. The predisposing causes of madness in like 
 manner sometimes act with so much force as to 
 induce it without the perceptible co-operation of 
 a remote or an exciting cause.
 
 72 
 
 ON THE DISEASES 
 
 CHAPTER III. 
 
 Of Partial Intellectual Derangement, and particularly 
 of Hypochondriasis. 
 
 PARTIAL derangement consists in error in opi- 
 nion and conduct, upon some one subject only, 
 with soundness of mind upon all, or nearly all 
 other subjects. The error in this case is two- 
 fold. It is directly contrary to truth, or it is dis- 
 proportioned in its effects or expected conse- 
 quences, to the causes which induce them. It 
 has been divided by the nosologists according to 
 its objects. When it relates to the persons, 
 affairs, or condition of the patient only, and is 
 attended with distress, it has been called hypo- 
 chondriasis. When it extends to objects exter- 
 nal to the patient, and is attended with pleasure, 
 or the absence of distress, it has been called 
 melancholia. They are different grades only of 
 the same morbid actions in the brain, and they 
 now and then blend their symptoms with each 
 other.
 
 OF THE MIND. 73 
 
 I wish I could substitute a better term than 
 hypochondriasis, for the lowest grade of derange- 
 ment. It is true the hypochondriac region is dis- 
 eased in it ; so it is after autumnal fevers, and yet 
 we do not designate the obstructions induced by 
 those fevers by that name. It would be equally pro- 
 per to call every other form of madness hypo- 
 chondriasm, for they are all attended with more or 
 less disease or disorder in the liver, spleen, sto- 
 mach, and bowels, from which the name of hypo- 
 chodriasm is derived. But I have another objec- 
 tion to that name, and that is, it has unfortunately 
 been supposed to imply an imaginary disease 
 only, and when given to the disease in question, is 
 always offensive to patients who are affected with 
 it. It is true, it is seated in the mind : but is as 
 much the effect of corporeal causes as a pleurisy, 
 or a bilious fever. Perhaps the term TRISTIMANIA 
 might be used to express this form of madness 
 when erroneous opinions respecting a man's per- 
 son, affairs, or condition, are the subjects of 
 his distress. 
 
 I object likewise to the term melancholia, when 
 used, as it is by Dr. Cullin, to express partial 
 madness from external causes. 
 
 10
 
 74 
 
 ON THE DISEASES 
 
 1. Because it is sometimes induced by causes 
 that are not external to the patient, but connected 
 with his person, affairs, or condition in life ; and, 
 
 2. Because it conveys an idea of its being 
 seated in the liver and derived from vitiated or 
 obstructed bile. Now the seat of the disease, 
 from facts formerly mentioned, appears to be in 
 the brain, and morbid or obstructed bile is evi- 
 dently an accidental symptom of it. Perhaps it 
 would be more proper to call it AMENOMANIA, from 
 the errors that constitute it, being generally at- 
 tended with pleasure, or the absence of distress. 
 
 The hypochondriasis, or tristimania, has some- 
 times been confounded with hysteria, but differs 
 from it, 
 
 1. In being induced chiefly by mental causes, 
 and particularly by such of them as act upon the 
 understanding, through the medium of the pas- 
 sions and moral faculties. Histeria is produced 
 chiefly by corporeal causes. Its paroxysms only 
 are excited by such as are mental. The chronic 
 operation of the passions, so far from inducing it, 
 sometimes cures it, or changes it into hypochon- 
 driasm.
 
 OF THE MIND. 75 
 
 2. In affecting men more than women. 
 
 3. In affecting chiefly persons of sedentary 
 employments. 
 
 4. In the absence of globus hystericus. 
 
 5. In affecting the blood-vessels of the brain as 
 well as the nerves. Hysteria affects the nerves 
 and muscles only, and never the blood-vessels, so 
 as to produce derangement, except for a short 
 time, and only during its paroxysms. 
 
 6. The nerves in hypochondriasis are in a 
 reverse state from that which takes place in hys- 
 teria. In the former they are torpid, or in what 
 Themison calls a strictum state. In the latter dis- 
 ease they are highly excitable, or what the same 
 author has called a laxum state. These terms 
 correspond with what Dr. Boerhaave has since 
 denominated a rigid and lax state of the fibres. 
 
 7. Hypochondriasis is generally attended with 
 costiveness or diarrhoea, and durable distress of 
 mind, which are transient affections only in hys- 
 teria; and,
 
 t 
 
 76 ON THE DISEASES 
 
 8. Hypochondriasis is relieved by warm weather 
 and warm drinks. Hysteria is made worse by 
 each of them. 
 
 Hypochondriasis, or tristimania, is to hysteria 
 what a typhus fever is to inflammatory fever. It 
 is often combined with it, and sometimes alter- 
 nates with it, and, when cured, it passes out of the 
 system with symptoms of hysteria, in all those 
 cases in which it was preceded by them. I beg 
 the attention of the reader to this view of these 
 two forms of disease. It is intended to destroy 
 the nosological distinctions between them. As 
 well might we divide the first and last stages of a 
 fever by specific characters, as divide those two 
 grades of morbid excitement by specific names. 
 
 I shall now deliver a history of the most cha- 
 racteristic symptoms of the two different forms of 
 partial derangement that have been mentioned, 
 and afterwards take notice of the remedies proper 
 for each of them. I shall begin with hypochon- 
 driasis or tristimania. 
 
 The symptoms of this form of derangement as 
 they appear in the body are, dyspepsia ; costive- 
 ness or diarrhoaa, with slimy stools; flatulency
 
 OP THE MIND. 77 
 
 pervading the whole alimentary canal, and called 
 in the bowels borborigini; a tumid abdomen, 
 especially on the right side ; deficient or preterna- 
 tural appetite ; strong venereal desires accompa- 
 nied with nocturnal emissions of semen ; or an 
 absence of venereal desires, and sometimes im- 
 potence ; insensibility to cold ; pains in the limbs 
 at times, resembling rheumatism; cough; cold 
 feet; palpitation of the heart; headach; vertigo; 
 tenitus aurium; a thumping like a hammer in the 
 temples, and sometimes within the brain ; a dis- 
 position to faint; wakefulness, or starting in sleep; 
 indisposition to rise out of bed, arid a disposition 
 to lie in it for days, and even weeks ; a cool and 
 dry skin, and frequently of a sallow colour, from 
 the want of a regular discharge of bile from the 
 liver, and its absorption into the blood. 
 
 While the alimentary canal is thus depressed, 
 and the blood-vessels, nerves and muscles, robbed 
 of nearly all their excitement, or possess it in parts 
 of the body only, the lymphatic system is often 
 preternaturally excited ; hence we frequently ob- 
 serve in this disease a constant and increased dis- 
 charge of urine. 
 
 The characteristic symptom of this form of de- 
 rangement, as it appears in the mind, is distress,
 
 78 ON THE DISEASES 
 
 the causes of which are numerous, and of a per- 
 sonal nature. I shall enumerate some of them, 
 as they have appeared in different people. They 
 relate, 1, to the patient's body. He erroneously 
 believes himself to be afflicted with various dis- 
 eases, particularly with consumption, cancer, 
 stone, and above all, with impotence, and the 
 venereal disease. Sometimes he supposes him- 
 self to be poisoned, or that his constitution had 
 been ruined by mercury, or that the seeds of the 
 hydrophobia are floating in his system. 
 
 2. He believes that he has a living animal in 
 his body. A sea-captain, formerly of this city, 
 believed for many years that he had a wolf in 
 his liver. Many persons have fancied they were 
 gradually dying, from animals of other kinds 
 preying upon different parts of their bodies. 3. 
 He imagines himself to be converted into an ani- 
 mal of another species, such as a goose, a cock, 
 a dog, a cat, a hare, a cow, and the like. In this 
 case he adopts the noises and gestures of the 
 animals into which he supposes himself to be 
 transformed. 
 
 4. He believes he inherits, by transmigration, 
 the soul of some fellow creatures, but much 
 oftener of a brute animal. There is now a mad-
 
 OP THE MIND. 79 
 
 man in the Pennsylvania Hospital who believes 
 that he was once a calf, and who mentions the 
 name of the butcher that killed him, and the stall 
 in the Philadelphia market on which his flesh 
 was sold previously to his animating his present 
 body. 
 
 5. He believes he has no soul. The late Dr. 
 Percival communicated to me, many years ago, 
 an account of a dissenting minister in England 
 who believed that God had annihilated his soul 
 as a punishment for his having killed a high-way 
 man by grasping him by the throat, who attempt- 
 ed to rob him. His mind was correct upon all 
 other subjects. 
 
 6. He believes he is transformed into a plant. 
 In the Memoirs of the Count de Maurepas we are 
 told this error took possession of the mind of one 
 of the princes of Bourbon to such a degree, that 
 he often went and stood in his garden, where he 
 insisted upon being watered in common with all 
 the plants around him. 
 
 7. The patient afflicted with this disease some- 
 times fancies he is transformed into glass.
 
 80 ON THE DISEASES 
 
 8. He believes, that by discharging the con- 
 tents of his bladder, he shall drown the world. 
 
 9. He believes himself to be dead. 
 
 It is worthy of notice, in all these cases of 
 erroneous judgment, the patients reason correctly, 
 that is, draw just inferences from their errors. 
 Thus the prince of Bourbon, when he supposed 
 himself to be a plant, reasoned justly when he 
 insisted upon being watered. In like manner, 
 the hypochondriac who supposes himself to be 
 dead, reasons with the same correctness when he 
 stretches his body and limbs upon a bed or a 
 board, and assumes the stillness and silence of 
 the shroud. 
 
 It is remarkable further, that all the erroneous 
 opinions, persons affected with this form of de- 
 rangement entertain of themselves, are of a 
 
 o ' 
 
 degrading nature. 
 
 But again. The distress of a hypochondriac 
 is derived from errors respecting, 1, his outward 
 circumstances, as they relate to his property. 
 
 2. The conduct of his friends, relations, or a 
 mistress.
 
 OP THE MIND. 81 
 
 3. His birth-place, and society of his family, 
 when absent from them. 
 
 4. The state of his country. 
 
 5. His spiritual state. 
 
 The mind, in its distress from all the above 
 causes, is in a reverse state from that which was 
 just now mentioned, in drawing erroneous, or dis- 
 proportionate, conclusions from just premises. 
 Thus the hypochondriac who possesses an in- 
 come which he admits to be equal to all the exi- 
 gencies of his family, reasons unjustly when he 
 anticipates ending his days in a poor-house. In 
 like manner the deranged penitent judges cor- 
 rectly when he believes that he has offended his 
 Maker, but he reasons incorrectly when he sup- 
 poses he has excluded him from his mercy. 
 
 In the hypochondriasis from all the causes that 
 have been mentioned, the patients are for a while 
 peevish and sometimes irascible. The lightest 
 noises, such as the grating of a door upon its 
 hinges, or its being opened and shut suddenly, 
 produce in them anger or terror. They quarrel 
 with their friends and relations. They change 
 
 11
 
 82 ON THE DISEASES 
 
 their physicians and remedies, and sometimes 
 they discover the instability of their tempers by 
 settling and unsettling themselves half a dozen 
 times in different parts of their native country, or 
 different foreign countries, in the course of a few 
 years, leaving each of them with complaints of 
 their climate, provisions, and the manners of their 
 inhabitants. 
 
 The hypochondriasis, or tristimania, like most 
 other diseases, has paroxysms, and remissions or 
 intermissions, all of which are influenced by many 
 circumstances, particularly by company, wine, 
 exercise, and, above all, the weather. 
 
 A pleasant season, a fine day, and even the 
 morning sun, often suspend the disease. Mr. 
 Cowper, who knew all its symptoms by sad expe- 
 rience, bears witness to the truth of this remark, 
 in one of his letters to Mr. Haley. "I rise," says 
 he, "cheerless and distressed, and brighten as 
 the sun goes on." Its paroxysms are sometimes 
 denominated u low spirits." They continue from 
 a day, a week, a month, a season, to a year, 
 and sometimes longer. The intervals differ, 1, 
 in being accompanied with preternatural high 
 spirits. 2. In being attended with remissions
 
 OF THE MIND. 83 
 
 only ; and, 3, with intermissions, or, in other 
 words, with correctness and equanimity of mind. 
 
 The extremes of low and high spirits which 
 occur in the same person, at different times, are 
 happily illustrated by the following case. A phy- 
 sician in one of the cities of Italy was once con- 
 sulted by a gentleman, who was much distressed 
 with a paroxysm of this intermitting state of 
 hypochondriasm. He advised him to seek relief 
 in convivial company, and recommended to him 
 in particular to 'find out a gentleman of the name 
 of Cardini, who kept all the tables in the city, to 
 which he was occasionally invited, in a roar of 
 laughter. " Alas ! Sir," said the patient, with a 
 heavy sigh, "I am that Cardini." Many such 
 characters, alternately marked by high and low 
 spirits, are to be found in all the cities in the 
 world. 
 
 But there are sometimes flashes of apparent 
 cheerfulness, and even of mirth, in the intervals 
 of this disease which are accompanied with latent 
 depression of mind. This appears to have been 
 the case in Mr. Cowper : hence, in one of his let- 
 ters to Mr. Haley, he says, " I am cheerful upon 
 paper, but the most distressed of all creatures."
 
 84 ON THE DISEASES 
 
 It was probably in one of these opposite states of 
 mind that he wrote his humorous ballad of John 
 Gilpin. 
 
 In the history of hypochondriasm, as far as it 
 has been given, there is a combination of some 
 of the symptoms of hysteria, from the nervous 
 system being partially or alternately in a strictum 
 or laxum, or, in other words, in an inirritable or 
 irritable state, and from the blood-vessels being 
 alternately in a diseased and sound state. 
 
 This mixture of the symptoms of hypochon- 
 driasis and hysteria, in these two opposite states 
 of the system, is described with great accuracy in 
 the following letter from a gentleman in Virginia, 
 which I received a few years ago, containing the 
 history of his own case. 
 
 January 25, 1808. 
 SIR, 
 
 " I write you to seek relief in a case of disease 
 of the most inveterate, though not uncommon, 
 nature. It is a nervous affection of the most 
 obstinate kind. An apathy and torpor of the 
 bowels and stomach, and a susceptibility of the 
 mind exceeding all description : loss of sleep to
 
 OP THE MIND. 
 
 an alarming degree at times, and the consequent 
 debility, despair, subsultus tendinum, and paraly- 
 tic sensations in many parts of my body, are the 
 principal evils I suffer. My mind is liable to be 
 excited by trifling and unsubstantial causes ; dis- 
 posed to cleave to unpleasant usages, to dwell on 
 dreadful consequences from really trifling circum- 
 stances, to be appalled with vain apprehensions, 
 and to cherish disgusts and disagreeable associa- 
 tions ; indeed, to labour under a fixidity of ideas 
 which causes my misery. I was attacked in the 
 winter of 1800 and 1801, and since that time have 
 suffered an immensity of distress, with long inter- 
 vals, however, of capacity for enjoyment. Moral 
 causes are the sources of my afflictions. The 
 barriers of reason are cobwebs to oppose to the 
 intrusion of this host of enemies. Am I in a con- 
 vivial company ? I think of some unpleasant cir- 
 cumstance. Do I eat heartily ? I still think ; my 
 mind cannot rise above its customary state of 
 feebleness. When I lie down, this fixed image 
 presents itself. I am distressed, alarmed, my blood 
 circulates rapidly, my brain is fired, a train of dis- 
 tressing ideas enter and seize my mind ; I am, as 
 it were, all nerve ; the least noise is like a shock 
 of thunder, so that for seven years I have been in 
 the constant habit of stopping both ears with wax,* 
 with intervals, however, of strength to bear noise,
 
 86 ON THE DISEASES 
 
 and sometimes even 1 am, as I think, almost well. 
 I am within a few days of forty-four years of age; 
 my appetite is always good; I eat every thing, 
 drink moderately of wine, have found no good 
 from any regimen, though I have not pursued any 
 regimen but a very short time. 
 
 " I go to bed, my mind is distressed, I get a lit- 
 tle quiet, and perhaps I am disposed to rest ; at 
 the moment of forgetfulness, which produces 
 sound sleep, this image strikes my mind ; I know 
 what I am to suffer; am alarmed; my blood 
 rushes through the jugular vessels; I hear my 
 heart beat, and feel it thumping the whole night; 
 my mind on fire, able to pursue no train of plea- 
 sant thought a moment; I get worse; despair; 
 think of nothing but my wretched condition, till 
 at last I lose several nights sleep ; my pulse is low 
 and threaded, and at last nature makes an effort 
 and gradually restores me. Such is almost al- 
 ways my course. 
 
 "I can assure you that no cause of distress 
 vexes my mind in which my conscience or my 
 honour is implicated, or which would be even 
 noticed by others. If I could indulge in religious 
 duties and contemplations, to which my heart, 
 my judgment, and natural disposition would lead
 
 OP THE MIND. 87 
 
 me, it would, I really believe, cure me; but pre- 
 vious to my first attack, near eight years ago, in 
 a previous state of debility and nervous affection, 
 which pressed hard on my spirits. I wished to 
 read on religious subjects, until all at once im- 
 pious and profane ideas struck my mind; my soul 
 recoiled, was shocked; I tried to banish them; 
 nothing would do; not a moment were those ideas 
 absent; at last they seized so fast, that I lost 
 many nights and days sleep; and I was brought 
 near the grave. I got better, and overcame, in 
 some sort, this immoral influence; but shall never 
 be able to indulge as I wish in religious duties. 
 My heart often expands with enthusiasm, and then 
 I taste of the joys of heaven. Now, Sir, can this 
 dreadful state of mind be cured ? Can I be made 
 to possess less feeling, and more resolution to 
 resist moral influences on the mind ; to bear vexa- 
 tious or distressing incidents; and to break this 
 association, i\\\8> fixidity of ideas? 
 
 " My feet, particularly my left foot, are always 
 cold ; and when I labour under great anxiety, 
 both feet have, when warm in bed, a sensation as 
 if they were asleep (as we say) which is very dis- 
 tressing. My whole left side is affected more 
 than the other ; the auditory nerve of my left ear 
 is affected curiously, and unpleasantly, with sharp
 
 88 ON THE DISEASES 
 
 sounds, as if the body touched the nerve ; I can 
 not well describe it. 
 
 If I could be tranquil, I should be well. 
 Whenever I can be moved by ambitious pros- 
 pects or entertain a desire for distinction, or any 
 such passion, I am well. This is sometimes the 
 case. When hopes or wishes of this sort take 
 possession of my mind, they drive out other im- 
 pressions; then I feel well. Active employment, 
 if I could get in it, would cure me, but I know of 
 none. When I feel well, I am uncommonly cheer- 
 ful, playful and happy. 
 
 " Now, Sir, I beg you, in consideration of suf- 
 fering humanity, to take my case into your serious 
 consideration, and extend to me the benefit of 
 your advice." 
 
 In proportion as the hypochondriac disease ad- 
 vances, the symptoms of the hysteria, which are 
 generally combined with it in its first stage, dis- 
 appear, and all the symptoms in which the disease 
 is seated acquire a uniformly torpid or irritable 
 state. The remissions and intermissions which 
 have been described, cease, and even the tran- 
 sient blaze of cheerfulness, which now and then 
 escapes from a heart smothered with anguish,
 
 OF THE MIND. 89 
 
 is seen no more. The distress now becomes con- 
 stant. " Clouds return after every rain." Not a 
 ray of comfort glimmers upon the soul in any of 
 the prospects or retrospects of life. " All is now 
 darkness without and within." These poignant 
 words were once uttered by a patient of mine with 
 peculiar emphasis, while labouring under this 
 stage of the disease. Neither nature nor art now 
 possess a single beauty, nor music or poetry a 
 single charm. The two latter often give pain 
 and sometimes offence. In vain do love and 
 friendship, and domestic affection, offer sympathy 
 or relief to the mind in this awful situation. Even 
 the consolations of religion are rejected, or heard 
 with silence and indifference. Night no longer 
 affords a respite from misery. It is passed in 
 distracting wakefulness, or in dreams more terri- 
 ble than waking thoughts ; nor does the light of 
 the sun chase away a single distressing idea. " I 
 rise in the morning," says Mr. Cowper, in a letter 
 to Mr. Haley, *' like an infernal frog out of Ache- 
 ron, covered with the ooze and mud of melan- 
 choly." No change of place is wished for that 
 promises any alleviation of suffering. " Could I 
 be translated to paradise," says the same elegant 
 historian of his own sorrows, in a letter to Lady 
 Hesketh, " unless I could leave my body behind 
 me, my melancholy would cleave to me there." 
 
 12
 
 90 ON THE DISEASES 
 
 But the last and worst state of this form of de- 
 rangement remains yet to be described. After it 
 has completely put off all its hysterical symptoms, 
 the patients fly for relief to such stimuli as act 
 upon the body, in order to counteract the insup- 
 portable pressure of distress upon their minds. 
 They take snuff, or chew tobacco. They eat 
 voraciously, and drink wine and spirits or take 
 laudanum, in large quantities, when they are able 
 to procure them. Sometimes the pain of a 
 bodily disease suspends for a short time their 
 mental distress. Mr. Boswell, in his life of Dr. 
 Johnson, relates a story of a London tradesman, 
 who, after making a large fortune, retired into the 
 country to enjoy it. Here he became deranged 
 with hypochondriasis, from the want of employ- 
 ment. His existence became finally a burden to 
 him. At length he was afflicted with the stone. 
 In a severe paroxysm of this disease, a friend 
 sympathized with him. " No, no," said he, 
 "don't pity me, for what I now feel is ease, 
 compared with that torture of mind from which it 
 relieves me," A woman in this city bore a child, 
 while she was afflicted with this disease. She 
 declared, immediately afterwards, that she felt no 
 more pain from parturition, than from a trifling 
 fit of the cholic. Where counteracting pains of 
 the body are not induced by nature or accident,
 
 OF THE MIND. 91 
 
 to relieve anguish of mind, patients often inflict 
 them upon themselves. Walking barefooted over 
 ground covered with frost and snow was resorted 
 to by a clergyman of great worth in England for 
 this purpose. Garden, an eminent physician of 
 the fifteenth century, made it a practice to bite 
 his lips, and one of his arms, also to whip his legs 
 with rods, in order to ease the distress of his 
 mind. Kempfer tells us that prisoners in Japan, 
 who often became partially deranged from dis- 
 tress, used to divert their mental anguish by 
 burning their bodies with moxa. The same de- 
 gree of pain, and for the same purpose, is often 
 inflicted upon the body, by cutting and mangling 
 it in parts not intimately connected with life. But 
 bodily pain, whether from an accidental disease, 
 or inflicted by the patients upon themselves, is 
 sometimes insufficient to predominate over the 
 distress of their minds. Dr. Heberden mentions 
 an instance of a man who was naturally so much 
 afraid of pain, that he dreaded even being bled, 
 who, in a fit of low spirits, cut off his penis and 
 scrotum with a razor, and declared, after he 
 recovered the natural and healthy state of his 
 mind, that he felt not the least pain from that 
 severe operation. A similar instance of insensi- 
 bility to bodily pain is related by Dr. Ruggieri, an 
 Italian physician, of a hypochondriac madman of
 
 92 ON THE DISEASES 
 
 the name of Loval, who fixed himself upon a 
 cross, and inflicted the same wounds upon him- 
 self, as far as he was able, that had been inflicted 
 upon our Saviour. He was discovered in this 
 situation and taken down alive. During the pa- 
 roxysms of his madness, he felt no pain from 
 dressing his wounds, but complained as soon as 
 they were touched in the intervals of his disease. 
 But this is not all. Hypochondriac distress seeks 
 relief in an evil still greater than bodily pain. 
 Can any thing be anticipated more dreadful than 
 universal madness? and yet I once attended a 
 lady in this city, whose sufferings from low spirits 
 were of such a nature, that she ardently wished 
 she might lose her reason, in order thereby to be 
 relieved from the horror of her thoughts. This 
 state of mind was not new in this disease. Shak- 
 speare has described it in the following lines, in 
 his inimitable history of all the forms of derange- 
 ment, in the tragedy of King Lear. They are 
 as truly philosophical, as they are poetical. 
 
 " Better I were distract ; 
 
 So should ray thoughts be sever' d from my griefs, 
 And woes, by wrong imaginations, lose 
 The knowledge of themselves."
 
 OP THE MIND. 93 
 
 But the most awful symptom of this disease 
 remains yet to be mentioned, and that is DESPAIR. 
 The marks of the extreme misery included in 
 this word are sometimes to be seen in the coun- 
 tenances and gestures of hypochondriacs in a 
 hospital ; but as it is difficult to obtain from such 
 persons a history of their feelings, I shall endea- 
 vour to give some idea of them in the following 
 account, communicated to me by a clergyman 
 who passed four years and a half in this state of 
 mind. 
 
 He said " he felt the bodily pains and mental 
 anguish of the damned; that he slumbered only, 
 but never slept soundly, during the long period 
 that has been mentioned ; that he lost his appe- 
 tites and passions, so as to desire and relish 
 nothing, and to love and hate no one ; that his 
 feet were constantly cold, and the upper part of 
 his body warm ; that he lost all sense of years, 
 months, weeks, days and nights, and even of 
 morning and evening; that in this respect, time 
 was to him no more." During the whole period 
 of his misery, he kept his hands in constant mo- 
 tion towards his head and thighs, and ceased not 
 constantly to cry out, " wretched man that 1 am ! 
 I am damned ; oh, I am damned everlastingly."
 
 94 ON THE DISEASES 
 
 Terrible as the picture of despair is, the dis- 
 ease has symptoms which mark a still greater de- 
 gree of misery. It sometimes creates such a dis- 
 gust of life, as to make the subjects of it wish to 
 die. How undescribable, and even incomprehen- 
 sible, must be that state of mind, which thus ex- 
 tinguishes the deep seated principle of the love of 
 life ! In the exquisite tortures of the stone, and 
 cholic, and even under the progress of an excru- 
 ciating and mortal cancer men are willing, nay 
 anxious, to live ; of course the sufferings from 
 the anguish of mind I have described, exceed the 
 sufferings from those diseases. But there is a 
 symptom of despair which places its horrors 
 beyond a mere wish to die. It often drives the 
 distracted subject of it to precipitate the slow 
 approaches of death with his own hand. A pis- 
 tol, a razor, a river, a mill-dam, a halter, or lau- 
 danum, are the means usually resorted to for this 
 purpose. Sometimes the instruments of death 
 are of a more painful nature. I have once seen 
 the body of a Russian officer mangled with thir- 
 teen wounds inflicted by himself. He had fallen 
 into despair in consequence of debts contracted 
 in a foreign country. Sometimes a horror is 
 entertained by persons in this situation at the 
 crime of suicide, but, in order to escape from life, 
 they provoke death from the hands of govern-
 
 OP THE MIND. 95 
 
 merit, by committing murder ; many instances of 
 this kind are to be met with, not only in the 
 records of medicine, but in our public newspa- 
 pers. Dreadful as this state of mind is, there is 
 one still more distressing, and that is, the desire, 
 and fear of death operating alternately upon the 
 mind. I have seen this state of hypochondriasm. 
 It was in the lady who wished to be relieved from 
 the horror of her thoughts by the complete loss 
 of her reason. 
 
 After the history that has been given of the 
 distress, despair and voluntary death, which are 
 induced by that partial derangement which has 
 been described, I should lay down my pen, and 
 bedew my paper with my tears, did I not know 
 that the science qf medicine has furnished a 
 remedy for it, and that hundreds are now alive, 
 and happy, who were once afflicted with it. 
 Blessed science! which thus extends its friendly 
 empire, not only over the evils of the bodies, but 
 over those of the minds of the children of men.
 
 96 ON THE DISEASES 
 
 CHAPTER IV. 
 
 Of the Remedies for Hypochondriasis or Tristimania. 
 
 THE remedies for this form of derangement 
 divide themselves into two classes. 
 
 I. Such as are intended to act directly upon 
 the body ; and, 
 
 II. Such as are intended to act indirectly upon 
 the body, through the medium of the mind. 
 
 1. Before we proceed to administer the reme- 
 dies that are indicated under our first head, it will 
 be proper carefully to review the history of all the 
 remote and exciting causes of this disease, and, 
 when possible, to remove them. If this be im- 
 practicable, or if the disease continue from habit, 
 after all its causes have been removed, recourse 
 should be had to,
 
 OF THE MIND. 97 
 
 1. BLOODLETTING, if the pulse be tense, or full; 
 or depressed, without either fulness, or tension. 
 I have prescribed this remedy with success, and 
 thereby in several instances suddenly prepared 
 the way for its being cured in a few days by other 
 medicines. I was led to use it by the following 
 fact, communicated to me by the late Dr. Thomas 
 Bond. A preacher among the Friends called 
 upon him, to consult him in this state of mad- 
 ness. He said he was possessed of a devil, and 
 that he felt him constantly in aches and pains in 
 every part of his body. The Doctor felt his pulse, 
 which he found to be full and tense. He advised 
 him to sit down in his parlour, and persuaded 
 him to let him open a vein in his arm. While 
 the blood was flowing the patient cried out, " I 
 am relieved, I felt the devil fly out of the orifice 
 in my vein as soon as it was opened." From this 
 time he recovered rapidly from his derangement. 
 The advantages of bleeding are evinced still fur- 
 ther by the relief obtained in this disease by the 
 loss of blood from the haemorrhoidal vessels, and 
 by other accidental haemorrhages. But, if expe- 
 rience had not thus established the efficacy of this 
 remedy, its use would be suggested by the habits 
 of such patients, of indulging their appetites, not 
 only to satisfy hunger, but to suspend their dis- 
 
 13
 
 98 ON THE DISEASES 
 
 tress; and by congestions of blood in the liver 
 and spleen, which usually takes place in this dis- 
 ease. After bleeding, if it be required. 
 
 2. PURGES should be given. They are indi- 
 cated by the obstructions of the viscera, and 
 torpor of the alimentary canal. They often bring 
 away black bile, and sometimes worms. The 
 more active purges, particularly aloes, jalap, and 
 calomel, should be preferred in this disease. The 
 daughters of Praetus, who supposed themselves to 
 be cows, were cured by Melampus by means of 
 hellebore, which is of a purging nature. The 
 medicine has ever since borne his name. 
 
 3. EMETICS, by exciting the stomach, often re- 
 move morbid excitement from the brain, and thus 
 restore the mind to its healthy state. They more- 
 over assist purges in exciting the alimentary ca- 
 nal, and in dislodging obstructions from the ab- 
 dominal viscera. 
 
 4. A REDUCED DIET, consisting of food and 
 drinks that contain but little nourishment, should 
 be combined with the three remedies that have 
 been mentioned. As the stomach is frequently in 
 a dyspeptic state, the aliment and drinks should
 
 OP THE MIND. 99 
 
 consist of such* articles as are least disposed to 
 increase or produce a morbid acid in it. 
 
 After reducing the action of the blood-vessels, 
 to a par of debility with the nervous system, or, 
 to borrow an allusion from a mechanical art, after 
 plumbing those two systems, the remedies should 
 consist, 
 
 5. Of STIMULATING ALIMEMT, DRINKS and MEDI- 
 CINES. 
 
 The diet should consist of solid animal food, 
 with such vegetables as are least disposed to 
 acidity, and both should be rendered palatable by 
 condiments. The drinks should consist of old 
 Madeira or sherry-wine, and porter diluted with 
 water, or taken alone, provided the stomach be 
 not affected with a morbid acid. I have once 
 known this disease cured by the liberal use of 
 Madeira wine. In some cases, old claret is bet- 
 ter received by the stomach than the white wines, 
 from its containing less fermentable matter in it. 
 The drinks should be taken warm, for the sto- 
 mach is generally too weak to react under the 
 sedative operation of such as are cold. Warm 
 tea and coffee, made weak, are generally grateful 
 to the stomach, and should be advised, when it is
 
 100 ON THE DISEASES 
 
 not affected with dyspepsia. The celebrated 
 Mr. Burke often relieved the low spirits which 
 were induced by the solicitude and vexations of 
 his political life by sipping a tea-cup full of hot 
 water. In cases of dyspepsia, or indigestion, as 
 little drink as possible should be taken with food. 
 The medicines proper in this disease should be the 
 different preparations of iron. I know they have 
 been said to be hurtful in it. It is true they are 
 often ineffectual, but this is because the system is 
 reduced below their stimulus in their ordinary 
 doses. When given in large doses, mixed with 
 ginger, or black pepper, and the common bitters 
 of the shops, and persisted in for several months, 
 they are powerful medicines. Tar, in the form of 
 pills, or infused in water, and garlic in substance, 
 or infused in peppermint-tea, afford great relief in 
 this disease, more especially when the stomach is 
 affected. Magnesia, lime-water and milk, and the 
 alkaline salts, should be given to relieve acidity 
 in the stomach, should that symptom of dyspepsia 
 call for them. Assafoetida is an excellent med- 
 icine in this depressed state of the system, and 
 preferable to any of the common foatid gums that 
 are in use to exhilarate the spirits. But our prin- 
 cipal reliance for that purpose should be upon 
 opium. Mr. Cowper says, ten drops of laudanum, 
 taken occasionally, saved him from being " de-
 
 OP THE MIND. 101 
 
 voured by melancholy." This noble medicine, 
 which has been happily called " the medicine of 
 the mind," has many advantages over ardent 
 spirits as a cordial. It affords more prompt 
 relief; a habit of attachment to it is more slowly 
 formed, and more easily broken. It does not pol- 
 lute the breath, nor does it ever tend to excite, or 
 increase that hysterical irritability of temper 
 which is sometimes connected with this disease. 
 However useful ardent spirits may be in transient 
 diseases, they can not be used in such as are of a 
 chronic nature without inducing such a fondness 
 for them as not only to prevent their acting as 
 remedies, but to convert them into poisons, often 
 alike fatal to the soul and body. 
 
 6. The WARM BATH, applied in the form of 
 water, or vapour, and rendered more stimulating, 
 if necessary, by the addition of saline or aromatic 
 substances to it. The heat of the water should 
 be a little above that of the body. It does most 
 service when it induces sweats. Mr. Cowper 
 was always relieved by that discharge from his 
 skin. 
 
 7. The COLD BATH. This remedy should not 
 be advised until the system has been prepared for 
 it by the previous use of the warm bath.
 
 102 
 
 ON THE DISEASES 
 
 8. FRICTIONS to the trunk of the body and 
 limbs. These tend very much to excite the cuta- 
 neous extremities of the nerves and blood-vessels, 
 and thus to equalize the excitement of the sys- 
 tem. I have known two instances in which a re- 
 covery from this disease succeeded an attack of 
 the itch. The remedy to this case was probably 
 the pleasurable sensation exhibited by scratch- 
 ing, in order to relieve it. 
 
 9. EXERCISE, especially upon horseback. La- 
 bour is still more useful, particularly in the open 
 air. 
 
 10. The excitement of PAIN. I mentioned the 
 accidental effects of the pain of a stone in the 
 bladder, and of burning moxa on the body, in sus- 
 pending anguish of mind in the history of this dis- 
 ease. It may be excited in various ways. Mus- 
 tard to the feet is generally sufficient for this 
 purpose. I once attended a gentleman from 
 Barbadoes, who suffered great distress of mind 
 from a hypochondriac gout which floated in his 
 nerves and brain; but no sooner did the gout fix 
 and excite pain in his hands or feet, than he re- 
 covered his spirits, and became pleasant and 
 agreeable to all around him.
 
 OP THE MIND. 103 
 
 11. SALIVATION. Mercury acts in this dis- 
 ease, 1, by abstracting morbid excitement from 
 the brain to the mouth. 2, By removing visceral 
 obstructions. And 3, by changing the cause of 
 our patient's complaints, and fixing them wholly 
 upon his sore mouth. The salivation will do 
 still more service if it excite some degree of 
 
 O 
 
 resentment against the patient's physician or 
 friends. The effects of mercury in this disease, 
 have sometimes been compared to those of a 
 handful of shot shaken in a bottle, lined with filth 
 and dirt, in order to clean it. It stimulates every 
 part of the body, renders the vessels pervious to 
 their natural juices, conveys morbid action out of 
 the body by the mouth, and thus restores the 
 mind to its native seat in the brain. 
 
 12. BLISTERS and ISSUES have been found useful 
 in this form of madness. They are calculated to 
 excite the action of the skin, and to produce what 
 has been happily called a centrifugal direction of 
 the fluids. They are more particularly indicated, 
 if the disease have been induced by eruptions re- 
 pelled from the skin. 
 
 II. We come next in order to mention the 
 remedies for the body, which are intended to
 
 104 ON THE DISEASES 
 
 act through the medium of the mind. The 
 first thing to be done by a physician, under this 
 head, is to treat the disease in a serious manner. 
 To consider it in any other light, is to renounce 
 all observation in medicine. However erroneous 
 a patient's opinion of his case may be, his dis- 
 ease is a real one. It will be necessary, therefore, 
 for a physician to listen with attention to his tedi- 
 ous and uninteresting details of its symptoms and 
 causes. In some cases, patients wish to think 
 their diseases are trifling, and attended with no 
 danger, but in hypochondriasis they are always 
 best satisfied in believing their disease to be diffi- 
 cult and dangerous. A physician should carefully 
 avoid likewise speaking lightly of his patient's 
 disease to his friends and neighbours, for he 
 will take uncommon pains to discover, from 
 them, his opinion of his case, and if it be differ- 
 ent from that which has been given to him, he 
 will not only reproach him with a want of can- 
 dour, but will immediately seek relief from ano- 
 ther physician. I once knew an instance of this 
 kind in this city. The patient refused to see the 
 physician afterwards, who had thus deceived him. 
 In the worst grade of this disease, he will not 
 bear contradiction, and hence it will be neces- 
 sary to conform our remedies as much as possi-
 
 OP THE MIND. 105 
 
 ble to his erroneous opinions of the nature of his 
 disease. If he believes himself to be affected 
 with any of the diseases that were formerly 
 named, medicines must be prescribed for them, 
 and administered in a manner calculated to act 
 upon his principle of faith, and to beget his con- 
 fidence in them. In the more moderate grade of 
 his errors upon the subject of his disease, contra- 
 diction and reasoning may be opposed to them. 
 When these means are employed, the conduct 
 of a physician should correspond with them. I 
 once injured myself, and my patient, who sup- 
 posed himself to be affected with the venereal 
 disease, by prescribing for him a few mercurial 
 pills, in compliance with his earnest solicitations, 
 after having assured him that he had not a parti- 
 cle of its virus in his system. I have in several 
 instances removed all doubt upon the subject, by 
 advising matrimony, or a renewal of conjugal in- 
 tercourse, if my patients were married, and by 
 offering them at the same time a bond for a large 
 sum of money, if any bad consequences should 
 follow their obedience to my advice. In this way 
 I have made many gentlemen happy, and never 
 in a single instance incurred the least discredit or 
 blame. 
 
 14
 
 106 ON THE DISEASES 
 
 Persons afflicted with this form of derange- 
 ment, I said formerly, now and then believe them- 
 selves to be poisoned. In this case it is some- 
 times necessary to humour their error, and to 
 prescribe suitable means to remove it. Dr. Cox, 
 in his Treatise upon Insanity, has furnished us 
 with an excellent precedent for this purpose. A 
 gentleman in England supposed a shirt which he 
 had worn, had been poisoned by his maid, and 
 determined to subject her to the punishment of 
 the law. His physician humoured his belief and 
 resentment, by pretending to have discovered a 
 poisonous matter in his shirt, by means of some 
 chymical experiments upon it, and concurred with 
 him in prosecuting his maid for an intended mur- 
 der. A new course was hereby given to his 
 thoughts, and a new action excited in his brain, 
 by which he was perfectly cured. 
 
 Terror once cured, for a while, a patient of mine, 
 of a belief that he had been poisoned by taking 
 arsenic as a medicine, and that it had eaten out 
 his bowels. A student of medicine, to whom he 
 told his tale, attempted to convince him of his 
 error, upon which he begged him to open him, 
 and to satisfy himself by examining the cavity of 
 his belly. After some preparation, the student 
 laid him upon a table, and drew the back of a knife
 
 OF THE MIND. 107 
 
 from one extremity of his belly to the other. 
 " Stop, stop." said my patient, " I've got guts," 
 and suddenly escaped from the hands of his ope- 
 rator. His cure would probably have been dura- 
 ble, after the use of this remedy, had not real dis- 
 tress, from another cause, brought back that 
 which was imaginary. 
 
 If our patient imagine he has a living animal in 
 his body, and he can not be reasoned out of a be- 
 lief of it, medicines must be given to destroy it; 
 and if an animal, such as he supposes to be in his 
 body, should be secretly conveyed into his close 
 stool, the deception would be a justifiable one, if 
 it served to cure him of his disease. 
 
 If our patient should believe himself to be 
 transformed into an animal of another species by 
 transmigration, or in any other way, our remedies 
 should be accommodated to the grade of his mad- 
 ness, and the nature of the animal into which he 
 supposes himself to be changed. Ridicule has 
 sometimes been employed with success in such 
 cases. Mr. Pinel mentions an instance of its sud- 
 den efficacy in curing a watchmaker in Paris, 
 who believed that his head had been cut off, and 
 that he carried the head of a man who had been 
 guillotined instead of his own.
 
 108 ON THE DISEASES 
 
 A physician, formerly of this city, used to di- 
 vert his friends, by relating the history of a cure 
 which had been performed of a patient in this 
 form of madness, who believed himself to be a 
 plant. One of his companions, who favoured his 
 delusion, persuaded him he could not thrive with- 
 out being watered, and while he made the patient 
 believe, for some time, he was pouring water 
 from the spout of a tea-pot, discharged his urine 
 upon his head. The remedy in this case was 
 resentment and mortification. 
 
 Cures of patients, who suppose themselves to 
 be glass, may easily be performed by pulling a 
 chair, upon which they are about to sit, from un- 
 der them, and afterwards showing them a large 
 collection of pieces of glass as the fragments of 
 their bodies. 
 
 An unwillingness to discharge the contents of 
 the bladder, from the cause that has been men- 
 tioned, was once cured by persuading the patient 
 that the world was on fire, and that nothing but 
 his water would extinguish it. This error was 
 cured by Dr. Ferriar by means of an emetic, 
 which by its action upon the stomach, destroyed 
 the command of the patient's will over the sphinc- 
 ter of the bladder.
 
 OF THE MIND. 109 
 
 I have heard of a person afflicted with this dis- 
 ease, who supposed himself to be dead, who was 
 instantly cured by a physician proposing to his 
 friends, in his hearing, to open his body, in order 
 to discover the cause of his death. 
 
 In all the cases that have been mentioned, of 
 error and distress which relate to the body only, 
 similar advantages would probably arise from ex- 
 citing fear or anger, or any other powerful emo- 
 tion of the mind. 
 
 I attended a young man in the year 1806, who 
 cherished an obstinate hypochondriac belief, after 
 his recovery from the autumnal fever, that he 
 should die, and felt at the same time a great dread 
 of death. I assured him over and over that he 
 was in no danger, but without being able to 
 inspire him with the least expectation of life. In 
 one of my visits to him, I asked him upon enter- 
 ing his room, how he was; "very bad," said he, 
 and repeated his belief that he should soon die. 
 His nurse, who sat by him, added, that he had 
 fixed upon an hour in the approaching night as 
 the time for his dissolution. After pausing a few 
 moments, I asked him if I should send a joiner to 
 measure him for his coffin. This question in- 
 stantly gave a new current to his feelings, and
 
 110 ON THE DISEASES 
 
 from that time he recovered rapidly, nor did he 
 ever mention an apprehension of dying to me, in 
 any of my subsequent visits to him. Anger had 
 uniformly the same beneficial effects upon a gen- 
 tleman in Maryland, who, when in health, was 
 accustomed to speculate upon controverted sub- 
 jects in religion. There was an opinion held by 
 one sect of Christians, which he held in great ab- 
 horrence. His friends, who knew this, always 
 contrived, when they saw him unusually dejected, 
 to provoke a controversy with him upon the sub- 
 ject that wa-s hateful to him. It never failed to 
 rouse his resentment, and thereby to banish, for a 
 while, a paroxym of his disease. 
 
 If debt be the cause of our patient's disease, we 
 may presume it has been incurred with a clear 
 conscience, and a fair character, for a dishonest 
 man seldom feels distress enough from this cause 
 to bring on disease. In this case we must advise 
 our patient to take the benefit of our insolvent 
 and bankrupt laws. Many men have been thus 
 saved from a miserable death, and restored to 
 health, and usefulness to their families and so- 
 ciety. 
 
 If the disease has been induced by the suppos- 
 ed or real ingratitude, neglect, or ill usage of
 
 * 
 
 OP THE MIND. Ill 
 
 friends or relations, there are two modes of treat- 
 ing it; one consists in advising forgiveness, or 
 contempt of the injury; the other, in exciting a 
 moderate degree of anger against the persons 
 who have offended or injured our patients. This 
 anger, by its stimulus, counteracts the depression 
 both of the body and mind. It should be carefully 
 guarded from venting itself in acts of malice or 
 revenge. 
 
 If the disease be induced by nostalgia, or what 
 is called home-sickness, the patient should be ad- 
 vised to visit his native country. It was once 
 cured by this means in a Welch soldier in the 
 British army. When this remedy can not be em- 
 ployed, it should be opposed by exciting a pow- 
 erful or active counter passion. In the year 1733, 
 General Praxin led a Russian army to the banks 
 of the Rhine. At this remote distance from their 
 native country, five or six soldiers became unfit 
 for duty every day from home-sickness. The 
 General issued an order to bury alive all who 
 were affected with it. This punishment was in- 
 flicted in two or three instances, in consequence 
 of which the disease instantly disappeared from 
 the army. Fear, excited by a far less cruel 
 remedy, I have no doubt, would have had the 
 same effect.
 
 112 ON THE DISEASES 
 
 The remedies for this disease, when brought 
 on by disappointed love, and by grief, shall be 
 mentioned, when we come to treat of the cure of 
 the diseases of the passions. 
 
 It will naturally occur to the reader that the 
 three last causes of hypochondriac madness will 
 be concealed by a patient from the knowledge of 
 a physician. But they must be extorted, by direct 
 or indirect means, or the appropriate remedies 
 can not be employed to remove their hurtful in- 
 fluence upon the system. 
 
 If the derangement of our patient has been in- 
 duced by the real or supposed distresses of his 
 country, it will be proper to advise him to avoid 
 reading newspapers, and conversing upon politi- 
 cal subjects, and thereby to acquire a total igno- 
 rance of public events. But if he object to this 
 remedy, he should be advised to take a part in 
 the disputes which divide his fellow-citizens. In 
 favour of this conduct, I shall mention a single 
 fact. There was a form of this disease, well 
 known, during the revolutionary war, in several of 
 the States, by the names of the tory-rot, and the 
 protection-fever. It was confined exclusively to 
 those friends of Great Britain, and to those timid 
 Americans who took no public part in the war.
 
 OF THE MIND, 1 1 3 
 
 Many of them died of it, but not a single whig 
 nor royalist, who took an active part in the revo- 
 lution, was affected with it. This was the more 
 remarkable, as many of them lost their fortunes 
 and former rank in society, by their exertions in 
 support of the principles and measures to which 
 they had devoted their passions or their lives. By 
 eating garlic, we become insensible of the breath 
 of persons that have been rendered offensive by it. 
 In like manner, by imbibing a portion of party 
 spirit, we become insensible of the vices and fol- 
 lies of our associates in politics, and thus diminish 
 more or less than one half (according to the num- 
 ber of our party) this source of hypochondriacal 
 derangement. Happily for our citizens, the dis- 
 ease that has been named has passed away with 
 the events of the American revolution, and from 
 the general operation of the above remedies, as 
 well as from causes formerly mentioned, it has 
 rarely been succeeded by any other form of po- 
 litical hypochondriasm in the United States. 
 
 If the disease be derived from a sense of guilt, 
 it is generally connected with ignorance or erro- 
 neous opinions in religion. The former must be 
 removed, by advising the visits of a sensible and 
 enlightened clergyman. The latter consist, gene- 
 rally, in our patient's believing one or both the
 
 ON THE DISEASES 
 
 following errors : 1 . That he is excluded from the 
 divine mercy by an irreversible decree of the Su- 
 preme Being; or, in other words, that he was 
 created on purpose to be made miserable for 
 ever . The second error believed by our patient 
 is, that he has committed the unpardonable sin. 
 To the first error we may reply, that there is no 
 pagan opinion more contrary to nature and rea- 
 son, and to the whole tenor, as well as to the 
 most consistent interpretations of the Scriptures, 
 than the doctrine of men being called into exist- 
 ence on purpose to endure the pains of eternal 
 misery. To the second error we may reply, that 
 no two divines agree in what constitutes the un- 
 pardonable sin; that many wise and good men 
 believe it is not possible to commit it, in the pre- 
 sent state of the gospel dispensation, and all di- 
 vines agree that " no man had committed it, who 
 was afraid he had." It is of consequence to a 
 physician, to be fully prepared upon the subjects 
 of the two errors that I have named, for they are 
 the two principal causes of religious hypochon- 
 driasm. 
 
 In the application of all these remedies to the 
 mind, it is of consequence to know that there are 
 acquiescing, reasoning, contradicting and ridi- 
 culing points in this disease, above which they
 
 OF THE MIND. 115 
 
 respectively do harm, and below which they are of 
 no efficacy. 
 
 In all cases it will be proper to seduce patients 
 from conversing upon their disease. " Conversa- 
 tion upon melancholy," says Dr. Johnson, feeds 
 it;" for which reason he advises his friend Bos- 
 well, who was subject to it, " never to speak of 
 it, to his friends, nor in company." 
 
 There are several other remedies which act 
 upon the body through the medium of the mind, 
 and that are proper, in this disease, from all its 
 causes. The first of these is, the DESTRUCTION of 
 all old associations of ideas. Every thing a hypo- 
 chondriac patient sees or hears, becomes tinc- 
 tured with some sad idea of his disease. Hence 
 the same objects and sounds never fail of renew- 
 ing the remembrance of it. Change therefore his 
 dress, his room, his habitation, and his company, 
 as often as possible. A gentleman of South Car- 
 olina used to cure himself of a fit of low spirits by 
 changing his clothes. Even change his person 
 as much as possible. Long nails, a long beard, 
 and uncombed hair, often become exciting causes 
 of a paroxysm of this disease. They should there- 
 fore be carefully prevented or removed.
 
 116 ON THE DISEASES 
 
 2. EMPLOYMENT, or business of some kind. Man 
 was made to be active. Even in paradise he was 
 employed in the healthy and pleasant exercises or 
 cultivating a garden. Happiness, consisting in 
 folded arms, and in pensive contemplation, be- 
 neath rural shades, and by the side of purling 
 brooks, never had any existence, except in the 
 brains of mad poets, and love-sick girls and boys. 
 Hypochondriac derangement has always kept 
 pace with the inactivity of body and mind which 
 follows wealth and independence in all countries. 
 It is frequently induced by this cause in those 
 citizens, who retire, after a busy life, into the 
 country, without carrying with them a relish for 
 agriculture, gardening, books, or literary society. 
 
 Building, commerce, a public employment, an 
 executorship to a will; above all, agriculture, 
 have often cured this disease. The last, that is, 
 agriculture, by agitating the passions by alternate 
 hope, fear and enjoyment, and by rendering bodily 
 exercise or labour necessary, is calculated to pro- 
 duce the greatest benefit. Great care should, 
 however, be taken, never to advise retirement to 
 a part of the country where good society can not 
 be enjoyed upon easy terms. 
 
 In those cases in which the body can not be
 
 OP THE MIND. 117 
 
 employed, the mind should be kept constantly 
 busy. Mr. Cowper often relieved his melancholy 
 by reading novels. Hence he has well said, 
 
 " Absence of occupation is not rest, 
 
 A mind quite vacant is a mind distressed." 
 
 I knew a lady in whom this disease was brought 
 on by a disappointment in love, who cured herself 
 by translating Telemachus into English verse. 
 The remedy here was, chiefly, constant employ- 
 ment. 
 
 Dr. Burton, in his Anatomy of Melancholy, de- 
 livers the following direction for its cure : " Be 
 not idle ; be not solitary." Dr. Johnson has im- 
 proved this advice by the following commentary 
 upon it. " When you are idle, be not solitary ; 
 and when you are solitary, be not idle." The 
 illustrious Spinola, upon hearing of the death of a 
 friend, inquired of what disease he died ? " Of 
 having nothing to do," said the person who men- 
 tioned it. "Enough" said Spinola, "to kill a 
 general." Not only the want of employment, but 
 the want of care, often increases, as well as 
 brings on this disease. This was exemplified in 
 the two instances, formerly mentioned, of suicide 
 being induced by situations in which the heart 
 wished and cared for nothing.
 
 118 ON THE DISEASES 
 
 Concerts, evening parties, and the society of 
 the ladies, to gentlemen affected with this disease, 
 have been useful. Of the efficacy of the last, Mr. 
 Green has happily said, 
 
 " With speech so sweet, so sweet a mien, 
 They excommunicate the spleen." 
 
 3. CERTAIN AMUSEMENTS. Those should be pre- 
 ferred, which, while they interest the mind, afford 
 exercise to the body. The chase, shooting, play- 
 ing at quoits, are all useful for this purpose. The 
 words of the poet, Mr. Green, upon this subject, 
 deserve to be committed to memory by all physi- 
 cians. 
 
 " To cure the mind's wrong bias, spleen, 
 Some recommend the bowling-green ; 
 Some hilly walks all exercise, 
 Fling but a stone the giant dies." 
 
 Chess, checkers, cards and even push-pin, 
 should be preferred to idleness, when the weather 
 forbids exercise in the open air. The theatre has 
 often been resorted to, to remove fits of low spi- 
 rits : and it is a singular fact, that a tragedy oftener 
 dissipates them than a comedy. The remedy, 
 though distressing to persons with healthy minds, 
 is like the temperature of cold water to persons
 
 OP THE MIND. 1 19 
 
 benumbed with frost; it is exactly proportioned 
 to the excitability of their minds, and it not only 
 abstracts their attention from themselves, but 
 even revives their spirits. 
 
 A female patient of mine, in whom this disease 
 had several times been excited by family afflic- 
 tions, lost a favourite child in November 1811, 
 which produced many of its symptoms. Soon 
 afterwards her husband became sick. The lighter 
 and dissimilar distress occasioned by this event, 
 suddenly removed her disease, and she regained, 
 with the recovery of her husband, her usual health 
 and spirits. Mirth, or even cheerfulness, when 
 employed as remedies in low spirits, are like hot 
 water to a frozen limb. They are dispropor- 
 tioned to the excitability of the mind, and, instead 
 of elevating, never fail to increase its depression 
 or to irritate it. Mr. Cowper could not bear to 
 hear his humorous story of John Gilpin read to 
 him in his paroxysms of this disease. It was to 
 his " heavy heart," what Solomon happily com- 
 pares to the conflict produced by pouring vinegar 
 upon nitre, or in other words, upon an alkaline 
 salt. 
 
 Certain objects, distinguished for their beauty 
 or grandeur, often afford relief in this disease. 
 Mr. Cowper experienced a transient elevation of
 
 120 ON THE DISEASES 
 
 spirits, from contemplating the ocean from the 
 house of his friend, Mr. Haley ; and the unfortu- 
 nate Mrs. Robinson soothed the gloom of her 
 mind, by viewing the dashing of the waves of the 
 same sublime object, by the light of the moon at 
 Brighton. Certain animals suspend the anguish 
 of mind of this disease by their innocence, inge- 
 nuity, or sports. Mr. Cowper, sometimes, found 
 relief in playing with three tame hares, and in ob- 
 serving a number of leeches to rise and fall in a 
 glass with the changes in the weather. The poet 
 says,' 
 
 " Laugh and be wdl. Monkeys have been 
 Extreme good doctors for the spleen. 
 And kitten if the humour hit, 
 Has harlequin'd away the fit." 
 
 The famous Luther was cheered under his fits 
 of low spirits by listening to the prattle, and ob- 
 serving the sports and innocent countenances of 
 young children. The tone of their voices is proba- 
 bly a source of a part of the relief derived from 
 their company. Mr. Cowper was always exhila- 
 rated by conversing with Mr. Haley's son, only 
 because he was pleased with the soft arid musical 
 tones of his voice. 
 
 4. Music has often afforded great relief in this 
 disease. Luther, who was sorely afflicted with it,
 
 OF THE MIND. 121 
 
 has left the following testimony in its favour. 
 " Next to theology, I give the highest place to 
 music, for thereby all anger is forgotten; the 
 devil, also melancholy, and many tribulations and 
 evil thoughts are driven away." For the same 
 reason that tragedies afford more relief than 
 comedies, plaintive tunes are more useful than 
 such as are of a sprightly nature. I attended a 
 citizen of Philadelphia, occasionally, in paroxysms 
 of this disease, who informed me that he was 
 cured of one of them by hearing the Old Hundred 
 psalm tune sung in a country church. His dis- 
 ease, he said, instantly went off in a stream of 
 tears. Dr. Cardan always felt a suspension of 
 the anguish of his mind from the same cause; and 
 Mr. Cowper tells his friend, Mr. Haley, in one of 
 his letters, that he was " relieved as soon as his 
 troubles gushed from his eyes." The tears in 
 these cases acted by indirectly depleting from the 
 brain. 
 
 It is remarkable, that sprightly tunes are as 
 offensive as comic representations in this disease. 
 This was once exemplified by a Mr. Derberow, 
 formerly a patient in the Pennsylvania Hospital. 
 In a fit of low spirits, he heard the sound of a 
 lively tune from a flute in an adjoining room. He 
 suddenly rushed into it, snatched the flute from 
 
 16
 
 122 ON THE DISEASES 
 
 the gentleman's hands who was playing upon it, 
 and broke it in pieces upon his head. 
 
 5. Committing entertaining passages of prose 
 and verse to MEMORY, and copying manuscripts, 
 have been found useful in relieving hypochon- 
 driasm. They divert and translate attention and 
 action from the understanding to a sound part of 
 the mind. Reading aloud has nearly the same 
 effect. 
 
 6. Dr. Burton recommends, in the highest 
 terms, the reading of the BIBLE to hypochondriac 
 patients. He compares it to an apothecary's 
 shop, in which is contained remedies for every 
 disease of the body. I have frequently observed 
 the langour and depression of mind which occur 
 in the evening of life, to be much relieved by the 
 variety of incidents, and the sublime and com- 
 fortable passages, that are contained in that only 
 true history of the origin, nature, duties and future 
 destiny of man. A captain Woodward, of Boston, 
 who lately suffered all the hardships of shipwreck 
 on an inhospitable island in the East Indies, found 
 great comfort in revolving the history of Joseph 
 and his brethren in his mind. A captain Ingle- 
 field revived his spirits, and those of his crew, in 
 a similar situation, by telling them pleasant 
 stories.
 
 OF THE MIND. 123 
 
 The mind requires a succession of connected 
 events to divert it from itself, and this is the rea- 
 son why stories of all kinds, which require con- 
 stant attention to comprehend them, are so useful 
 in this disease. 
 
 Where there is no relish for the simple and 
 interesting stories contained in the Bible, the 
 reading of novels should be recommended to our 
 patients. They contain a series of supposed 
 events which arrest the attention, and cause the 
 mind to forget itself. It is because they so uni- 
 formly produce this effect that they are often re- 
 sorted to by old people even of elevated under- 
 standings, in order to divert themselves from the 
 depression of spirits which the death or treachery 
 of friends, bodily pain, and the dread of futurity, 
 create in their minds. 
 
 7. MENTIONING the NAME of a parent, relation, 
 or friend, from whom the patient has received 
 acts of kindness, protection or relief, in early life. 
 We fly from habit to those persons, when in dis- 
 tress in any part of our lives, who have succoured 
 us under the pains and distresses of childhood. 
 These persons are generally our parents. I once 
 assisted in performing the operation of lithotomy 
 upon a young gentleman in this city, whose only
 
 124 ON THE DISEASES 
 
 cry during the operation was, " O ! my father, my 
 father !" I have heard a woman utter the name 
 of her mother only, during the whole time of the 
 excision of a cancerous breast. I attended a 
 young gentleman in our Hospital, in the year 
 1803, in this disease, who had lived with a most 
 indulgent grandfather when a boy. In the lowest 
 stage of his depression, the mentioning the name 
 only, of his grandfather, revived him, and often 
 drew him into pleasant conversation. The same 
 advantages might probably be derived, from car- 
 rying a patient's memory and imagination back 
 to the innocent and delightful sports and studies 
 of early life. 
 
 8. MATRIMONY, if our patients are single. The 
 constant pursuits and wholesome cares of a 
 family generally prevent and cure 'such as are 
 transient and imaginary. 
 
 9. TERROR, by the concussion it gives to both 
 body and mind, has sometimes cured this disease. 
 A lady in New York, in whom it was induced by 
 the habitual use of opium, was cured by this 
 remedy, administered by the hand of her physi- 
 cian. In one of his visits to her, he took a large 
 snuff-box out of his pocket. She looked at it as 
 if she wished for a pinch of snuff. The physician
 
 OP THE MIND. >* 125 
 
 put it into her hands. Upon opening it, an artifi- 
 cial snake that had been coiled up in it, suddenly 
 leaped upon her shoulder. She was convulsed 
 with terror, and from that time left off the use of 
 opium, and rapidly recovered. She lived forty 
 years afterwards in good health, and finally died 
 about eighty years of age. 
 
 10. TRAVELING. Long journies should be pre- 
 ferred to short excursions from home. They re- 
 lieve the mind from a monotony of objects, and 
 awaken a constant succession of new ideas. 
 They moreover create a necessity for constant 
 bodily exertion, and they remove the patient from 
 the society of his friends, who, by being obliged 
 to listen to his complaints, add fuel to the disease. 
 
 The journies in those cases should be to a 
 warm climate, and the patient should be advised, 
 before he leaves home, to change every article of 
 his dress, even the furniture of his pockets, that 
 he may see nothing while abroad, that can revive 
 his disease by association. 
 
 In the history of this disease I remarked that 
 there is, in hypochondriacs, a disposition to inflict 
 pain upon their bodies by means of wounds, in 
 order to suspend anguish of mind. This should
 
 126 ON THE DISEASES 
 
 be prevented by removing all the instruments out 
 of their way that are usually employed for that 
 purpose. Sometimes this anguish of mind, I have 
 said, leads its miserable subjects to seek to put 
 an end to their existence with their own hands. 
 This should be prevented, not only by depriving 
 them of all the means of destroying themselves, 
 but by securing the windows and doors in which 
 they are confined, and never permitting them to 
 be alone; also by such other means as accident or 
 design have proved to be successful, and which 
 act upon the mind through the medium of the 
 body, and upon the body through the medium of 
 the mind. These are wine, blood-letting, an un- 
 expected sense of pain, compassion, a sudden 
 and violent exertion of the active power of the 
 body and mind, terror, a sense of shame, and, 
 lastly, infamy. I shall briefly mention instances 
 of the efficacy of each of them in preventing sui- 
 cide. 
 
 1. A gentleman afflicted with this disease went 
 with a loaded pistol into a tavern in London, with 
 a design to destroy himself. To conceal his in- 
 tention, he called for a small decanter of wine, 
 and, after locking the door of the room into which 
 he had been conducted, cocked his pistol, but 
 before he discharged its contents through his
 
 OP THE MIND. 127 
 
 head, determined to try the quality of his wine. 
 Perceiving it to be very good, he drank a second, 
 and then a third glass, after which he uncocked 
 his pistol, and finished the whole decanter. Find- 
 ing such a prompt remedy for his despair in this 
 cordial liquor, he continued to use it freely, and 
 was thereby cured. 
 
 2. In the year 1803, I visited a young gentle- 
 man in our Hospital, who became deranged from 
 remorse of conscience in consequence of killing a 
 friend in a duel. His only cry was, for a pistol, 
 that he might put an end to his life. I told him, 
 the firing of a pistol would disturb the patients in 
 the neighbouring cells, and that the wound made 
 by it would probably cover his cell with blood, 
 but that I could take away his life in a more easy 
 and delicate way, by bleeding him to death, from 
 a vein in his arm, and retaining his blood in a 
 large bowl. He consented at once to my propo- 
 sal. I then requested Dr. Hartshorn, the resident 
 physician and apothecary to the hospital, to tie 
 up his arm, and bleed him to death. The Doctor 
 instantly feigned a compliance with this request. 
 After losing nearly twenty ounces of blood, he 
 fainted, became calm, and slept soundly the en- 
 suing night. The next day when I visited him, 
 he was still unhappy; not from despair and a
 
 128 ON THE DISEASES 
 
 hatred of life, but from the dread of death; for he 
 now complained only, that several persons in the 
 hospital had conspired to kill him. By the conti- 
 nuance of depleting remedies, this error was re- 
 moved, and he was soon afterwards discharged 
 from the hospital. 
 
 It will naturally occur to the reader, that this 
 remedy, and the use of wine, should be regulated 
 by a strict attention to the state of the pulse. 
 
 3. A maniac in the Pennsylvania Hospital some 
 years ago, expressed a strong desire to drown 
 himself. Mr. Higgins, the present steward of the 
 hospital, seemed to favour this wish, and pre- 
 pared water for the purpose. The distressed 
 man stripped himself and eagerly jumped into it. 
 Mr. Higgins endeavoured to plunge his head un- 
 der the water, in order, he said, to hasten his 
 death. The maniac resisted, and declared he 
 would prefer being burnt to death. " You shall 
 be gratified," said Mr. Higgins, and instantly ap- 
 plied a lighted candle to his flesh. " Stop, stop," 
 said he, " I will not die now ;" and never after- 
 wards attempted to destroy himself, nor even ex- 
 pressed a wish for death. 
 
 It has been said that persons who make unsuc- 
 cessful attempts to destroy themselves, seldom
 
 OF THE MIND. ]29 
 
 repeat them. If this remark be true, I suspect it 
 is only in those cases in which the attempt, like 
 the one above mentioned, has been accompanied 
 with pain. 
 
 4. The famous actress, Mrs. Bellamy, in an 
 hour of despair, was restrained from suicide by 
 hearing the cry of distress from a child, near a 
 bridge from whence she was preparing to throw 
 herself into the river Thames. 
 
 5. Mr. Pinel mentions an instance of a gentle- 
 man who was kept from drowning himself in the 
 same river, by an attempt of two or three ruffians 
 to pick his pocket, and which he defeated by a 
 singular exertion of strength and courage. 
 
 6. Zacutus relates the history of a hypochon- 
 driac, who had made several unsuccessful at- 
 tempts to destroy himself by fire. His physician, 
 in order to cure him, wrapped him in a fresh 
 sheepskin, which he had previously wetted with 
 spirit of turpentine. He applied fire to his skin, 
 which instantly enveloped him in a blaze, that so 
 terrified him, that he never attempted afterwards 
 to put an end to his life. 
 
 7. Suicide was prevented in the virgins of Mi- 
 
 17
 
 130 ON THE DISEASES 
 
 letus, among whom it was common, from the in- 
 fluence of a new and false opinion in religion, by 
 exposing their naked bodies in a public part of 
 the city. 
 
 8. Dr. John Hunter tells us, in his account of 
 the diseases of Jamaica, that the negroes, when 
 they become deranged, sometimes destroy them- 
 selves by eating large quantities of earth. After 
 many fruitless attempts to put a stop to it, it was 
 finally prevented, by cutting off the heads of the 
 negroes who died in this manner, and exposing 
 them to view in a public part of the Island. 
 
 Sometimes patients, in this state of derange- 
 ment, destroy themselves by abstinence from food 
 and drinks. I have twice seen death induced in 
 this way in the Pennsylvania Hospital, and once 
 in a private patient. Persuasion and force were 
 alike ineffectual in prevailing upon them to take 
 nourishment. Perhaps some such means as the 
 following might be more effectual for that pur- 
 pose. 
 
 1. In the Memoirs of Count Maurepas, it is 
 related of the same prince of Bourbon who fan- 
 cied himself to be a plant, that he sometimes sup- 
 posed himself to be dead, at which time he re-
 
 OF THE MIND. 131 
 
 fused to take any food, for which he said he had 
 no further occasion. To cure this alarming de- 
 lusion, they contrived to disguise two persons, 
 who were introduced to him as his grandfather, 
 and Marshal Luxemburg, and who, after convers- 
 ing with him for some time about the shades that 
 inhabited the place of the dead, invited him to 
 dine with Marshal Turene. The prince followed 
 them into a cellar prepared for the purpose, 
 where he made a hearty meal, which immediate- 
 ly restored him to a belief that he was alive. A 
 similar case of a man being cured of a belief that 
 he was dead, by being prevailed upon to eat, is 
 related by Dr. Turner, in his Treatise upon the 
 Diseases of the Skin. 
 
 2. Mr. Pinel mentions an instance of a man 
 who determined to put an end to his life by ab- 
 stinence from food only, but who continued to 
 drink as usual. His attendants whithheld drinks 
 from him until he consented to take food with 
 them. The bodily pain of thirst, in this case, 
 predominated over the anguish of the mind, 
 which had disposed him to seek for death in this 
 mode of suicide. 
 
 3. Leaving food in a patient's cell, or room, 
 and carefully avoiding importuning him to eat.
 
 132 ON THE DISEASES 
 
 The constant sight of food will tend to excite his 
 appetite, and a consciousness that he possesses 
 his free agency may induce him to eat, when the 
 most powerful arguments for that purpose would 
 not have that effect. I have heard of a criminal 
 in Scotland who attempted to destroy himself by 
 famine, in whom it was completely prevented by 
 this practice. 
 
 It is a singular fact in the history of suicide, 
 that it has sometimes been hereditary in families. 
 There are two families in Pennsylvania, in which 
 three of their respective branches have perished 
 by their own hands, in the course of a few years. 
 Similar instances of this issue of family derange- 
 ment are to be met with in other countries. 
 
 In watching patients, so as to prevent their in- 
 juring, or destroying themselves, it is of impor- 
 tance to know that the paroxysm of despair that 
 prompts to both, often comes on suddenly, and is 
 sometimes preceded by unusual tranquillity of 
 mind, and even by high spirits.
 
 OF THE MIND. 133 
 
 CHAPTER IV. 
 
 Of dmenomania, or the second form of Partial Intel- 
 lectual Derangement. 
 
 THIS form of madness is a higher grade of hy- 
 pochondriasis, and often succeeds it. It differs 
 from it, 
 
 1. In the absence of dyspepsia, or in its cessa- 
 tion, in consequence of the increase of morbid 
 excitement in the brain, predominating over the 
 disease in the stomach. 
 
 2. In a difference, or change, of the patient's 
 opinions respecting his health, affairs and condi- 
 tion. Instead of supposing himself to be diseased, 
 he now denies that he has any disease ; and in- 
 stead of feeling, or complaining of misery, he is 
 now happy in the errors which accompany his 
 madness. 
 
 3. The errors in this form of derangement are 
 more deeply seated than in hypochondriasm. As
 
 134 ON THE DISEASES 
 
 a proof of this, we observe, when it arises from 
 love, the sight or possession of the object beloved 
 relieves or cures it in the latter disease, but it has 
 no effect in the former. I have seen it tried to 
 no purpose in a young gentleman in this city. 
 Dr. Nicholas Robinson mentions an instance, in 
 which even the marriage of a young woman to 
 the man whom she loved, was so far from curing 
 her, that she attempted to murder him imme- 
 diately afterwards. 
 
 Let it not be supposed that amenomania uni- 
 formly succeeds hypochondriasis. It often pre- 
 cedes it, and they both frequently blend their 
 symptoms together. They likewise alternate with 
 each other. There is, moreover, now and then, a 
 mixture of some of the symptoms of hysteria with 
 amenomania, as well as with hypochondriasis. 
 These successive changes and combinations of 
 those forms of disease are to be ascribed to irrita- 
 bility or inirritability being different in the sys- 
 tems in which they are seated, and, in some in- 
 stances, to their being different in different parts 
 of the same system. 
 
 Amenomania is a common form of partial in- 
 sanity. We see it in the enthusiastic votaries of 
 all the pursuits and arts of man. The alchymists,
 
 OP THE MIND. 135 
 
 the searchers after perpetual motion, the astrono- 
 mers, the metaphysicians, the politicians, the 
 knights-errant, and the travellers, have all in their 
 turns furnished cases of this form of derangement. 
 I once met with a striking instance of it, from 
 alchymical pursuits, in a gentleman, at the table 
 of Mr. Wolfe, in London. He related the issue of 
 several experiments, in which some of the base 
 metals had been converted into gold, and he de- 
 clared, further, his belief, that there was at that 
 time, a man living in India, whose life had been 
 prolonged above 600 years by an elixir that had 
 been discovered by an alchymist. Upon other 
 subjects he was rational and well informed. Dr. 
 Johnson has given a just picture of this disease in 
 the character of an astronomer in his Rasselas, 
 prince of Abyssinia. Several of the nations of 
 Europe have lately furnished instances of men 
 deranged, from a belief in the possibility of pro- 
 ducing perfection in human nature, and in civil 
 government, by means of what they absurdly 
 called the omnipotence of human reason. But 
 we see this disease of the mind most frequently in 
 the enthusiasts in religion, in whom it discovers 
 itself in a variety of ways ; particularly, 
 
 1. In a belief that they are the peculiar favour- 
 ites of heaven, and exclusively possessed of just
 
 136 ON THE DISEASES 
 
 opinions of the divine will, as revealed in the 
 Scriptures. 
 
 2. That they see and converse with angels, and 
 the departed spirits of their relations and friends. 
 
 3. That they are favoured with visions, and the 
 revelation of future events. And, 
 
 4. That they are exalted into beings of the 
 highest order. I have seen two instances of per- 
 sons, who believed themselves to be the Messiah, 
 and I have heard of each of the sacred names 
 and offices of the Father, Son, and Holy Ghost, 
 having been assumed at the same time by three 
 persons, under the influence of this partial form 
 of derangement, in a hospital in Mexico. 
 
 There was a time when persons thus deranged 
 were subjected to fines, imprisonment, the extir- 
 pation of their tongues, and even to death from 
 fire and the halter. To the influence of the science 
 of medicine we are indebted, for teaching that 
 these opinions are generally as devoid of impiety 
 as an epileptic fit; and for consigning, by that 
 humane discovery, the deluded subjects of them 
 to the cells of a hospital instead of a jail, and to 
 the hand of a physician, instead of the hands of
 
 OF THE MIND. 137 
 
 the last officer, of what has improperly been call- 
 ed, criminal justice. 
 
 In all these cases of partial derangement, the 
 understanding is not only sound upon subjects un- 
 connected with that which produced the disease, 
 but all the other faculties of the mind are unim- 
 paired; nor do we observe the subjects of it, as 
 in general madness, to be irritated, or unusually 
 excited, by conversing upon the single and origi- 
 nal subject of their disease. 
 
 It is remarkable that all the errors of amenoma- 
 nia are the reverse of those of tristimania, form- 
 erly mentioned, in elevating the patient above his 
 ordinary rank and condition of life. 
 
 The physical remedies for this form of partial 
 derangement are nearly the same as those which 
 have been recommended for tristimania, particu- 
 larly bleeding, purging, emetics, and low diet, in 
 an excited state of the blood-vessels, and, after 
 they are reduced, stimulating diet, drinks, and me- 
 dicines, and a change of company, pursuits, and 
 climate. The errors which predominate in the 
 mind should be soothed, diverted, or opposed by 
 reasoning or ridicule, according to their force. 
 There is one error, which is sometimes opposed 
 
 18
 
 1 38 ON THE DISEASES 
 
 by reasoning with success, and that is, a belief, 
 which patients in this pleasant state of derange- 
 ment now and then entertain, that they are favour- 
 ed with extraordinary revelations, and particularly 
 a knowledge of future events. In these cases 
 they should be told, that supernatural knowledge 
 of that kind has generally been revealed to two 
 or more persons at the same time, and that it 
 has always been accompanied with a power of 
 working miracles. Even the Saviour of the world 
 did not rest the credibility of his divine origin, and 
 the objects of his mission, upon his single testi- 
 mony in favour of himself, nor yet upon the 
 supreme and miraculous power he exercised over 
 spirit and matter; but condescended to receive 
 the testimony of his twelve apostles in favour of 
 the former, and compelled a belief in the latter, 
 by endowing them with a power, similar to his 
 own, over all the operations of nature. 
 
 Both tristimania and amenomania often con- 
 tinue for months and years, in the form in which 
 they have been described, but they are as often 
 followed by derangement in every part of the un- 
 derstanding, and in all, or a part of, the other 
 faculties of the mind. When this is the case, it 
 is called GENERAL MADNESS, which is the next sub- 
 ject of our inquiries and observations.
 
 OF THE MIND. 139 
 
 CHAPTER V. 
 
 Of General Intellectual Derangement. 
 
 I SHALL divide this general form of derange- 
 ment into three grades or states. 
 
 I. MANIA, by which I mean what has been 
 called tonic madness by some writers, and ma- 
 nia furibunda by Vanswieten. 
 
 II. MANICULA, or madness in a reduced, and 
 most commonly, in a chronic state. 
 
 III. MANALGIA, or that state of general mad- 
 ness, in which a universal torpor takes place in 
 the body and mind. 
 
 This division of gejieral madness into three 
 states, accords with similar divisions, which have 
 lately been adopted of several other diseases, par- 
 ticularly rheumatism, and inflammation of the
 
 140 ON THE DISEASES 
 
 liver. The former is known by the names of 
 rheumatismus, rheumaticula, and rhcumatalgia, 
 ana 1 the latter by the names of hepatitis, hepati- 
 cula, and hepitalgia. The propriety of thus con- 
 forming madness to the divisions of those two 
 diseases will appear when we consider the unity 
 of their proximate cause, and that they all depend 
 upon similar morbid actions in the blood-vessels. 
 Rheumatism and hepatitis, therefore, may be con- 
 sidered, if I may be allowed the illustration, as 
 madness in the joints, or liver; and madness, as 
 rheumatism, or hepatitis, in the brain. 
 
 I. I shall begin with the history and cure of 
 general madness of the first grade, or of what I 
 have called MANIA. Its premonitory signs are, 
 watchfulness, high or low spirits, great rapidity of 
 thought, and eccentricity in conversation and 
 conduct; sometimes pathetic expressions of hor- 
 ror, excited by the apprehension of approaching 
 madness; terrifying or distressing dreams; a 
 great irritability of temper ; jealousy ; instability 
 in all pursuits; unusual acts of extravagance, 
 manifested by the purchases of houses, and cer- 
 tain expensive and unnecessary articles of furni- 
 ture, and hostility to relations and friends. The 
 face is pale or flushed, the eyes are dull, or wild, 
 the appetite is increased, the bowels are costive,
 
 OF THE MIND. 141 
 
 and the patient complains sometimes of throb- 
 bing in the temples, vertigo, and headach. The 
 gentleman formerly mentioned, in whom madness 
 was excited by a number of small shot lodged in 
 his foot, when a school-boy was afflicted with 
 deafness. A sudden return of his hearing was 
 always a premonitory sign of an approaching 
 attack of derangement. 
 
 The remedies in this case should be, 
 
 1. The removal of all the remote and exciting 
 causes of the disease, and particularly to abstract 
 the patient from study and business, if they have 
 produced it, and to substitute in their room re- 
 laxation and amusements. Dr. Boerhaave once 
 passed several weeks without sleep, and disco- 
 vered other signs of approaching derangement. 
 He was cured by being torn from his books, and 
 allured into agreeable company. 
 
 2. Changing the subject of our patient's stu- 
 dies, when they are abstruse and difficult, to such 
 as are of a lighter nature. Rousseau often re- 
 moved, by this means, the premonitory symptoms 
 of madness. The celebrated Mr. M'Laurin, the 
 friend and cotemporary of Sir Isaac Newton, 
 made it a practice to relieve his mind, when de-
 
 142 ON THE DISEASES 
 
 bilitated by hard study, and thereby predisposed 
 to this disease, by reading novels and romances 
 and such was his knowledge of them, that the late 
 Dr. Gregory informed me he was often appealed 
 to for the character of every work of that kind 
 that appeared in the English language. 
 
 3. Low diet, and a few gentle doses of purging 
 physic, and, if the pulse be full or tense, the loss 
 of ten or twelve ounces of blood. By means of 
 these remedies, I have in many instances pre- 
 vented an attack of madness. 
 
 The symptoms of this state of derangement, 
 when completely formed, as they appear in the 
 body, are, a wild and ferocious countenance, en- 
 larged and rolling eyes, constant singing, whist- 
 ling or hallooing, imitation of the noises of dif- 
 ferent animals ; walking with a quick step, or 
 standing still, often with the hands and eyes ele- 
 vated towards the heavens ; wakefulness for whole 
 nights, weeks, months, and, according to Dr. 
 Morely's account of a boy at Naples, for years ; 
 great muscular strength, uncommon adroitness in 
 performing certain acts, and uncommon swiftness 
 in running. The nerves are insensible to cold, 
 heat, and to irritants of all kinds. 1 am aware 
 that insensibility to cold is denied by Mr. Halsam
 
 OF THE MIND. 143 
 
 to be a symptom of general madness. I admit 
 that it does not take place in one of its states, 
 that is, in manicula, but it is uniformly present, 
 as I shall prove by facts hereafter, in its highest 
 and lowest grades, in which states the system 
 resists not cold only, and heat, but all the usual 
 remote causes of fever from the insensible quali- 
 ties of the atmosphere. Sometimes the nerves 
 exhibit, in great mobility, several of the signs of 
 hysteria mixed with general madness. The chief 
 of these signs are laughing and weeping. They 
 occur oftener in women than men. 
 
 The skin is dry, cool, and sometimes covered 
 with profuse sweats. A coldness often affects 
 the feet only, for days and weeks, while the head, 
 and other parts of the body are preternaturally 
 warm, or of their natural temperature. 
 
 The senses of hearing and seeing are uncom- 
 monly acute. This is obvious, from their hearing 
 so distinctly low and distant sounds, and from 
 their prompt recollection of long unseen and for- 
 gotten faces, and of the resemblance of persons, 
 whom they have never seen before, to their 
 parents, or to some other of their ancestors.
 
 144 ON THE DISEASES 
 
 The tongue is generally moist, and frequently 
 has a whitish appearance, such as occurs in com- 
 mon fevers. There is sometimes a preternatural 
 secretion of saliva and mucus in the mouth and 
 throat, which is of a viscid nature, and discharged 
 with difficulty by spitting. From the constancy 
 of this symptom in some mad people, they ob- 
 tained the name of sputatorep, or spitters. There 
 is generally a stoppage of the secretion of mucus 
 in the nose. Dr. Moore found this to be the case 
 in two-thirds of all the maniacs in the Pennsylva- 
 nia Hospital, whom he examined at my request, 
 with a reference to this symptom. Where this 
 secretion was not suspended, he found the mucus 
 of the nose dry arid hard* 
 
 The appetite for food is great, or there is a 
 total want of it. The bowels are generally cos- 
 tive, and the stools white, small and hard. The 
 urine is scanty in quantity, and, for the most part, 
 of a high colour. 
 
 The pulse is synocha, intermitting, preternatu- 
 rally slow, frequent, quick, depressed, or mor- 
 bidly natural, exactly as we find it in other arte- 
 rial diseases of great morbid action. It is gene- 
 rally depressed, where the muscles are in a state 
 of violent excitement.
 
 OF THE MIND. 145 
 
 The symptoms of mania, as they appear in the 
 mind, vary with its causes. When it is induced 
 by impressions that have been made upon the 
 brain through the medium of the heart, all the 
 faculties of the mind discover marks of the dis- 
 ease in all their operations. In its highest grade, 
 it produces erroneous perception. In this state 
 of derangement, the patient mistakes the persons 
 and objects around him. This may arise either 
 from a disease in the external senses, in which 
 case it is called morbid sensation; or from a dis- 
 ease in the brain. It is when it arises from the 
 latter cause only, a symptom of the first or higher 
 grade of intellectual derangement. We have a 
 striking illustration of this diseased state of per- 
 ception in the character of Ajax, in the tragedy 
 of Sophocles. He becomes mad, in consequence 
 of Ulysses being preferred to him in the compe- 
 tition for the arms of Achilles. In one of his 
 paroxysms of madness, he runs into the fields, 
 and slays a number of shepherds and their cattle, 
 under a belief that they were Agamemnon, Me- 
 nalaus, and others, who had been the instruments 
 of his dishonour. Afterwards he brings a number 
 of cattle to his tent, and among them a large 
 ram, which he puts to death for his rival and 
 antagonist Ulysses. Persons under the influence 
 of this grade of madness, sometimes mistake 
 
 19
 
 146 ON THE DISEASES 
 
 their friends for strangers, and common visiters 
 for their relations and friends. They now and 
 then fancy they see good or bad spirits stand- 
 ing by their bed-sides, waiting to carry them to a 
 place of torment or happiness, according as 
 their moral dispositions and habits in health have 
 prepared them for those different abodes of 
 wicked or pious souls. Not only the eyes, but 
 the ears likewise, are the vehicles of false per- 
 ceptions, and to these we are to ascribe the 
 soliloquies we sometimes observe in mad people. 
 They fancy they are spoken to, and their conver- 
 sation frequently consists of replies only to certain 
 questions they suppose to be put to them. These 
 false perceptions are more common through the 
 ears than the eyes in mad people. The latter 
 occur constantly more or less in delirium, but we 
 occasionally see them in the highest grade of in- 
 tellectual madness. When these errors in per- 
 ception take place, madness has been called ideal 
 by Dr. Arnold, but, more happily, diseased percep- 
 tion by Dr. Creighton. It is in this state of mad- 
 ness only that it is proper to say, persons are 
 "out of their senses;" for the mind no longer 
 receives the true images of external objects from 
 them. 
 
 To account for these erroneous or diseased per-
 
 OP THE MIND. 147 
 
 ceptions, it will be necessary to remark, that the 
 correspondence of ideas and thoughts, with im- 
 pressions, depends upon the sameness of the im- 
 pressions, which produced the original ideas and 
 thoughts. Now this correspondence can take 
 place only when the brain is in a healthy state. 
 When it is diseased, impressions induce unrelated 
 ideas and thoughts, as in the case of Ajax just 
 now mentioned. It will be necessary to remark 
 further in this place, that no idea can be excited 
 in the mind, however erroneous it may be, from a 
 want of relation between impression and percep- 
 tion, that did not pre-exist in the mind. Ajax 
 could not have fancied a large ram to be Ulysses, 
 had not his image from a former impression of 
 his person upon his brain, pre-existed in his 
 mind; and it was because the part of his brain 
 which was stimulated by the image of the ram 
 did not emit a corresponding perception, but con- 
 veyed the motion excited by it to that part of the 
 brain in which the image of Ulysses had been 
 imprinted, that he saw him instead of a ram. 
 The nature of this error of perception may be 
 understood, by recollecting how often impressions 
 upon a sound part of the body produce sensation 
 and motion, in parts that are affected with a mor- 
 bid sensibility and irritability, that are remote
 
 148 ON THE DISEASES 
 
 from it. These errors, as applied to the body, 
 have lately received the names of error sensus, 
 and error motus. They occur in all the senses 
 as well as in the nerves, muscles and brain. 
 
 Where these erroneous perceptions do not take 
 place, the associations of a madman are often dis- 
 cordant, ludicrous, or offensive, and his judgment 
 and reason are perverted upon all subjects. He 
 sometimes attempts to injure himself or others. 
 Even inanimate objects, such as his clothing, bed, 
 chairs, tables, and the windows, doors, and walls 
 of his room, when confined, partake of his rage. 
 All sense of decency and modesty is suspended; 
 hence he besmears his face with his own excre- 
 tions, and exposes his whole body without a 
 covering. When he roams at large, or escapes 
 from a place of confinement, lonely woods, 
 marshes, caves, or graveyards* are his usual 
 places of resort, or retirement. What is called 
 consciousness is at this time destroyed in his 
 mind. He is ignorant of the place he occupies, 
 and of his rank and condition in society, of the 
 lapse of time, and even of his own personal 
 identity. Shakspeare has very happily described 
 a part of this state of mind, when he makes King 
 Lear utter the following words :
 
 OF THE MIND. 149 
 
 " I am mainly ignorant 
 
 What place this is ; and all the skill 1 have 
 Remembers not these garments, nor I know not 
 Where I did sleep last night." 
 
 This grade of derangement is generally of short 
 duration. It gradually leaves the memory, and 
 appears with less force in the passions and moral 
 faculties, but still occupies, in a greater or less 
 degree, every part of the understanding. 
 
 The sameness in the operations of nature, in 
 thus gradually contracting the seat and extent of 
 this disease to one faculty of the mind, and in 
 contracting the seat and extent of violent fevers 
 to the blood-vessels, was noticed in a former part 
 of these Inquiries. 
 
 In this reduced state of madness, the mind be- 
 comes more coherent, and perceives, and asso- 
 ciates correctly, but judges incorrectly, that is, 
 draws erroneous conclusions from false premises. 
 But there are cases in this reduced grade of de- 
 rangement in which the patient perceives justly, 
 associates naturally, judges correctly, but rea- 
 sons erroneously, that is, draws false conclusions 
 from just propositions. Sometimes he discovers 
 the reverse of this state of mind, by drawing just 
 conclusions from erroneous perceptions, associ-
 
 150 ON THE DISEASES 
 
 ations and judgments. Thus, when he fancies 
 himself to be a king, he errs in all the ways that 
 have been mentioned. But observe his conduct; 
 he covers himself with a blanket which he calls 
 a robe, he puts a mat upon his head which he 
 calls a crown, struts with a majestic step, and 
 demands the homage due to royalty from all 
 around him. In this respect he reasons justly 
 from false premises, and acts conformably to the 
 high opinion he entertains of his rank and power. 
 In a more advanced state of the disease, the hos- 
 tility of the patient is confined to his friends and 
 relations only, and this is frequently great in pro- 
 portion to the nearness of the connection, and 
 the extent of the obligations he owes to them. 
 Its intensity can not be conceived of by persons 
 who have observed that passion only in ordinary 
 life. I once advised a ride in a chair, for one of 
 my private patients in this state of mind, in the 
 Pennsylvania Hospital. Before he got into it, he 
 made the steward of the hospital, who was to 
 accompany him, declare, that no one of his family 
 had ever rode in it. But further, while the dis- 
 ease occupies the whole understanding, the pa- 
 tient discovers more derangement in talking upon 
 some subjects than others. These subjects are 
 sometimes of a pleasant, but oftener of a distress- 
 ing nature. The disease varies with each of
 
 OF THE MIND. 151 
 
 them by putting on the appearance of amenoma- 
 nia in the former and tristimania in the latter 
 case. It differs from them both in the errors 
 and prejudices that are entertained by the patient, 
 being accompanied with more corporeal and men- 
 tal excitement; in being less fixed to one object, 
 and in occupying every part of the understand- 
 ing. 
 
 From a part of the brain being preternaturally 
 elevated, but not diseased, the mind sometimes 
 discovers not only unusual strength and acuteness, 
 but certain talents it never exhibited before. The 
 records of the wit and cunning of madmen are 
 numerous in every country. Talents, for elo- 
 quence, poetry, music, and painting, and uncom- 
 mon ingenuity in several of the mechanical arts, 
 are often evolved in this state of madness. A 
 gentleman whom I attended in our hospital in the 
 year 1810, often delighted, as well as astonished, 
 the patients and officers of our hospital, by his 
 displays of oratory, in preaching from a table in 
 the hospital-yard every Sunday. A female patient 
 of mine, who became insane after parturition in 
 the year 1807, sang hymns and songs of her 
 own composition, during the latter stage of her 
 illness, with a tone of voice so soft and pleasant, 
 that 1 hung upon it with delight, every time I
 
 152 ON THE DISEASES 
 
 visited her. She had never discovered a talent 
 for poetry nor music in any previous part of her 
 life. Two instances of a talent for drawing, 
 evolved by madness, have occurred within my 
 knowledge: and where is the hospital for mad 
 people, in which elegant and completely rigged 
 ships, and curious pieces of machinery have not 
 been exhibited, by persons who never discovered 
 the least turn for a mechanical art previously to 
 their derangement. Sometimes we observe in 
 mad people an unexpected resuscitation of know- 
 ledge ; hence we hear them describe past events, 
 and speak in ancient or modern languages, or 
 repeat long and interesting passages from books, 
 none of which, we are sure, they were capable of 
 recollecting, in the natural and healthy state of 
 their minds. 
 
 The disease which thus evolves these new and 
 wonderful talents and operations of the mind, may 
 be compared to an earthquake, which, by con- 
 vulsing the upper strata of our globe, throws upon 
 its surface precious and splendid fossils, the ex- 
 istence of which was unknown to the proprietors 
 of the soil in which they were buried. 
 
 Sometimes the cause which induced derange- 
 ment is forgotten, and the subjects of the ravings,
 
 OF THE MIND. 153 
 
 as well as the conduct of patients, are contrary to 
 their usual habits ; but they both more frequently 
 accord with their natural tempers and disposi- 
 tions, and with the cause of their disease. 
 
 Are they naturally proud and ambitious ? They 
 imagine themselves to be kings or noblemen, and 
 demand homage and respect. Are they naturally 
 avaricious ? They fancy they possess incalculable 
 wealth. Are they ferocious and malicious ? They 
 assume the nature of wild beasts, and attempt to 
 injure their friends and keepers. Are they sen- 
 sual and slovenly in their dispositions and dress ? 
 They discover marks of both in their conversa- 
 tion and appearance. Are they pious and bene- 
 volent ? They are inoffensive in their deportment, 
 and spend much time in devotional exercises. 
 But the conduct and language of madmen are 
 much influenced by the specific cause that in- 
 duces it. Does it arise from reciprocal love, 
 opposed in the object of mutual wishes by inte- 
 rested friends ? It vents itself in sighs and songs, 
 or sonnets and love letters. Is madness induced 
 by perfidy in a lover? It discovers itself in all the 
 usual marks of resentment, rage, and, when prac- 
 ticable, of revenge. Ariosto has with great ele- 
 gance and correctness described these marks in 
 the conduct of Orlando, when deserted by his be- 
 
 20
 
 154 ON THE DISEASES 
 
 loved Angelica. He lies down upon a bed in 
 order to rest a few minutes, but the moment he 
 recollects that Angelica once slept upon that bed, 
 he instantly starts from it, tears up the tree by the 
 roots upon which she had cut her name, and 
 finally dries up the water in which she had been 
 accustomed to view her face. 
 
 Has the disease been induced by a conflict be- 
 tween the moral faculty, and the sexual appetite, 
 or by the undue gratification of it ? The habitual 
 and morbid impurity of the mind discovers itself 
 in corresponding conversations and actions. Se- 
 veral cases of this kind in both sexes, have occur- 
 red in our hospital. 
 
 But, further, is madness induced by the ingra- 
 titude or treachery of friends, or by the unjust 
 calumnies of the world ? The conversation and 
 conduct of the patient indicate a coldness or hos- 
 tility to the whole human race. In this state of 
 mind, the walls of a cell, and even darkness, are 
 welcomed, to protect the miserable sufferer from 
 the sight of the supposed monster man. 
 
 Mr. Merry has very forcibly described the feel- 
 ings of a person deranged from this cause, in the 
 following lines :
 
 OP THE MIND. 155 
 
 " By sharp sensation wounded to the soul, 
 He ponders on the world ; abhors the whole. 
 In the dire working of his wakeful dreams, 
 The human race, a race of demons seems. 
 All is unjust, discordant and severe ; 
 He asks not mercy's smile, nor pity's tear." 
 
 Is it induced by misfortunes in business, and by 
 the rapacity and cruelty of creditors? He sees a 
 sheriff, or one of his deputies, in every person that 
 opens his door, and talks of nothing but the hor- 
 rors of a jail. Mr. Merry has described this state 
 of mind likewise, with great correctness in the 
 following lines. 
 
 " But most to him shall memory prove a curse, 
 Who meets capricious fortune's sad reverse. 
 Who once, in wealth, indulged each gay desire, 
 While to possess, was only to require. 
 Who scattered bounty with a liberal hand. 
 And rov'd, at will, through pleasure's flow'ry land ; 
 By ruin cast amongst the lowly crew, 
 What doleful visions pass before his view ! 
 His taste, his worth, his wisdom disappear, 
 His virtues, too, none notice, none revere, 
 Cold is the summer friend, who lived to trace 
 His playful fancy's ever varying grace. 
 Even nature's self a different aspect wears, 
 Dimm'd by the mists of slow consuming cares, 
 Glows not a flower, nor pants a vernal breeze, 
 As in his hours of affluence and ease. 
 While every luxury that the world displays, 
 Wounds him afresh, and tells of better days."
 
 156 ON THE DISEASES 
 
 Is madness induced by remorse for real and 
 imaginary crimes? The wretched sufferer fan- 
 cies his bed-room a dungeon, and his physician 
 an executioner ; or he cries out to be delivered 
 from infernal spirits, which he supposes to be 
 waiting around his bed, to carry his soul to a 
 place of torment. 
 
 It is induced by false and gloomy opinions of 
 the attributes of the Deity, and a belief of being 
 destined to endless misery? His apartment be- 
 comes vocal day and night with the groans and 
 sighs, and the excruciating language of despair. 
 
 It is brought on by a belief in his being a pecu- 
 liar favourite of heaven, and destined to fulfil 
 some of its high and benevolent decrees? His 
 mind overflows with enthusiastic joy, and he 
 stands aloof from an intercourse, and even from 
 the contact of mortals. Two instances of this 
 kind have come under my knowledge in this city. 
 
 Has the sudden and unexpected acquisition of 
 great wealth perverted the natural operations of 
 the mind ? The maniac from this cause is elevated, 
 cheerful, sings and laughs from morning till night. 
 I have seen one instance of this state of madness 
 in our hospital, from the cause I have mentioned.
 
 OP THE MIND. 157 
 
 It is from such cases of madness, that it has been 
 said to be attended with pleasure. Horace's 
 madman complained of his physician, for restor- 
 ing him to his former humble grade of life, by 
 curing him, and Dr. Thomas Willis mentions an 
 instance of a man, who was so happy in his pa- 
 roxysms of madness, that when he was well he 
 longed with impatience for their return ; but such 
 instances of happiness in madness are very rare. 
 It is more frequently, I shall say hereafter, accom- 
 panied with misery or a total insensibility to it. 
 
 The nature of a paroxysm of madness is much 
 diversified, by its affecting the moral faculties, or 
 leaving them in a sound state. Shakspeare has 
 happily illustrated the encroachment of intellec- 
 tual madness upon the moral faculty, and the 
 sudden recovery of its correct state, in the follow- 
 ing lines, which he makes his man, King Lear, to 
 utter upon being called upon to punish one of his 
 subjects for adultery. 
 
 " Thou shalt not die die for adultery! 
 No ! to it luxury pell mell 
 For I want soldiers." 
 
 And then, as if suddenly penetrated with a sense 
 of the indecency of what he had said, he adds,
 
 158 ON THE DISEASES 
 
 Fie ! Fie ! Fie ! Pah ! 
 
 Give me an ounce of civet, good apothecary, 
 To sweeten my imagination." 
 
 The reader will excuse my frequent recurrences 
 to the poets for facts to illustrate the history of 
 madness. They view the human mind in all its 
 operations, whether natural or morbid, with a 
 microscopic eye, and hence many things arrest 
 their attention, which escape the notice of phy- 
 sicians. 
 
 To the history that has been given of the cor- 
 respondence between the ravings and conduct of 
 mad people, and their natural tempers and dispo- 
 sitions, there are several exceptions. These are, 
 all those cases in which persons of exemplary 
 piety and purity of character, utter profane, or 
 impious, or indelicate language, and behave in 
 other respects contrary to their moral habits. 
 The apparent vices of such deranged people may 
 be compared to the offensive substances that are 
 sometimes thrown upon the surface of the globe 
 by an earthquake, mixed with the splendid fos- 
 sils formerly mentioned, which substances had 
 no existence in nature, but were formed by a 
 new arrangement in the particles of matter in
 
 OF THE MIND. 159 
 
 consequence of the violent commotions in the 
 bowels of the earth. 
 
 Not only the ravings of mad people, for the 
 most part, accord with their habitual tempers and 
 dispositions, and the causes of their disease, but 
 their conduct corresponds in like manner with 
 their habitual occupations. The lawyer, the 
 physician, and the minister of the gospel, fre- 
 quently employ themselves in the exercises of 
 their several professions. The merchant spends 
 much of his time in making out invoices, and in 
 writing letters, the politician devours a daily news- 
 paper; the poet writes verses; and the painter 
 draws pictures upon the walls of their respective 
 cells; the mechanic cuts out houses, ships, car- 
 riages, and bridges, from pieces of sticks, with 
 his penknife; the sailor heaves his log or his 
 line; and the soldier goes through his manual 
 exercise with a cane, and never fails to salute his 
 visiters by lifting the back of his hand to the side 
 of his head. 
 
 These habitual actions seldom take place until 
 the disease has subsided, in a considerable de- 
 gree, in the temper and passions. 
 
 After the detail of the symptoms of general 
 madness that has been given, I feel disposed to
 
 160 ON THE DISEASES 
 
 look back for a few minutes, and contemplate, 
 with painful and melancholy wonder, the immense 
 changes in the human mind, that are induced by 
 a little alteration in the circulation of the blood 
 in the brain. What great effects are produced in 
 this instance by little causes ! How slender the 
 tenure by which we hold our intellectual and 
 moral existence ! and how humiliating our situa- 
 tion from its loss ! Well might the eloquent Mr. 
 Cowper, from this view of the mind of man, con- 
 sider it as 
 
 " A harp, whose chords elude the sight, 
 
 Each yielding harmony, dispos'd aright. 
 
 The screws revers'd ! (A task, which, if he please, 
 
 God in a moment executes with ease) 
 
 Ten thousand times ten thousand strings go loose ; 
 
 Lost, till he tune them, all their power and use." 
 
 There is a considerable variety in the forms of 
 general madness. It appears, 
 
 I. In a single, acute and violent paroxysm, such 
 as has been described, which continues for days, 
 weeks, and sometimes months, and ends in death, 
 a remission, or a perfect and durable recovery. 
 In one of the cases of a protracted paroxysm of 
 madness which came ander my notice, the dis- 
 ease continued from June 1810 until April 1811,
 
 OF THE MIND. 161 
 
 with scarcely any abatement in the excitement of 
 the body and mind, notwithstanding the patient 
 was constantly under the operation of depleting 
 remedies. I have seen another case, in which 
 the same remedies were insufficient to produce 
 an interruption of five minutes of speech or voci- 
 ferations, except during a few short intervals of 
 sleep, for two months. 
 
 II. General madness appears in a chronic, but 
 more moderate form, without paroxysms. 
 
 HI. It appears with paroxysms, with chronic, 
 but moderate, derangement in its intervals. In 
 these intervals, the patient sometimes recovers 
 so far as to discover derangement upon one sub- 
 ject only. In these cases a return of general 
 madness is easily excited at any time, by touching 
 upon the subject of his partial insanity in con- 
 versing with him. Thus the touch of one of the 
 chords of a musical instrument causes all its 
 chords to vibrate with it. In this, 1 remarked 
 formerly, general madness differs from the two 
 forms of partial madness which have been de- 
 scribed. 
 
 IV. It appears in paroxysms, with the restora- 
 tion of reason in their intervals. These parox- 
 
 21
 
 162 ON THE DISEASES 
 
 ysms occur annually, or at longer intervals, twice 
 a year, particularly during the equinoxes, monthly, 
 weekly, and according to Lazoni, an Italian phy- 
 sician, every day. Perhaps this diurnal attack of 
 madness was what has lately been called the ma- 
 niacal state of fever. 
 
 * 
 
 Successive paroxysms of madness, with perfect 
 intervals between them, occur most frequently in 
 habitual drunkards; and they would probably oc- 
 cur much oftener, were they not prevented by a 
 vicarious affection of the stomach, known by 
 puking, redness of the eyes, an active pulse, and a 
 peculiar and specific fcetor of the breath. From 
 the correspondence of several of the actions 
 which take place in this disease of the stomach, 
 with those which take placejn the brain in mad- 
 ness, and from the sameness of the ordinary dura- 
 tion of a paroxysm of each of them, I have called 
 the former, derangement in the stomach. 
 
 The longer the intervals between the paroxysms 
 of madness, the more complete is the restoration 
 of reason. Remissions, rather than intermissions 
 take place when the intervals are of short dura- 
 tion, and these distinguish it from febrile delirium, 
 in which intermissions more generally occur. In 
 many cases, every thing is remembered that passes 
 under the notice of the patient during a paroxysm
 
 OP THE MIND. 1G3 
 
 of general madness, but in those cases in which 
 the memory is diseased, as well as the understand- 
 ing, nothing is recollected. I attended a lady, in 
 the month of October 1802, who had crossed the 
 Atlantic ocean during a paroxysm of derange- 
 ment, without recollecting a single circumstance 
 of her voyage, any more than if she had passed 
 the whole time in sleep. Sometimes every thing 
 is forgotten in the interval of a paroxysm, but 
 recollected in a succeeding paroxysm. I once 
 attended the daughter of a British officer, who had 
 been educated in the habits of gay life, who was 
 married to a methodist minister. In her parox- 
 ysms of madness she resumed her gay habits, 
 spoke French, and ridiculed the tenets and prac- 
 tices of the sect to which she belonged. In the 
 intervals of her fits she renounced her gay habits, 
 became zealously devoted to the religious princi- 
 ples and ceremonies of the Methodists, and forgot 
 every thing she did and said during the fits of her 
 insanity. A deranged sailor, some years ago in 
 the Pennsylvania Hospital, fancied himself to be 
 an admiral, and walked and commanded with all 
 the dignity and authority that are connected with 
 that high rank in the navy. He was cured and 
 discharged ; his disease some time afterwards 
 returned, and with it all the actions of an admiral 
 which he assumed and imitated in his former
 
 164 ON THE DISEASES 
 
 paroxysm. It is remarkable, some persons when 
 deranged talk rationally, but act irrationally, .while 
 others act rationally and talk irrationally. We 
 had a sailor some years ago in our hospital, who 
 spent a whole year in building and rigging a small 
 ship in his cell. Every part of it was formed by 
 a mind apparently in a sound state. During the 
 whole of the year in which he was employed in 
 this work, he spoke not a word. In bringing his 
 ship out of his cell, a part of it was broken. He 
 immediately spoke, and became violently de- 
 ranged soon afterwards. Again, some madmen 
 talk rationally, and write irrationally; but it is 
 more common for them to utter a few connected 
 sentences in conversation, but not to be able to 
 connect two correct sentences together in a let- 
 ter. Of this I have known many instances in our 
 hospital. 
 
 V. Mania is sometimes combined with phreni- 
 tis. The brain, in this case, is in the same state 
 as the lungs, when an acute pneumony blends it- 
 self with a pulmonary consumption. Excitement 
 in both cases is abstracted from the muscles, so 
 that the patients are usually confined to their 
 beds. The tongue is more furred, and the skin 
 much warmer, in this mixture of mania and phre- 
 nitis, than in madness alone. It occurs most fre-
 
 OP THE MIND. 165 
 
 quently after parturition. I have taken the liberty 
 of caljing it Phrenimania. 
 
 VI. Mania is sometimes combined with the 
 burning, sweating, cold, chilly intermitting, and 
 even hydrophobic states of fever. Instances of 
 them were mentioned in treating upon the seat 
 and proximate cause of madness. A case of its 
 union with hydrophobia occurred in a lady under 
 my care in the month of February 1812. She 
 attempted several times to bite her attendants, 
 and was greatly agitated when the word " water" 
 was mentioned in her room. As the pulse in this 
 mixture of mania and common fever is generally 
 synochus, I have called it Syfiocomania. . 
 
 In all the forms and combinations of madness 
 that have been described, the duration of the dis- 
 ease, after it is completely formed, seems to be as 
 much fixed by nature as the duration of an au- 
 tumnal fever. It may be weakened, and life may 
 be preserved during its continuance, but, unless it 
 be overcome in its first stage, it generally runs its 
 course, in spite of all the power of medicine. 
 
 VII. There is a form of mania which is seldom 
 the object of medical attention, either in hospitals,
 
 166 ON THE DISEASES 
 
 or in private practice, but which is well known, 
 not only to physicians, but to persons of common 
 observation in every part of the world. Dr. Cox 
 has described it very happily and correctly in the 
 following words. 
 
 " Among the varieties of maniacs met with in 
 medical practice, there is one, which, though by 
 no means rare, has been little noticed by writers 
 on this subject : I refer to those cases, in which 
 the individuals perform most of the common du- 
 ties of life with propriety, and some of them, in- 
 deed, with scrupulous exactness, who exhibit no 
 strongly marked features of either temperament, 
 no traits of superior or defective mental endow- 
 ment, but yet take violent antipathies, harbour 
 unjust suspicions, indulge strong propensities, 
 affect singularity in dress, gait, and phraseology ; 
 are proud, conceited, and ostentatious ; easily 
 excited, and with difficulty appeased ; dead to 
 sensibility, delicacy, and refinement ; obstinately 
 riveted to the most absurd opinions ; prone to 
 controversy, and yet incapable of reasoning; 
 always the hero of their own tale, using hyper- 
 bolic highflown language to express the most 
 simple ideas, accompanied by unnatural gesticu- 
 lation, inordinate action, and frequently by the
 
 OP THE MIND. 167 
 
 most alarming expression of countenance. On 
 some occasions they suspect similar intentions on 
 the most trivial grounds, on others are a prey to 
 fear and dread from the most ridiculous and im- 
 aginary sources ; now embracing every opportu- 
 nity of exhibiting romantic courage and feats of 
 hardidood, then indulging themselves in all man- 
 ner of excesses. 
 
 "Persons of this description, to the casual ob- 
 server, might appear actuated by a bad heart, but 
 the experienced physician knows it is the head 
 which is defective. They seem as if constantly 
 affected by a greater or less degree of stimulation 
 from intoxicating liquors, while the expression of 
 countenance furnishes an infallible proof of men- 
 tal disease. If subjected to moral restraint, or a 
 medical regimen, they yield with reluctance to 
 the m-eans proposed, and generally refuse and 
 resist, on the ground that such means are unne- 
 cessary where no disease exists ; and when, by the 
 system adopted, they are so far recovered, as to 
 be enabled to suppress the exhibition of the 
 former peculiarities, and are again fit to be 
 restored to society, the physician, and those 
 friends who put them under the physician's care, 
 are, generally, ever after objects of enmity and 
 frequently of revenge."
 
 168 ON THE DISEASES 
 
 VIII. There is a form of madness which is 
 altogether internal, and of which I have met with 
 several instances. It consists in the same kind 
 of alienation of mind that takes place in common 
 madness, but which is subject to the command 
 of the will ; persons affected with it feel all the 
 distraction of thoughts and anguish of madness 
 when alone, and sometimes in company, when 
 they are silent, or inattentive to conversation, but 
 without discovering any of its signs in their 
 countenances or behavour. It resembles, in this 
 respect, that feeble grade of the delirium of a 
 fever, which is chased away by the visit of a phy- 
 sician, or by speaking to the patient upon any inte- 
 resting subject. I have suspected the cases of 
 suicide, which sometimes occur in persons appa- 
 rently in a sound state of mind, are occasioned by 
 this form of madness. They may be compared, 
 in this situation, to patients in the walking state 
 of the yellow fever, in whom all the sympathies of 
 the body are destroyed, in consequence of which 
 its external parts appear sound and healthy, while 
 the stomach, and other vital parts are perishing 
 by disease. I have called this internal form of 
 madness mania larvata. 
 
 There has been a diversity of opinions respect- 
 ing the influence of the moon inducing, or in-
 
 OF THE MIND. 169 
 
 creasing, paroxysms of madness, after it has 
 taken possession of the system. The late Dr. 
 James Hutchinson, who spent several years in the 
 Pennsylvania Hospital as its resident physician 
 and apothecary, assured me, that he had never 
 seen the least change in the disease of the ma- 
 niacs from the state of the moon. Mr. Halsam 
 tells us, that in two years close attention to the 
 state of the maniacs in Bethlehem Hospital, in 
 London, he had never seen their disease increase 
 at the lunar periods. To these facts is opposed 
 the testimony of ages, in all countries. There is, 
 I believe, an equal portion of truth on the side of 
 both these opinions. In order to reconcile them, 
 it will be proper to remark, 1st, that in certain 
 diseases and in certain debilitated states of the 
 system, the body acquires a kind of sixth sense, 
 that is, a perception of heat and cold, of moisture 
 and dryness, of the density and rarity of the air, 
 and of light and darkness, of which it is insensible 
 in a healthy state. 2, The moon, when full, in- 
 creases the rarity of the air and the quantity of 
 light, each of which, I believe, acts upon sick 
 people in various diseases, and, among others, in 
 madness. A predisposition to the action of such 
 feeble causes is required in all cases. From the 
 conversion of excitability into excitement in 
 mania, and from its absence in manalgia, it is 
 
 *& J 
 
 22
 
 170 ON THE DISEASES 
 
 easy to conceive, in both those states of derange- 
 ment, the system will be insensible to the influ- 
 ence of the moon. Now when we consider that 
 a great majority of the patients in most hospitals 
 are in one of those states of madness, it is easy to 
 account for their exhibiting no marks of lunar in- 
 fluence, according to the observations of Dr. 
 Hutchinson and Mr. Halsam. In the year 1807, 
 I requested Mr. Thornton, then one of the apothe- 
 caries of the hospital, to attend particularly to 
 the influence of the morning light upon all the 
 maniacal patients that were at the time confined 
 in it. He informed me, that many of them be- 
 came noisy as soon as the day began to break, 
 and that, with the exception of two or three re- 
 cent cases, they all became silent and quiet after 
 night. During the eclipse of the sun on the 16th 
 of June, 1806, there was a sudden and total 
 silence in all the cells of the hospital. 
 
 The inference from these facts is, that the 
 cases are few in which mad people feel the influ- 
 ence of the moon, and that when they do, it is 
 derived chiefly from an increase of its light. It 
 is possible the absence of its light may be attend- 
 ed with equal commotions in the system of pa- 
 tients who are afflicted with that form of derange- 
 ment which I have called tristimania.
 
 
 OP THE MIND. 171 
 
 It is possible, further, that in the few cases in 
 which the light of the moon or the rarity of the 
 air, is felt by deranged persons in a hospital, that 
 their noise, by keeping a number of patients in 
 neighbouring cells awake, and in a state of in- 
 quietude from the want of sleep, may have con- 
 tributed to establish that general belief in the 
 influence of the moon upon madness, which has 
 so long obtained among physicians.
 
 172 ON THE DISEASES 
 
 CHAPTER VII. 
 
 Of the Remedies of Mania. 
 
 BEFORE we proceed to mention the remedies 
 for mania, or the highest grade of general mad- 
 ness, it will be necessary to mention the means 
 of establishing a complete government over pa- 
 tients afflicted with it, and thus, by securing their 
 obedience, respect, and affections, to enable a 
 physician to apply his remedies with ease, cer- 
 tainty and success. 
 
 The first thing to be done, to accomplish these 
 purposes, is to remove the patient from his family, 
 and from the society of persons whom he has 
 been accustomed to command, to a place where 
 he will be prevented from injuring himself and 
 others. If there be objections to removing him 
 to a public or private mad-house, or if this be im- 
 practicable, the patient should be confined in a 
 chamber, in which he has not been accustomed
 
 OP THE MIND. 173 
 
 to sleep, and a stranger or strangers should be 
 employed exclusively to attend him. The effect 
 of thus depriving a madman of his liberty, has 
 sometimes been of the most salutary nature, by 
 suddenly creating a new current of ideas, as well 
 as by the depression it produces in his mind. 
 
 1. This preliminary measure being taken, the 
 first object of a physician, when he enters the cell 
 or chamber of his deranged patient, should be, to 
 catch his EYE, and look him out of countenance. 
 The dread of the eye was early imposed upon 
 every beast of the field. The tiger, the mad bull, 
 and the enraged dog, all fly from it; now a man 
 deprived of his reason, partakes so much of the 
 nature of those animals, that he is for the most 
 part easily terrified, or composed, by the eye of a 
 man who possesses his reason. I know this do- 
 minion of the eye over mad people, is denied by 
 Mr. Halsam, from his supposing that it consists 
 simply in imparting to the eye a stern or ferocious 
 look. This may sometimes be necessary ; but a 
 much greater effect is produced, by looking the 
 patient out of countenance with a mild and stea- 
 dy eye, and varying its aspect from the highest 
 degree of sternness, down to the mildest degree 
 of benignity; for there are keys in the eye, if I 
 may be allowed the expression, which should be
 
 174 ON THE DISEASES 
 
 suited to the state of the patient's mind, with the 
 same exactness that musical tones should be suit- 
 ed to the depression of spirits in hypochondriasis. 
 Mr. Halsam again asks, " Where is the man 
 that would trust himself alone with a madman, 
 with no other means of subduing him than by his 
 eye?" This may be, and yet the efficacy of the 
 eye as a calming remedy not be called in ques- 
 tion. It is but one of several other remedies that 
 are proper to tranquilize him, and when used 
 alone, may not be sufficient for that purpose. 
 Who will deny the efficacy of bleeding for the 
 cure of madness? and yet who would rely upon it 
 exclusively, without the aid of other remedies? 
 In favour of the power of the eye, in conjunction 
 with other means in composing mad people, I 
 1 can speak from the experience of many years. 
 It has been witnessed by several hundred students 
 of medicine in our hospital, and once by several 
 of the managers of the hospital, in the case of a 
 man recently brought into their room, and whose 
 conduct for a considerable time resisted its effi- 
 cacy. 
 
 2. A second means of securing the obedience 
 of a deranged patient to a physician, should be 
 by his VOICE. Milton calls the human face " di- 
 vine." It would be more proper to apply that
 
 OP THE MIND. 175 
 
 epithet to the human voice, from its wonderful 
 effects upon the mind of man, whether employed 
 in simple tones, in music, or in speech. Even 
 brutes feel and obey it. In governing mad peo- 
 ple, it should be harsh, gentle, or plaintive, ac- 
 cording to circumstances. I have observed, with 
 great pleasure, the most beneficial effects pro- 
 duced by it in all those ways. A patient in the 
 Pennsylvania Hospital, who called his physician 
 his father, once lifted his hand to strike him. 
 " What!" said his physician, with a plaintive tone 
 of voice, " strike your father !" The madman 
 dropped his arm, and instantly showed marks of 
 contrition for his conduct. 
 
 In Java, madness of a furious kind is often 
 brought on by the intemperate use of opium. 
 The poor, when affected with it, are put to death; 
 but the rich, who are able to purchase the ser- 
 vices of female nurses, generally recover. May 
 not their recovery be ascribed, in part, to their 
 ears being constantly exposed to the gentleness 
 and softness of a female voice ? 
 
 3. The COUNTENANCE of a physician should 
 assist his eye and voice in governing his de- 
 ranged patients. It should be accommodated to 
 the state of the patient's mind and conduct. There
 
 176 ON THE DISEASES 
 
 is something like contagion in the different as- 
 pects of the human face, and madmen feel it in 
 common with other people. A grave counten- 
 ance in a physician has often checked the frothy 
 levity of a deranged patient in an instant, and a 
 placid one has as suddenly chased away his 
 gloom. A stern countenance in like manner has 
 often put a stop to garrulity, and a cheerful one 
 has extorted smiles even from the face of melan- 
 choly itself. 
 
 4. The CONDUCT of a physician to his patients 
 should be uniformly dignified, if he wishes to ac- 
 quire their obedience and respect. He should 
 never descend to levity in conversing with them. 
 He should hear with silence their rude or witty 
 answers to his questions, and upon no account 
 ever laugh at them, or with them. 
 
 5. ACTS of justice, and a strict regard to truth, 
 tend to secure the respect and obedience of de- 
 ranged patients to their physician. Every thing 
 necessary for their comfort should be provided 
 for them, and every promise made to them should 
 be faithfully and punctually performed. I once 
 lost the confidence of a maniac, by simply failing 
 to enlarge him on an appointed day, in conse- 
 quence of an unexpected revival of some of the 
 symptoms of his disease.
 
 
 OF THE MIND. 177 
 
 6, A physician should treat his deranged pa- 
 tients with respect, and with all the ceremonies 
 which are due to their former rank and habits of 
 living. Carpets upon the floors of their rooms or 
 cells, curtains to their beds, taste in the prepara- 
 tion and manner of serving their' meals, will all 
 serve to prevent distress and irritation, from a 
 supposed change in their condition in life. I 
 have known a deranged gentleman complain of 
 being addressed without the title of Mr.; and I 
 have seen several others turn with an indignant 
 look from their food, when served to them upon 
 a table not covered with a cloth, or in vessels 
 they had not been accustomed to in their own 
 families. With this habitual attachment to forms 
 in behaviour, and taste in living, there is in this 
 class of patients a similar respect for former 
 habits of society, for which reason they should 
 always eat, sit, and partake of amusements, by 
 themselves. The great advantage which private 
 madhouses have over public hospitals, is derived 
 chiefly from their conforming to this principle in 
 human nature; which the highest grade of mad- 
 
 o o 
 
 ness is seldom able to eradicate. 
 
 7. And lastly. A physician acquires the obe- 
 dience and affections of his deranged patients by 
 ACTS of KINDNESS. For this purpose, all his di- 
 
 23
 
 178 ON THE DISEASES 
 
 rections for discontinuing painful or disagreeable 
 remedies, and all his pleasant prescriptions, 
 should be delivered in the presence of his pa- 
 tients ; while such as are of an unpleasant nature, 
 should be delivered only to their keepers. Small 
 presents of fruit or sweet-cake, will have a happy 
 effect in attaching maniacal patients to their phy- 
 sicians, for it is a fact, that in proportion to the 
 intensity of misery, the subjects of it feel most 
 sensibly the smallest diminution of it. Perhaps 
 the recovery of the madmen in Java, just now 
 mentioned, may be ascribed, further, to their being 
 nursed by women, in whom kindness to the sick 
 and distressed is so universal, that it forms an es- 
 sential and predominating feature in the female 
 character. 
 
 As an inducement to treat mad people in the 
 manner that has been recommended, I shall only 
 add, that in those cases in which the memory has 
 been greatly impaired, they seldom forget three 
 things after their recovery, viz. acts of cruelty, 
 acts of indignity, and acts of kindness. 1 have 
 known instances in which the two former have 
 been recollected by them with painful, and the : t 
 last with pleasant associations for many years. 
 
 In gratitude for kindness and favours shown to 
 them, they exceed all other classes of patients
 
 OF THE MIND. 179 
 
 after their recovery. A physician once asked a 
 young woman of the society of Friends, whom he 
 had assisted in curing in the Pennsylvania Hos- 
 pital, if she had forgiven him for compelling her 
 to submit to the remedies that had been employed 
 for that purpose. " Forgive thee !" said she, 
 " why I love the very ground thou walkest on." 
 
 If all the means that have been mentioned 
 should prove ineffectual to establish a govern- 
 ment over deranged patients, recourse should be 
 had to certain modes of coercion. These will 
 sometimes be necessary in order to prevent their 
 destroying their clothes and the furniture of their 
 cells, as well as to punish outrages upon their 
 keepers and upon each other. The following 
 means will generally be found sufficient for these 
 purposes. 
 
 1. Confinement by means of a strait waistcoat, 
 or of a chair, which I have called a tranquillzer. 
 He submits to them both with less difficulty 
 than to human force, and struggles less to disen- 
 gage himself from them. The tranquilizer has 
 several advantages over the strait waistcoat or 
 mad shirt. It opposes the impetus of the blood 
 towards the brain, it lessens muscular action 
 every where, it reduces the force and frequency
 
 180 ON THE DISEASES 
 
 of the pulse, it favours the application of cold 
 water and ice to the head, and warm water to the 
 feet, both of which, I shall say presently, are ex- 
 cellent remedies in this disease; it enables the 
 physician to feel the pulse and to bleed without 
 any trouble, or altering the erect position of the 
 patient's body; and, lastly, it relieves him, by 
 means of a close stool, half filled with water, over 
 which he constantly sits, from the fcetor and filth 
 of his alvine evacuations.* 
 
 2. Privation of their customary pleasant food. 
 
 3. Pouring cold water under the coat sleeves, 
 so that it may descend into the arm pits, and 
 down the trunk of the body. 
 
 4. The shower bath, continued for fifteen or 
 twenty minutes. If all these modes of punish- 
 ment should fail of their intended effects, it will 
 be proper to resort to the fear of death. Mr. 
 Higgins proved the efficacy of this fear, in com- 
 pletely subduing a certain Sarah T , whose 
 
 profane and indecent conversation and loud vo- 
 ciferations, offended and disturbed the whole hos- 
 
 * A chair, such as has been described, may be seen in the 
 Pennsylvania Hospital, and an engraving of it in the last volume 
 of Dr. Coxe's Medical Museum.
 
 OF THE MIND. 181 
 
 pital. He had attempted in vain by light punish- 
 ments and threats, to put a stop to them. At 
 length he went to her cell, from whence he con- 
 ducted her, cursing and swearing as usual, to a 
 large bathing tub, in which he placed her. " Now, 
 (said he) prepare for death. I will give you time 
 enough to say your prayers, after which I intend 
 to drown you, by plunging your head under this 
 water." She immediately uttered a prayer, such 
 as became a dying person. Upon discovering 
 this sign of penitence, Mr. Higgins obtained from 
 her a promise of amendment. From that time no 
 profane or indecent language, nor noises of any 
 kind, were heard in her cell. 
 
 By the proper application of these mild and 
 terrifying modes of punishment, chains will sel- 
 dom, and the whip never, be required to govern 
 mad people. I except only from the use of the 
 latter, those cases in which a sudden and unpro- 
 voked assault of their physicians or keepers may 
 render a stroke or two of a whip, or of the hand, 
 a necessary measure of self-defence. 
 
 To encourage us in the use of all the means 
 that have been mentioned for subduing the tem- 
 pers of mad people, and acquiring a complete 
 government over them, I shall only add to the
 
 182 ON THE DISEASES 
 
 history I have given of their disease, that there is 
 a predisposition in their minds to be acted upon 
 by them, founded in their timidity. They are 
 not only afraid of their keepers and attendants, 
 but of one another. Some years ago, a madman 
 of the name of Hoops, disturbed the whole vil- 
 lage of Chester, in this state, by his conduct. A 
 person more rnad than himself, came into the 
 town. Hoops instantly ran from him, and took 
 shelter in the court house while the court was 
 sitting. There was an instance of the same ti- 
 midity in a madman in our hospital, in the month 
 of February, 1810. In consequence of the house 
 being unusually crowded with mad people, two 
 men were confined in one cell. One of them, who 
 was very noisy, was instantly silenced by the re- 
 bukes of his less deranged companion. He even 
 crept into the corner of a cell to avoid him. 
 
 The remedies for general mania next come 
 under our consideration. In enumerating them, 
 I shall adopt the same order that I followed in 
 treating upon partial insanity, by mentioning, 
 
 I. Such as should be applied to the mind, 
 through the medium of the body ; and,
 
 OF THE MIND. 183 
 
 II. Such as should be applied to the body, 
 through the medium of the mind. *y v 
 
 I. The first remedy under this head, should be 
 blood-letting. 
 
 This evacuation is indicated, 
 
 1. By all the facts and arguments formerly 
 mentioned, in favour of this grade of madnes% 
 being an arterial disease, of great morbid excite- 
 ment or inflammation in the brain, particularly 
 by the state of the pulse, and, when this is natu- 
 ral, by the state of the countenance, by wakeful- 
 ness, and by a noisy and talkative disposition. 
 
 2. By the appetite being uninterrupted, and 
 often unrestrained, whereby the blood-vessels be- 
 come overcharged with blood. 
 
 3. By the importance and delicate structure of 
 the brain, which forbid its bearing violent morbid 
 action for a length of time, without undergoing 
 permanent obstruction or disorganization. The 
 danger from this cause is much increased by 
 the wakefulness, hollowing, singing, and strong 
 muscular exertions of persons in this state of 
 madness.
 
 184 ON THE DISEASES 
 
 4. By there being no outlet from the brain, in 
 common with other viscera, to receive the usual 
 results of disease or inflammation, particularly 
 the discharge of serum from the blood-vessels. 
 
 5. By the accidental cures which have followed 
 the loss of large quantities of blood. Many mad 
 people, who have attempted to destroy themselves 
 by cutting their throats, or otherwise opening 
 
 Jarge blood-vessels, have been cured by the pro- 
 fuse haemorrhages which have succeeded those 
 acts. Of this, several instances have occurred 
 within my knowledge. 
 
 6. By the morbid appearances of the blood 
 which has been drawn for the cure of this form 
 of madness. It is generally diseased beyond that 
 grade in which it exhibits a buffy coat. Of 200 
 patients bled by Mr. Halsam, in the Bethlehem 
 Hospital, the blood was sizy in but six cases, and 
 from the cause that has been assigned. I have 
 seen nearly all the morbid appearances of the 
 blood which I have enumerated in my defence of 
 blood-letting, and never a single instance in which 
 it put on a natural appearance. 
 
 7. Blood-letting is indicated by the extraordi- 
 nary success which has attended its artificial use
 
 OF THE MIND. 185 
 
 in the United States, and particularly in the Penn- 
 sylvania Hospital. 
 
 In the use of bleeding in this state of madness, 
 the following rules should be observed: . 
 
 1. It should be copious on the first attack 
 of the disease. From 20 to 40 ounces of blood 
 may be taken at once, unless fainting be induced 
 before that quantity be drawn. It will do most 
 service if the patient be bled in a standing pos- 
 ture. The effects of this early and copious 
 bleeding are wonderful in calming mad people. 
 It often prevents the necessity of using any 
 other remedy, and sometimes it cures in a few 
 hours. 
 
 2. It should be continued not only while any 
 of those states of morbid action in the pulse re- 
 main which require bleeding in other diseases, 
 but in the absence of them all, provided great 
 wakefulness, redness in the eyes, a ferocious 
 countenance, and noisy and refractory behaviour 
 continue, all of which indicate a highly morbid 
 state of the brain. We bleed in the same 
 natural state of the pulse in the pneumonia 
 notha. We do the same thing in a similar form 
 of hepatitis. 
 
 24
 
 186 ON THE DISEASES 
 
 The propriety of bleeding in this mania notha, 
 if I may be allowed to use a term founded upon 
 the unity of its cause (that is, congestion of blood 
 without inflammation) with the causes of the 
 above diseases of the lungs and liver, has often 
 been demonstrated in the Pennsylvania Hospital. 
 Its advantages, I well recollect, attracted the at- 
 tention of the pupils of the hospital in the year 
 1805, in a more than ordinary manner, in the 
 case of a man of the name of Pickins. His mad- 
 ness was recent, his skin was cool, and his pulse 
 natural, but his eyes suffused with blood, and he 
 was unable to sleep. 1 bled him copiously, after 
 which his pulse became frequent and tense. I 
 repeated the bleeding, and gave him several 
 doses of purging physic, which cured him in a 
 few days. 
 
 3. It should be more copious in phrenimania 
 and synochomania, than in simple madness. Its 
 liberal use is particularly indicated in the latter, 
 when it is formed by the union of madness with 
 pregnancy, or with the autumnal or puerperal 
 fever, in all which the blood-vessels labour un- 
 der disease in other parts of the body, as well as 
 the brain. 
 
 4. It should be less copious in madness from
 
 OF THE MIND. 1 87 
 
 drunkenness, than from any of its other causes, 
 all the circumstances that call for it being equal. 
 For the reasons for this caution, the reader will 
 please to consult the defence of blood-letting, in 
 the third volume of the author's Medical Inquiries 
 and Observations. 
 
 5. It is indicated no less in the seventh and 
 eighth forms of general mania, formerly described, 
 than in those which preceded them. I think I 
 once prevented suicide by it, in a young gentle- 
 man descended from a family in which several of 
 its members had perished by their own hands. 
 
 6. The quantity of blood drawn, should be 
 greater than in any other organic disease. This 
 is indicated not only by most of the reasons for 
 bleeding formerly given, but by the strong and 
 uncommon hold which the disease takes of the 
 brain. Many circumstances prove this to be the 
 case, but none more than its not being cured, and 
 scarcely suspended, by the acute and painful dis- 
 ease of parturition, several instances of which 
 have come under my notice. From among many 
 cases of the successful issue of profuse bleeding 
 in this form of madness, I shall select but two: 
 the former was in Mr. T. H. of the state of New 
 Jersey, a man of sixty-eight years of age, from
 
 8 ON THE DISEASES 
 
 whom I drew nearly 200 ounces of blood, between 
 the 20th of December and the 14th of February, 
 in the year 1 807 ; the latter was in Mr. D. T. of 
 the state of New York, who lost about 470 
 ounces, by my order, by 47 bleedings, between 
 the months of June 1810, and April 1811. Both 
 these gentlemen were my private patients in the 
 Pennsylvania Hospital. Were it necessary, I 
 could add to these cases several others, commu- 
 nicated to me by my pupils, particularly by Dr. 
 Wallace, of Virginia, and Dr. Anan, of Maryland, 
 in which a similar practice had been attended 
 with the same success. 
 
 After all the symptoms which "ball for blood- 
 letting have disappeared, we sometimes observe 
 the disease to continue. In this case, morbid ex- 
 citement becomes insolated, but still so considera- 
 ble as not to yield to purges or blisters. Here, 
 CUPPING is indicated. The cups should be ap- 
 plied to the temples, behind the ears, and to the 
 nape of the neck. Leeches may be used for the 
 same purpose, and to the same places. They 
 may likewise be applied to the haemorrhoidal ves- 
 sels with advantage, in persons who have been 
 subject to the piles. The sympathy of the brain 
 with these vessels is so intimate, that the disease 
 yields as readily to the loss of blood from them,
 
 OF THE MIND. 189 
 
 as from the parts that have been mentioned near 
 the brain. 
 
 Arteriotomy performed upon the temporal ar- 
 tery, it is said, is more useful than venesection, 
 or local bleeding with cups and leeches. I can 
 say nothing in its favour from my own experience. 
 
 I have only to add to these remarks upon the 
 use of cups and leeches, that they are not only 
 useless, but often hurtful, if applied before the ac- 
 tion of the pulse is reduced. By inducing de- 
 bility in the blood-vessels of the brain, they invite 
 morbid excitement to it from the blood-vessels of 
 the trunk and extremities of the body, provided 
 they retain a predominance, or even an equality 
 of action with the blood-vessels of the brain. 
 
 3. SOLITUDE is indispensably necessary in this 
 state of madness. The passions become weak 
 by the abstraction of company, and by refrain- 
 ing from conversation. For this reason, visiters 
 should be excluded from the cells and apartments 
 of highly deranged people, and there are times in 
 which the visits of a physician, and of the cell- 
 keeper or nurse, should be as seldom and short 
 as are consistent with the proper treatment and 
 care of the patient.
 
 
 190 ON THE DISEASES 
 
 4. DARKNESS should accompany solitude in the 
 first stage of this disease. It invites to silence, 
 and it induces a reduction of the pulse, by the 
 abstraction of the stimulus of light, and by the 
 influence of fear, which is naturally connected 
 with darkness. There are four cells in the Penn- 
 sylvania Hospital, so formed that it is possible to 
 render them dark with but little trouble. I have 
 seen the happiest effects from confining noisy 
 patients in them. 
 
 5. An ERECT position of the body. There is a 
 method of taming refractory horses in England, 
 by first impounding them, as it is called, and then 
 keeping them from lying 'down or sleeping, by 
 thrusting sharp pointed nails into their bodies for 
 two or three days and nights. The same advan- 
 tages, I have no doubt, might be derived from 
 keeping madmen in a standing posture, and 
 awake, for four and twenty hours, but by different 
 and more lenient means. Besides producing 
 several of the effects of the tranquillizing chair, it 
 would tend to reduce excitement by the expendi- 
 ture of excitability, from the constant exertion of 
 the muscles which support the body. The de- 
 bility thus induced in these muscles would attract 
 morbid excitement from the brain and thereby 
 relieve the disease. That benefit would arise
 
 
 OP THE MIND. 191 
 
 from preventing sleep, I infer from its salutary 
 effects in preventing delirium, and from delirium 
 being always increased by it in fevers of great 
 morbid excitement. 
 
 6. Low DIET, consisting wholly of vegetables, 
 and those of the least nutritious nature. What 
 would be the effect of fasting for two or three 
 days in this state of madness ? I am disposed to 
 think favourably of it, from a fact communicated 
 to me by a gentleman who resided twenty years 
 in the interior parts of India. He informed me 
 that the wild elephants, when taken, are always 
 tamed by depriving them of food, until they dis- 
 cover signs of great emaciation. They are then 
 fed with mild aliment, and soon acquired their 
 usual flesh, but without the least return of their 
 ferocity. Fasting is calculated to act in two 
 ways, in the cure of tonic madness: 1, by lessen- 
 ing the quantity of blood by the abstraction of 
 aliment; and 2, by exciting the disease of hunger 
 in the stomach to such a degree, as to enable it 
 to predominate over the disease of the brain, and 
 by that means attract it to a less vital part of 
 the body. The effects of this severe remedy in 
 curing inflammatory dropsy, render it still more 
 probable that it might be employed, with advan- 
 tage, in this disease of the brain. Against its
 
 192 ON THE DISEASES 
 
 use it may be said that the ferocity of certain 
 wild animals is increased by hunger; this is true, 
 but ferocity is not derangement. It is possible 
 it might exist for a little while, and be attended 
 with symptoms totally different from those which 
 take place in madness, and of a nature that would 
 yield more easily to the power of medicine. 
 
 The drinks of a patient in this state of mad- 
 ness, should be of the most simple kinds. 
 
 7. PURGING. Cremor tartar, salts, senna, ca- 
 lomel and jalap, have all been employed for this 
 purpose. Their use is indicated by the obstruc- 
 tions in the viscera, and torpor of the alimentary 
 canal, which generally accompany this form of 
 madness. There are cases in which the purges 
 should be given daily, so as to excite an artificial 
 diarrhoea. Nature, as I shall say presently, some- 
 times cures madness in this way. It is much in 
 favour of this chronic mode of purging, that few 
 persons are ever delirious in their last moments, 
 who die of discharges from their bowels. In the 
 mixture, which sometimes takes place, of mania, 
 with the synochus form of bilious fever, purging 
 should be employed more freely than in simple 
 madness. Calomel and jalap should be preferred 
 for that purpose.
 
 OF THE MIND. 193 
 
 8. EMETICS are spoken of very differently by 
 authors. Some commend, while others condemn, 
 them. When they have done harm, it must have 
 been by giving them before, or after, the system 
 was reduced below the emetic point. When given 
 at that point, they have done good in many 
 cases. I mentioned formerly their manner of ope- 
 rating, in treating of their efficacy in partial de- 
 rangement. 
 
 9. NITRE has done the same service in this 
 disease, that it has done in other diseases, which 
 affect the blood-vessels. Its efficacy is increased 
 by such additions of tartarized antimony and calo- 
 mel to it, as shall increase its disposition to act 
 upon the bowels and skin. 
 
 10. BLISTERS, like emetics, have been con- 
 sidered as remedies of doubtful efficacy; but it is 
 only because they have not been employed in the 
 manner, or at the precise time, that was neces- 
 sary to obtain benefit from them. In a letter 
 which I received in the year 1794, from Dr. Wil- 
 lis, senr. he informed me that he always applied 
 them to the ankles in this disease, instead of the 
 head or neck. He gave no reason for this prac- 
 
 .tice, but it immediately suggested a principle to 
 me, from which I have derived great advantages, 
 
 25
 
 194 ON THE DISEASES 
 
 not only in the treatment of madness, but of 
 several other diseases. In the first stage of tonic, 
 or violent, madness, the disease is intrenched, as 
 it were, in the brain. It must be loosened, or 
 weakened, by depleting remedies, before it can 
 be dislodged, or translated to another part of the 
 body. When this has been effected, blisters easily 
 attract it to the lower limbs, and thus often con- 
 vey it at once out of the body. The same reason- 
 ing applies, with equal force and the same prac- 
 tice with equal success, to all the violent diseases 
 of the breast and bowels. The blisters do the 
 same service when applied to the wrists, and still 
 more when applied at the same time, or alter- 
 nately, to both extremities. After the complete 
 reduction of the pulse, they may be applied with 
 advantage to the neck and head. 
 
 11. COLD, in the form of air, water, and ice. 
 The cold air should be applied both partially and 
 generally. To favour its partial action, the hair 
 should be cut off, and shaved from every part of 
 the head. Dr. Moreau, a French physician, has 
 related a cure of madness performed by this sim- 
 ple remedy alone. How far the hair, by its sym- 
 pathy with the brain, which it discovers by pre- 
 ternatural dryness in the forming state of many 
 diseases, and by the alteration in its figure, colour,
 
 OP THE MIND. 1 95 
 
 and quantity, from the influence of certain emo- 
 tions and passions of the mind, may increase this 
 disease, we know not; but we are certain, by cut- 
 ting off, we not only expose the head to a greater 
 degree of cold, but we favour by it, at the same 
 time, depletion from the brain, by means of insen- 
 sible perspiration; for, however strange it may 
 appear, there is a grade of action in the perspir- 
 ing vessels, in which their discharges are in- 
 creased by the sedative operation of cold. 
 
 Cold air, by its action upon the whole body, 
 has likewise done service in this state of madness. 
 I have heard of two instances, in which it was 
 cured by the patients escaping from their keepers 
 in the evening, and passing a night in the open 
 air in the middle of winter. One of them re- 
 lapsed ; in the other the cure was permanent. 
 
 Cold water should be applied in like manner to 
 the head, and the whole body. To the former it 
 should be applied by means of cloths, or a blad- 
 der, to which ice, when it can be obtained, should 
 be added ; for the head, from its greater insensi- 
 bility to cold than any other part of the body, 
 feels, in but a feeble degree, the coldness of sim- 
 ple water. I have found this to be a more effec- 
 tual, as well as a more delicate, mode of applying
 
 
 196 ON THE DISEASES 
 
 cold to the head, than by means of the clay cap, 
 as advised by Dr. Cullin. The water, or ice, 
 should be frequently renewed, and they should be 
 continued for several days and nights. The sig- 
 nal for removing them should be, when they pro- 
 duce chilliness, and sobbing or weeping in the 
 patient. The advantages of these cold applica- 
 tions to the head will be much increased, by 
 placing the feet at the same time in warm water. 
 The circulation is thereby more promptly equal- 
 ized. The reader will find a striking instance of 
 the efficacy of using cold and warm water in this 
 manner to the two extremities, by my advice, in 
 a case of mania published by Dr. Spence, of Dum- 
 fries, in Virginia, in Dr. Cox's Medical Museum. 
 
 In order to derive benefit from the application 
 of cold water to the whole body, it should be im- 
 mersed in it for several hours, by which means 
 we prevent the re-action of the system, and thus 
 render the sedative effects of the water perma- 
 nent. Pumping for an hour or two upon a pa- 
 tient, acts in the same way; but as it has some- 
 times been employed in curing a fit of drunken- 
 ness, and may be considered as a punishment, 
 rather than a remedy, immersion of the body 
 should be preferred to it. The patience and in- 
 sensibility of the system to cold in this state of
 
 OP THE MIND. 197 
 
 the system, is illustrated by a striking fact, men- 
 tioned by Dr. Currie in his Medical Reports. He 
 tells us, a deranged young woman slept upon a 
 cold floor during a whole night, so cold as to 
 freeze water and milk upon her table, without 
 suffering the least inconvenience from it. 
 
 11. A SALIVATION. I mentioned the manner in 
 which this remedy operated upon the brain, the 
 bowels and the mind, in treating of the cure of 
 hypochondriac derangement. Too much cannot 
 be said in its favour in general madness. I once 
 advised it in a case of this disease from parturi- 
 tion, in which the patient conceived an aversion 
 from the infant that had been the cause of her 
 suffering. On the day that she felt the mercury 
 in her mouth, she asked for her infant, and pressed 
 it to her bosom. From that time she rapidly re- 
 covered. 
 
 It is sometimes difficult to prevail upon patients 
 in this state of madness, or even to compel them, 
 to take mercury in any of the ways in which it is 
 usually administered. In these cases I have suc- 
 ceeded, by sprinkling a few grains of calomel daily 
 upon a piece of bread, and afterwards spreading 
 over it, a thin covering of butter.
 
 198 ON THE DISEASES 
 
 12. The PERUVIAN BARK. In all those cases in 
 which mania is complicated with the intermitting 
 fever,' or with those prostrate states of fever, in 
 which bark is usually administered, this medicine 
 may be given with advantage. 
 
 I have thus enumerated the principal remedies, 
 which have been employed in reducing the pre- 
 ternatural excitement of the system which takes 
 place in tonic madness. There are some others 
 which have been employed for the same purpose, 
 upon which I shall make a few remarks. 
 
 13. OPIUM. From an erroneous belief in the 
 supposed sedative power of this medicine, it has 
 been prescribed in this state of derangement, but 
 I believe always with bad effects. When given 
 in small doses, so as to prevent sleep, and by that 
 means gradually to waste the excitability, or what 
 Dr. Darwin calls the sensorial power of the sys- 
 tem, it may be useful. 
 
 14. DIGITALIS. I have occasionally adminis- 
 tered this medicine in tonic madness, but never 
 with any radical or permanent success. 
 
 15. CAMPHOR has been supposed to possess spe- 
 cific virtues in this state of madness. I have often
 
 
 OF THE MIND. 199 
 
 prescribed it when a young practitioner, but with- 
 out any obvious advantage. I should feel some he- 
 sitation in bearing a testimony against this, and 
 the preceding medicine, had I not lately discover- 
 ed that my experience of their inefficacy in this 
 disease, accords with that of the ingenious Dr. 
 Ferriar. They have both derived their credit in 
 madness from their lessening the frequency of the 
 pulse, in which disease has very improperly been 
 supposed to consist. But the frequency of a pulse 
 may be lessened, without a reduction of its force, 
 and even both may be effected by these medicines 
 upon the pulse on the wrist, and yet irregular 
 action in the blood-vessels of the brain, which 
 constitutes the disease, still continue, and until 
 this be removed, they are calculated to do harm, 
 by inducing obstruction in the brain, and thereby 
 perpetuating the disease. 
 
 When madness arises from drunkenness, those 
 medicines are safer and more useful, than when it 
 arises from those causes which require copious 
 blood-letting. In addition to them, volatile salts, 
 bitters, and small quantities of ardent spirits, may 
 be given with advantage, provided the system be 
 first moderately reduced by the use of depleting 
 remedies.
 
 200 ON THE DISEASES 
 
 I suspect many, and perhaps all, the cures that 
 have been performed by opium, digitalis, and cam- 
 phor, have been of madness from the intemperate 
 use of strong drink. The disease in most of these 
 cases partakes of the nature of a soap bubble. 
 With all its apparent force, it is both feeble, and 
 transient, and not only bears stimulants with 
 safety, but sometimes requires them immediately 
 after gentle evacuations of any kind. 
 
 16. HELLEBORE has been famed for many cen- 
 turies, as a specific for madness. It is generally 
 admitted that.it is useful, only, when it acts as a 
 purge. 
 
 17. Dr. Gregory, senr. used to relate, in his 
 lectures, a method of curing tonic madness, which 
 was practised by a farmer in the neighbourhood 
 of Aberdeen, in Scotland. It consisted in yoking 
 a number of madmen in a plough, and compelling 
 them, by fear or force, to plough the fields. This 
 remedy acted, by reducing and expending the 
 morbid excitement of the system. Refractory do- 
 mestic animals are sometimes subdued in the 
 same way; but experience has taught us that they 
 may be tamed by more gentle means. Experi- 
 ence has proved, in like manner, that the system 
 in tonic madness may be reduced by remedies
 
 OP THE MIND. 201 
 
 that offer less violence to humanity, and that 
 do not add to the affliction of the disease, by de- 
 grading the patient to a level with our domestic 
 animals. 
 
 18. As soon as the disease shows signs of 
 abatement, the patient should be relieved from 
 his confinement, in order to partake of the benefits 
 of fresh air and exercise. Swinging, riding in a 
 carriage, and moderate walking, will be highly 
 proper in this state of his disease. To these should 
 be added. 
 
 19. The SHOWER BATH. This excellent remedy 
 acts upon the head, by the stimulus arising from 
 the weight and momentum of the water, and by 
 the reaction of the blood-vessels, after the seda- 
 tive effects of the water are over. I have seen 
 very happy results from it. To do much service, 
 it should be used two or three times a day. 
 
 20. The diet and drinks of the patient should 
 now be of a cordial nature; and where obstinate 
 wakefulness or restlessness attends, opium may be 
 given at bed-time with safety and advantage. 
 
 21. When the disease affects the nervous and 
 muscular systems, in common with the blood-ves- 
 
 26
 
 
 202 ON THE DISEASES 
 
 sels, with hysterical or convulsive symptoms ; as- 
 safcetida, castor, and the oil of amber, should be 
 given with all remedies that have been men- 
 tioned. 
 
 II. We come next to mention the remedies that 
 are proper to act upon the body through the me- 
 dium of the mind. 
 
 1. The first remedy under this head, is to di- 
 vert the ruling passion or subject which occu- 
 pies the mind, if it be one, and fix it upon some 
 other. Nothing effectual can be done without 
 great attention to this direction. The author 
 has endeavoured to show, in an inquiry into the 
 influence of physical causes upon morals, how 
 much the passions may be made to neutralize 
 and decompose each other, and thus to lessen 
 their influence upon the body. History furnishes 
 several examples of the truth of this remark. I 
 mentioned formerly the effects of opposing the 
 fear of shame to a false opinion in religion, in pre- 
 venting suicide in the virgins of Miletus. Achil- 
 les was diverted by his mother Thetys from grati- 
 fying his revenge upon the body of Hector, by 
 supplanting that baneful passion by the passion of 
 love. Anger, and even rage, have often been op- 
 posed with success by terror and fear, and delibe-
 
 OF THE MWD. 203 
 
 rate malice by a delicate stroke of wit. Where 
 the mind is deranged upon all subjects, we should 
 endeavour to fix it upon but one. In order to do 
 this, it will be necessary to find out the favourite 
 studies and amusements of our patients. The late 
 Dr. Ash, Dr. Priestly informed me, was cured of 
 derangement upon a variety of subjects by seducing 
 him to the study of mathematics, of which he had 
 been fond in early life. The distracted mind of 
 the poet Cowper was composed, while he was em- 
 ployed in the single business of translating Homer; 
 and I have heard of a woman who was cured of 
 madness, by keeping her constantly employed for 
 several days in playing cards, to which it was 
 known she had always had a strong attachment. 
 There are few persons so much deranged, as not 
 to exhibit, for a half an hour or more, marks of 
 correctness of mind, when drawn into conversation 
 upon some subject not connected with their de- 
 rangement. I admit that this diversion of the pas- 
 sions and understanding can not be effected, where 
 the whole mind, and all the passions, are under 
 the influence of madness. Thus the virgins of 
 Miletus could not have been cured by an appeal to 
 the female sense of shame, had their moral faculties 
 partaken of the disease of their other passions ; nor 
 could Dr. Ash have been cured of his intellectual
 
 204 ON THE DISEASES 
 
 derangement by the study of mathematics, had he 
 lost all his recollection of quantity and numbers. 
 
 2. A sudden sense of the ABSURDITY, FOLLY, 
 or CRUELTY of certain actions, produced by con- 
 versation, has sometimes cured madness. The 
 cure in this case bears a resemblance to the sud- 
 den reduction of a dislocated bone. Some years 
 ago a maniac made several attempts to set fire to 
 our hospital. Upon being remonstrated with, by 
 Mr. Coates, one of its managers, he said, " I am 
 a salamander ;" " but recollect (said Mr. Coates) 
 all the patients in the hospital are not salaman- 
 ders ;" that is true, said the maniac, and never af- 
 terwards attempted to burn the hospital. Many 
 similar instances of a transient return of reason, 
 and some of cures, by pertinent and well directed 
 conversations, are to be met with in the records 
 of medicine. 
 
 3. Madness has sometimes been cured by the 
 influence of PLACE, TIME, and COMPANY, upon 
 the human mind. In favour of the benefits of as- 
 sociation from place 1 shall mention the following 
 facts. Van Swieten relates a story of a cabinet- 
 maker, who always recovered his reason as soon 
 as he entered his work-shop. A certain Mrs. 
 D , of this city, formerly a patient of mine, on
 
 OF THE MIND. 205 
 
 the 27th of March, 1792, was suddenly seized 
 with derangement on her way from market. She 
 rambled for two hours up and down the city, and 
 at length was conducted to her own house. The 
 moment she looked around her, she recovered her 
 reason, nor did she relapse afterwards. I have 
 known one clergyman, and have heard of another, 
 who were deranged at all times, except when they 
 ascended the pulpit, in which place they discover- 
 ed in their prayers and sermons, all the usual 
 marks of sound and correct mind. I once attend- 
 ed a judge from a neighbouring state, who was 
 rational and sensible upon the bench, but constant- 
 ly insane when off it. Time, by its influence upon 
 a deranged mind, sometimes produces healthy 
 and regular associations of ideas and conduct. 
 The late Rev. Dr. , of Baltimore, was ob- 
 served to be less deranged on Saturday, than on 
 any other day of the week, probably from that day 
 being formerly devoted exclusively to retirement 
 and study, in preparing for the exercises of the 
 ensuing Sabbath. Company has a similar effect 
 in restoring healthy and regular associations in 
 the mind. It should always be of that kind which 
 produced respect in former times. It will readily 
 occur to the reader, that all these remedies, de- 
 rived from association, will be proper only in the 
 declining and moderate state of the disease.
 
 206 ON THE DISEASES 
 
 4. Great care should be taken by a physician, 
 to suit his conversation to the different and vary- 
 ing states of the minds of his patients in this dis- 
 ease. In its furious state, they should never be 
 contradicted, however absurd their opinions and 
 assertions may be, nor should we deny their re- 
 quests by our answers, when it is improper to grant 
 them. In the second grade of this disease, we 
 should divert them from the subjects upon which 
 they are deranged, and introduce, as if it were ac- 
 cidentally, subjects of another, and of an agreea- 
 ble, nature. When they are upon the recovery, 
 we may oppose their opinions and incoherent tales 
 by reasoning, contradiction, and even ridicule. I 
 attended a lady some years ago in our hospital, 
 in whom this practice succeeded to my wishes. 
 In the first and raving state of her disease, she 
 said the spirit of General Washington visited and 
 conversed with her every night. I took no notice 
 of this assertion, but prescribed only for the ex- 
 cited state of her pulse. After this was reduced, 
 I entered into conversation with her, and instantly 
 obtruded a subject foreign to the nightly visits of 
 the spirit of General Washington, whenever she 
 mentioned it. One day, when she appeared ra- 
 tional upon all the subjects upon which we con- 
 versed, she lifted up the skirt of her silk gown, 
 and said, " See what a present General Washing-
 
 OF THE MIND. 207 
 
 ton made me last night !" O ! fie ! said I, madam, 
 I thought you had more understanding than to 
 suppose General Washington would leave his pre- 
 sent abode, to bring a silk gown to any lady upon 
 the face of the earth. She laughed at this rebuke, 
 and never mentioned the name of General Wash- 
 ington to me afterwards, nor discovered any other 
 mark of the remains of her disease. 
 
 From the history of this case, we see there are 
 the same acquiescing, diverting, and opposing 
 points in this grade of madness that were men- 
 tioned in treating upon the cure of tristimania, 
 and amenomania, all of which should be carefully 
 attended to in conversing with persons who are 
 affected with it. 
 
 We see further from this case, that the cure of 
 mental and bodily diseases is to be effected by the 
 same means. We first reduce the system, then 
 create revulsive actions, and finally remove sub- 
 sequent debility, or feeble morbid actions, by 
 stimulating remedies. From the nature of the 
 last of these remedies, the necessity of rescuing 
 maniacal patients from solitude must be very ob- 
 vious, in order to their producing a salutary effect. 
 Indeed they should never be confined a day af-
 
 
 208 ON THE DISEASES 
 
 ter they cease to be disposed to injure themselves 
 or others. 
 
 5. The return of regularity and order in the 
 operations of the mind will be much aided, by 
 obliging mad people to read with an audible voice, 
 to copy manuscripts, and to commit interesting 
 passages from books to memory. By means of 
 the first, their attention will be more intensely fix- 
 ed upon one subject than by conversation. In 
 this way only, they read when alone, and in this 
 way only, they comprehend what they read. They 
 revert in this respect to the state of childhood. 
 By copying manuscripts, the attention will be 
 still more fixed to one subject, and abstracted 
 from all others. I have witnessed the most salu- 
 tary effects from it, particularly in a gentleman 
 from New England, whose cure was completed 
 by transcribing a volume of lectures for a student 
 of medicine. Committing select passages from 
 books to memory will be more useful than either 
 of them, inasmuch as it requires greater efforts of 
 mind to accomplish it. To facilitate this mode 
 of exciting and regulating the faculties and opera- 
 tions of the mind, a few entertaining books of his- 
 tory, travels, and prints, should compose a part 
 of the shop furniture of every public and private 
 mad-house.
 
 OF THE MIND. 209 
 
 6. Music has been much commended in this 
 state of madness. History records two cures of 
 royal patients being effected by it. Dr. Cox men- 
 tions a striking instance of its power over the 
 mind of a madman. It should be accommodated 
 to the state of the disease. In that grade of it 
 which is now under consideration, the tunes should 
 be of a plaintive, that is, of a sedative nature. 
 
 7. TERROR acts powerfully upon the body, 
 through the medium of the mind, and should be em- 
 ployed in the cure of madness. I once advised gentle 
 exercise upon horseback, in the case of a lady in 
 Virginia who was deranged. In one of her excur- 
 sions from home, her horse ran away with her. He 
 was stopped after a while by a gate. The lady dis- 
 mounted, and when her attendants came up to her, 
 they found her, to their great surprise, and joy, per- 
 fectly restored to her reason, nor has she had since 
 the least sign of a return of her disease. A fall down 
 a steep ridge cured a mania of twenty years continu- 
 ance. Dr. Joseph Cox relates three cures of mad- 
 ness by nearly similar means. Dr. M. Smith, of 
 Georgia, informed me, that a madman had been 
 suddenly cured in Virginia, by the breaking of a 
 rope, by which he had been let down into a well 
 that was employed as a substitute for a bathing 
 tub. He was nearly drowned before he was taken 
 
 27
 
 210 ON THE DISEASES 
 
 out. The cures in all these cases were effected, 
 by the new actions induced in the brain by the 
 powerful stimulant that has been mentioned. In 
 the use of it great care will be necessary to suit 
 its force to the existing state of the system. 
 
 8. FEAR, accompanied with PAIN, and a sense of 
 SHAME, has sometimes cured this disease. Bartho- 
 lin speaks in high terms of what he calls " flagel- 
 lation," in certain diseases. I have heard of se- 
 veral instances of its efficacy in tonic madness. 
 Two soldiers were cured by it in the American 
 army during the revolutionary war. A madman, 
 who escaped from his keepers in Maryland, ran to 
 one of his neighbours with an intention to kill him. 
 His neighbour met him with a heavy whip, and 
 beat him until he fell upon his knees, and implored 
 him to spare his life. He rose from his knees in a 
 sound state of mind, and had no symptom of his dis- 
 ease afterwards. In mentioning the cures per- 
 formed by the whip, let it not be supposed that I 
 am recommending it in this state of madness. Fear, 
 pain, and a sense of shame, may be excited in many 
 other ways, that shall not leave upon the memory 
 of the patient the distressing recollection, that he 
 owes his recovery to such a degrading remedy. 
 
 9. How far artificial GRIEF might be employed
 
 OP THE MIND. 211 
 
 with advantage in this disease, I shall not deter- 
 mine, but I have heard of its having been suspend- 
 ed for several days, in a clergyman now in the 
 Pennsylvania Hospital, by the death of one of his 
 children; and of mania of five years standing, de- 
 scending to manalgia, in a lady in New York, by 
 hearing of the death of her husband. It caused 
 her to weep for several weeks. The disease in this 
 case, which had been diffused through all her pas- 
 sions, was suddenly concentrated in but one of 
 them, and in her understanding, from whence it 
 gradually passed out of her system. If these facts 
 should not be deemed a sufficient warrant to cre- 
 ate artificial grief, they will show that relief may 
 be expected, from communicating to persons af- 
 fected with this grade of madness the intelligence 
 of the death of their relations and friends. 
 
 10. Convalescents from derangement should be 
 defended from the TERRIFYING or DISTRESSING 
 NOISES of patients in the raving state of this dis- 
 ease, by removing the latter to small lodges, re- 
 mote from the hospital, or private mad-houses, or 
 by confining them in cells that are made with dou- 
 ble walls, doors, and windows, so as to obstruct 
 the passage of sound. A relapse has often been 
 induced by the neglect of this caution.
 
 212 ON THE DISEASES 
 
 CHAPTER VII. 
 
 II. Of Manicula. 
 
 THIS second grade of general madness, which 
 I have called manicula, differs from mania, as 
 chronic rheumatism differs from that which is 
 acute, that is, in being accompanied with a more 
 moderate degree of the same symptoms. The 
 pulse is usually synocula, typhoid or typhus. 
 It is in this case of madness that we discover that 
 peculiar sensibility to cold, which is generally 
 absent in its highest and lowest grades. Shaks- 
 peare, who saw this disease in common life, and 
 out of the restraints and conveniences of a hospi- 
 tal, has very happily illustrated this symptom in 
 the character of Edgar, whom he often makes to 
 exclaim, in counterfeiting madness, " poor Tom's 
 a cold." From the operations of fresh exciting 
 causes, manicula now and then rises into mania, 
 in which state it is sometimes cured, but it oft- 
 ener descends in a few days or weeks to its chro- 
 nic, or habitual form. It is now and then com-
 
 OF THE MIND. 213 
 
 bined with typhus fever, in which state it has been 
 called by Dr. Cullen, typhomania. We see it 
 occasionally in the last stage of the puerperal, 
 the jail, and autumnal fever. 
 
 The REMEDIES for this grade of madness should 
 be the same in its inflammatory state as for mania, 
 but of less force. In its typhoid and typhus states, 
 they should be the same as in the declining state 
 of mania, with the addition of garlic in substance 
 or infusion, and the different preparations of iron. 
 In the typhomania, the remedies should be com- 
 bined with those usually employed in the treat- 
 ment of typhus fever, particularly bark and opium. 
 The latter is an invaluable medicine in such cases. 
 The dose of it should be much larger than in 
 common diseases of the same grade of action.
 
 214 ON THE DISEASES 
 
 CHAPTER VIII. 
 III. Of Manalgia. 
 
 THE symptoms of this third and last form of ge- 
 neral madness are, taciturnity, downcast looks, a 
 total neglect of dress and person, long nails and 
 beard, dishevelled or matted hair, indifference to 
 all surrounding objects, insensibility to heat and 
 cold. A remarkable instance of insensibility to the 
 latter occurred in a certain Thomas Perrin, who 
 was admitted into the Pennsylvania Hospital, with 
 manalgia, in March 1765, and who died there in 
 September 1774, during all which time he ate and 
 slept in the cupola of the hospital, and never, in 
 the coldest weather of nine winters, came near to 
 a fire. A fixed position of the body sometimes at- 
 tends this form of madness. Of this there have 
 been two remarkable instances in our hospital. 
 In one of them, the patient sat with his body bent 
 forwards for three years without moving, except 
 when compelled by force, or the calls of nature. In
 
 OP THE MIND. 215 
 
 the other, the patient occupied a spot in a ward, an 
 entry, or in the hospital yard, where he appeared 
 more like a statue than a man. Such was the tor- 
 por of his nervous system, that a degree of cold, 
 so intense as to produce inflammation and gan- 
 grene upon his face and limbs, did not move him 
 from the stand he had taken in the open air. The 
 cause of this young man's insanity was as singular 
 as its nature. In was induced by his father's sell- 
 ing a pleasant farm, upon the Delaware, in the 
 neighbourhood of Philadelphia, on which he was 
 born, and had passed his youth, and which he ex- 
 pected to inherit after the death of his father. The 
 skin in manalgia is dry, cold, pale, yellow, brown, 
 livid, and dark coloured, and now then covered 
 here and there with black spots. The eyes, when 
 originally dark, acquire a light colour in this dis- 
 ease. I took notice formerly of the prevalence of 
 this colour in the deranged patients in the Penn- 
 sylvania Hospital. It probably arises from the ten- 
 dency of the system to dissolution, for we frequently 
 see it in the last stage of pulmonary consumption, 
 and it rarely fails to take place in old age. The 
 appetite in manalgia is inordinate or weak, the 
 bowels are costive, the urine is scanty in quantity, 
 and there is sometimes a discharge or slabbering 
 of saliva. This symptom, with one other, was se-
 
 216 ON THE DISEASES 
 
 lected by David, when he counterfeited madness 
 in order to prevent the discovery of his person 
 by the king of Gath, after his escape from the 
 hands of Saul. " And he changed his behaviour 
 before them (says the sacred historian) and feign- 
 ed himself mad, and scrabbled upon the doors of 
 the gate, and let his spittle fall down upon his 
 beard." The discharge of saliva in this case ap- 
 peared to be involuntary, and in this we perceive 
 a distinguishing mark between manalgia and tonic 
 madness, in the latter of which I said formerly 
 the saliva is discharged with difficulty by spit- 
 ting. The respiration is slow, the breath and 
 perspiration have a peculiar and offensive smell, 
 and the puke is languid and frequent, but some- 
 times natural. Nebuchadnezzar seems to have 
 been affected with this low grade of madness. 
 He was said to resemble a beast, probably from 
 the uncommon growth of his hair, beard, and 
 nails. 
 
 A strong attachment to tobacco is common in 
 the patients who have been previously in the habit 
 of using it. They frequently ask strangers for it, 
 or a few cents to buy it. 
 
 These are the usual symptoms of manalgia in 
 hospitals, but when persons who are affected with
 
 OF THE MIND. 217 
 
 it passes their liberty, they rather seek for, than 
 shun human society. They are often admitted by 
 private families to pass nights in their kitchens, 
 garrets, or barns. Sometimes they wander through 
 neighbourhoods in the capacity of beggars. Shak- 
 speare has described this state of derangement, 
 -very accurately, in the character of Edgar, in 
 King Lear, when he makes him adopt the resolu- 
 tion of counterfeiting the character of a madman. 
 
 " I will, (says Edgar) take the basest and poorest shape, 
 
 That ever penury, in contempt of man, 
 
 Brought near to beast. My face I'll grime with filth, 
 
 Blanket my loins, tie all my hair with knots, 
 
 And, with presented nakedness, outface 
 
 The winds and persecutions of the sky : 
 
 And with this horrible object, from low farms, 
 
 Poor pelting villagers, sheep cotes, and mills, 
 
 Sometimes with lunatic bans, sometimes with prayers, 
 
 Enforce their charity." 
 
 There are some instances in which the moral 
 faculties are impaired in manalgic patients, in 
 which case they are mischievous and vicious, but 
 they are more generally inoffensive, and disposed 
 to be kind, and even useful in hospitals and fami- 
 lies. In some of them the sense of Deity is not 
 only unimpaired, but in an elevated state. The 
 mad poet, Christopher Smart, often kneeled do\vn 
 
 28
 
 218 ON THE DISEASES 
 
 and prayed in the streets of London, when he was 
 permitted to leave his house, and he never suffer- 
 ed any of his visiters to leave him without re- 
 questing them to pray with him. 
 
 A late poet has described this pious form of ma- 
 nalgia, in a young woman, very happily in the fol- 
 lowing lines : 
 
 " But her praise was still, to be 
 
 Where holy congregations bow. 
 
 Wrapt in wild transports, while they sang, 
 
 And when they pray'd, would bow her low." 
 
 Madness in this form sometimes continues for 
 ten, fifteen, twenty, and even fifty years, when 
 not accompanied with paroxysms, but it more 
 generally terminates in death in a shorter time, 
 and frequently by diseases to be mentioned here- 
 after. 
 
 The equanimity of temper, together with the 
 want of exercise, and the inordinate appetite, 
 which generally accompany this disease, some- 
 times produce obesity. They had that effect, Dr. 
 Johnson tells us, upon Mr. Smart. I have seen 
 two instances of it in Philadelphia.
 
 ' 
 
 OP THE MIND. 
 
 219 
 
 The REMEDIES for MANALGIA should consist, like 
 those under a former head, of such as act, 
 
 I. Upon the mind, through the medium of the 
 body; and, 
 
 II. Upon the body, through the medium of the 
 mind. 
 
 I. To the first head belong, 
 
 1. Cordial food and drinks. The former should 
 be made savoury and grateful to the taste, and 
 the stimulus from the pleasure imparted by it 
 should be increased by its variety. The latter 
 should consist of wine, cider, and malt liquors. 
 Ardent spirits should be given with great caution, 
 lest a destructive fondness should be acquired for 
 them. There is least danger of this being the 
 case, when they are given in an undiluted state 
 once or twice a week. I have seen the most 
 beneficial effects from them, when administered 
 in this manner. To patients, in whom this form 
 of madness has been induced by intemperance in 
 drinking, they may be given daily, and in liberal 
 quantities.
 
 220 ON THE DISEASES 
 
 2. The WARM BATH. The water should be 
 heated above the natural temperature of the body, 
 in which state it acts powerfully upon the arterial 
 system. I have once known it induce 150 strokes 
 in the pulse in a minute, and excite the brain into 
 delirium, in an experiment made upon himself by 
 a student of medicine in the University of Penn- 
 sylvania. From the occasional effects of fevers, 
 which act in a similar way upon the blood-vessels, 
 I have been led to think highly of the remedy. An 
 epidemic fever, many years ago, pervaded the cells 
 of our hospital, which restored the greater part of 
 the maniacs to their reason. These accidental 
 cures struck the late Dr. Bond so forcibly, that he 
 attempted to exercise a fever in several of his pa- 
 tients in manalgia afterwards, by sending them to 
 the swamps of Gloucester county, near to the 
 city, in the state of New Jersey. With what suc- 
 cess I have never heard. 
 
 3. The COLD SHOWER BATH. The impulse im- 
 parted to the head by the descent of the water 
 upon it, adds very much to its efficacy, and gives 
 it great advantage over the plunging bath. 
 
 4. The COLD shower bath in succession to the 
 WARM bath. While I attended the Pennsylvania 
 Hospital, in the summer of 1785, 1 often employ-
 
 OF THE MIND. 221 
 
 ed these two remedies in the manner I have men- 
 tioned. I kept my torpid patient in the warm 
 bath for an hour or two, and then led him, smok- 
 ing with vapour, to the shower bath, which gave a 
 most powerful shock to his system. It extorted 
 cries and groans from persons that had been dumb 
 for years. In one case it relieved, and in another, 
 it restored reason to my patient; bat from his be- 
 ing confined in a damp cell, he died some time 
 after his recovery from his madness of a pulmona- 
 ry consumption. 
 
 5. Exciting an artificial diarrhoea. In the tonic 
 state of madness, purging, I said formerly, acted 
 as a depleting remedy. In manalgia it does good, 
 by exciting a revulsive action or disease, in a less 
 delicate part of the body than the brain. Nature, 
 I said formerly, sometimes cures manalgia in this 
 way. An instance of a cure from this cause oc- 
 curred in our hospital some years ago, in a wo- 
 man who had been deranged nine years. An acute 
 dysentery cured in a woman in Chester county, 
 after it had continued two years. It may be ex- 
 cited by a laxative diet, or any gently opening 
 medicine. 
 
 6. A CAUSTIC applied to the back of the neck, 
 or between the shoulders, and kept open for months,
 
 222 ON THE DISEASES 
 
 or years. This remedy acts by the permanent 
 discharge it induces from the neighbourhood of 
 the brain. Four patients have been cured of ma- 
 nalgia in our hospital, by abcesses in different 
 parts of the body. One of them had passed a 
 third of his life in the hospital. Dr. Johnson tells 
 us, in his Lives of the Poets, that Dean Swift had 
 a temporary return of his reason during the con- 
 tinuance of an abscess in his eye. 
 
 7. A SALIVATION. I know it is difficult to ex- 
 cite this disease in the throat and mouth in manal- 
 gia, but the mercury, if given ineffectually for this 
 purpose, will be useful as a general stimulant and 
 tonic. It will moreover serve to remove visceral 
 obstructions, which so generally succeed madness. 
 Where it excites a salivation, it seems to resuscitate 
 the mind. I have seen two instances in our hospi- 
 tal, in which a taciturnity of a year's continuance 
 was removed by it. Speech was excited, in one 
 of them, on the very day on which the mercury 
 affected the mouth, and the use of reason follow- 
 ed in a few days afterwards. 
 
 8. EXERCISE. This should consist of swing- 
 ing, seesaw, and an exercise discovered by Dr. 
 Cox, which promises more than either of them, 
 and that is, subjecting the patient to a rotary mo-
 
 
 OF THE MIND. 223 
 
 tion, so as to give a centrifugal direction of the 
 blood towards the brain. He tells us he has cured 
 eight persons of torpid madness by this mode of 
 exercise. I have contrived a machine for this pur- 
 pose in our hospital, which produces the same ef- 
 fects upon the body which are mentioned by Dr. 
 Cox. These are vertigo and nausea, and a general 
 perspiration. I have called it Gyrater. It would 
 be more perfect, did it permit the head to be placed 
 at a greater distance from its centre of motion. It 
 produces great changes in the pulse. In one ex- 
 periment made with it, it increased the pulse from 
 84 to 88 strokes in one minute, and to 120 in two 
 minutes. It increased its fulness at the same 
 time. In a second experiment made upon a ma- 
 nalgic patient, it increased the frequency of the 
 pulse from 104 in two minutes to 150. In a third 
 experiment it reduced the pulse from 108 in three 
 minutes to 100, and lessened its force. In this 
 patient, the pulse was preternaturally active be- 
 fore he entered the gyrater. 
 
 From the strong impression this mode of ex- 
 ercise makes upon the brain, there is reason to 
 believe it will be a useful remedy in manalgia. 
 A cheap contrivance, to answer all its purposes, 
 might easily be made, by placing a patient upon a 
 board moved at its centre upon a pivot, with his
 
 224 0\ THE DISEASES 
 
 head towards one of its extremities, and then giv- 
 ing it a rotary motion. The centrifugal force of 
 the blood would exceed, in this way, that which 
 it receives from the chair employed by Dr. Cox, 
 or from the gyrater in the Pennsylvania Hospital. 
 In addition to these exercises, pleasant amuse- 
 ments should be contrived for this class of mad 
 people. If they are unhappy, these amusements 
 will suspend their misery. If they are in a torpid 
 state, a transient sense of pleasure will be excited 
 by them, which may serve to remind them that 
 the chain is still unbroken which united them 
 with their fellow men. 
 
 9. LABOUR has several advantages over exer- 
 cise, in being not only more stimulating, but more 
 durable in its effects, whereby it is more calcu- 
 lated to arrest wrong habits of action, and to re- 
 store such as are regular and natural. It has 
 been remarked that the maniacs of the male sex 
 in all hospitals, who assist in cutting wood, mak- 
 ing fires, and digging in a garden, and the females 
 who are employed in washing, ironing, and scrub- 
 bing floors, often recover, while persons, whose 
 rank exempts them from performing such ser- 
 vices, languish away their lives within the walls 
 of the hospital. In favour of the benefits of la- 
 bour, in curing this disease, I shall select one from
 
 OP THE MIND. 225 
 
 among many facts that might be mentioned. In 
 the year 1801, 1 attended an English gentleman, 
 soon after his arrival in America, who was afflict- 
 ed with this grade of madness. My prescriptions 
 relieved, but did not cure him. He returned to 
 his family in Maryland, where, in the time of hay 
 harvest he was allured into a meadow, and pre- 
 vailed upon to take a rake into his hands, and to 
 assist in making hay. He worked for some time, 
 and brought on thereby a profuse sweat, which 
 soon carried off his disease. This account of his 
 remedy and cure I received from himself, in a 
 very sensible letter written a few weeks after his 
 recovery. I have often wished, and lately advised, 
 that the mad people in our hospital should be 
 provided with the tools of a number of mechani- 
 cal arts. Some of them should be laborious, and 
 employ the body chiefly; others ingenious, and 
 of a nature to exercise and divert the mind more 
 than the body. None of them should be carried 
 on by instruments, with which it would be easy 
 for the maniacs to hurt themselves or others. 
 For certain exploits of industry or skill, they 
 should receive such rewards in food, or dress, as 
 accord most with their inclinations, for few of 
 them are capable of any higher or other gratifica- 
 tion. The advantages of thus producing a cur- 
 rent of new actions, both corporeal and mental, 
 
 29
 
 226 ON THE DISEASES 
 
 which should continue for weeks and months, and 
 perhaps years, could not fail of being accompa- 
 nied with great advantages. Some emolument 
 might likewise be derived from their labour to 
 their friends, or to the institution that supported 
 them. What a different view would a number 
 of mad people exhibit, all thus imitating the 
 habits of rational industry, compared with the 
 antic gestures, the rapid or sauntering walks, 
 the listless attitudes and the vociferous or mut- 
 tering conversations they hold with themselves, 
 with which they excite pity or horror in all who 
 see them. 
 
 In both the exercises and labours of mad peo- 
 ple, they should be as much separated from each 
 other as possible. We are naturally imitative 
 animals j and our minds are formed in a degree 
 by ambient circumstances ; for which reason mad 
 people should associate and work only with per- 
 sons of sound and healthy minds. 
 
 10. Music should not be omitted as a remedy 
 in this state of madness. The tunes employed 
 for this purpose should be of the most invigora- 
 ting nature.
 
 OF THE MIND. 227 
 
 11. GREAT PAIM. Mr. Stewart, the pedestrian 
 traveller, informed me, that he once saw a tran- 
 sient interval of reason induced upon several 
 idiots in Italy, by means of torture, inflicted from 
 pious, but superstitious motives by some priests. 
 Dr. Cox mentions an instance of chronic madness 
 being cured by trepanning, and of the same good 
 effects being produced by accidental contusions of 
 the head. It is probable that both acted only by 
 inducing pain. The return of reason which I 
 shall say hereafter sometimes takes place in the 
 last hours of life, is probably occasioned, in part, 
 by the bodily pains which attended the passage 
 out of life. Should this remedy be resorted to, it 
 should be induced by means that are not of a de- 
 grading nature, and which are calculated at the 
 same time to excite violent passion or emotion of 
 the mind. 
 
 12. ERRHINES. These are suggested by the 
 general absence of secretion in the nose in mad 
 people, and by the relief which the discharge of a 
 few drops of tears affords in tristimania. The 
 insensibility of the nose to the stimulus of com- 
 mon snuff, from its habitual use by that class of 
 patients, forbids us to expect any benefit from it, 
 for which reason the sulphate of mercury, and the
 
 228 ON THE DISEASES 
 
 muriate of ammonia, mixed with a little flour, 
 should be preferred for that purpose. 
 
 13. CERTAIN ODOURS. The dyer, formerly men- 
 tioned, informed me, that he had often observed 
 the men that were employed in dyeing scarlet to 
 be uncommonly cheerful, and sometimes to sing 
 from morning till night. The odour which pro- 
 duces this effect is derived from a mixture of co- 
 chineal with a solution of tin in the nitric acid. 
 The exhilaration produced by the fragrance of a 
 flower garden in the spring of the year, and of 
 the Spice Islands in the Indian Ocean, favours 
 the idea still more, of exciting the brain by 
 means of pleasant odours applied to the organ of 
 smelling. 
 
 14. What would be the effect of loud and un- 
 common SOUNDS, acting through the ears upon the 
 brain and mind in this disease ? Menalgic patients, 
 it has been observed, are much excited by the 
 military music that sometimes passes by the Penn- 
 sylvania Hospital. It is still more in favour of loud 
 sounds, or noises, in manalgia, that in the lowest 
 stage of typhus fever, they have recalled depart- 
 ing life, and in asphixa, restored it from its appa- 
 rent extinction in death.
 
 OP THE MIND. 229 
 
 15. Exciting certain stimulating PASSIONS and 
 EMOTIONS, also the domestic AFFECTIONS. I men- 
 tioned several instances of the good effect of 
 terror, in tristimania and in tonic madness in 
 its declining state. To be useful in manalgia, 
 it should be often repeated. Of the good benefits 
 of anger, I shall mention a striking instance. 
 Mr. Derborow, whose name was mentioned for- 
 merly, during his long confinement in our hospital, 
 in a state of manalgia, became silent for several 
 months. Many attempts were made to compel 
 him to speak, but to no purpose. The late Dr. 
 Thomas Bond at length contrived to force him 
 to break his long and obstinate silence. It was 
 the practice of Mr. Derborow to amuse himself 
 occasionally during this time in drawing. One 
 day the Doctor looked over his shoulder, and saw 
 the picture of a flower under his pencil. " A very 
 pretty cabbage," said the Doctor. You are a 
 fool and a liar," said Mr. Derborow, "it is a 
 flower." From that time he continued to speak 
 as usual. Reading aloud and incorrect to pa- 
 tients in this situation has sometimes induced a 
 transient feeling of uneasiness or irritation, which 
 has unsealed their lips, and revived their former 
 habits of conversation.
 
 230 ON THE DISEASES 
 
 The advantages to be expected from exciting 
 the domectic affections will appear from the fol- 
 lowing fact. A woman in our hospital was de- 
 livered many years ago, of a fine child during 
 her derangement, which was of a chronic and tor- 
 pid nature. The affection which was suddenly 
 awakened for this child, removed her disease for 
 several days. The child was taken from her breast, 
 lest it should contract the seeds of madness from 
 her milk. Her disease immediately returned, and 
 she is now, and probably always will be, an incu- 
 rable tenant of our hospital. 
 
 There are several medicines which have been 
 given in this disease, upon which I shall make a 
 few remarks. These are, 
 
 16. Opium, iron, the datura stammonium, 
 strong infusions of green tea and green coffee, 
 garlic, valerian, the nitrous oxyd, and electricity. 
 
 I have administered all these medicines in this 
 disease in the Pennsylvania Hospital, and some 
 of them for several months, but never in a single 
 instance with success, when given alone. Garlic 
 now and then produced a temporary frequency 
 and fulness in the pulse, and electricity has pro- 
 duced a transient excitement in the temper, but
 
 OF THE MIND. 231 
 
 neither of them made a permanent impression 
 upon the disease. Where a recovery has suc- 
 ceeded the use of any of those medicines, I have 
 supposed the disease was cured by time, instances 
 of which will be mentioned hereafter. In thus 
 stating the inefficacy of the above medicines in 
 manalgia, I would by no means reject them alto- 
 gether. They may be given as auxiliaries to those 
 more powerful and rational remedies which agi- 
 tate the whole body and mind. 
 
 In the use of all our remedies for manalgia, an 
 advantage will arise from prescribing them in 
 succession and rotation, and in choosing certain 
 seasons of the year, according to the habits of the 
 patient, for their exhibition. 
 
 To encourage us to persevere for years in the 
 use of remedies for this disease, or to wait for a 
 cure from the hand of time, founded upon those 
 spontaneous changes that are always going for- 
 ward in the human body, I shall select two cases 
 of recoveries from among many others, the one 
 from the former, the other from the latter cause. 
 
 1. In the year 1795, a young man of the name 
 of Donaldson, from York county, in Pennsylva- 
 nia, was admitted into our hospital, in the lowest
 
 232 ON THE DISEASES 
 
 state of manalgia. He had been in that situation 
 between four and five years. He appeared to have 
 no mind, and scarcely any locomotive powers. 
 When placed at the head of a pair of stairs, he 
 rolled to the bottom of it. By means of most of 
 the remedies I have recommended, he was nearly 
 cured. He acquired the use of his speech, knew 
 his attendants, and called me by my name when 1 
 visited him. Unhappily, in his progress to a per- 
 fect cure he was attacked with a malignant fever, 
 and died in the hospital on the fifth day of his 
 disease. 
 
 2. The following account of a spontaneous re- 
 covery was communicated to me, many years ago, 
 by Dr. A. Hunter, with his history of the Lunatic 
 Asylum, in York, in Great Britain. 
 
 "On the twenty-fifth of October, 1778, a sea- 
 faring person, about forty years of age, was re- 
 commended to the Lunatic Asylum for cure. 
 About two years before that time he had sustained 
 considerable loss by sea, which operated so vio- 
 lently upon his mind, as to deprive him, almost 
 instantly, of all his reasoning faculties. In that 
 state of insensibility he was received into the Asy- 
 lum. During his abode there, he was never ob- 
 served to express any desire for nourishment; and
 
 OP THE MIND. 233 
 
 so great was his inattention to this particular, that 
 for the first six weeks it was necessary to feed him 
 in the manner of an infant. Food and medicines 
 were equally indifferent to him. A servant un- 
 dressed him at night, and dressed him in the 
 morning; after which he was conducted to his 
 seat in the common parlour, where he remained 
 all day with his body bent, and his eyes fixed upon 
 the ground. From all the circumstances of his 
 behaviour, he did not appear to be capable of re- 
 flection. Every thing was indifferent to him ; and 
 from the fairest judgment that could be formed, 
 he was considered by all about him as an animal 
 converted nearly into a vegetable. In this state of 
 insensibility he remained till the morning of Tues- 
 day the fourteenth of May, 1783, when, upon en- 
 tering the parlour, he saluted the recovering pa- 
 tients with a "Good morrow to you all." He 
 then thanked the servants of the house, in the 
 most affectionate manner, for their tenderness to 
 him; of which, he said, he began to be sensible 
 some weeks before, but had not till then the reso- 
 lution to express his gratitude. A few days after 
 this unexpected return to reason, he was permitted 
 to write a letter to his wife, in which he expressed 
 himself with decency and propriety. At this time 
 he seemed to have a peculiar pleasure in the en- 
 joyment of the open air, and in his walks con- 
 
 30
 
 234 ON THE DISEASES 
 
 versed with freedom and serenity. Talking with 
 him on what he felt during the suspension of rea- 
 son, he said that his mind was totally lost; but 
 that about two months before his return to him- 
 self, he began to have thoughts and sensations ; 
 these, however, only served to convey to him 
 fears and apprehensions, especially in the night 
 time. With regard to his medical treatment, I 
 shall only observe, that the medicines usually pre- 
 scribed for melancholic persons were in his case 
 studiously avoided, and instead of evacuants, cor- 
 dials and a generous diet were constantly recom- 
 mended. Had the natural powers been weakened, 
 I am satisfied that the mind never would have re- 
 gained her empire. During the remainder of his 
 stay in the Asylum, he continued to behave him- 
 self with steadiness and propriety. He ate and 
 drank moderately, and upon all occasions showed 
 a gentle and benevolent disposition. Finding his 
 mind sufficiently strong, he returned to his family 
 on the 28th of May, 1783. Soon after this he 
 was appointed to the command of a ship employ- 
 ed in the Baltic trade, in which service he is at 
 this time engaged." 
 
 I shall dismiss the history of all the different 
 forms of madness, and of their respective reme- 
 dies, by remarking, that they do not always occur
 
 OP THE MIND. 235 
 
 in the order in which they have been described. 
 Partial and general madness sometimes precede 
 and sometimes succeed each other. Manicula 
 sometimes exists without mania, and both, with- 
 out being succeeded by manalgia. There are in- 
 stances in which manalgia has preceded mania 
 and manicula ; and lastly, we now and then see 
 them all combine, and alternate with each other. 
 From this view of the successive and alternate 
 changes of the different forms of madness into 
 each other, we derive fresh proofs of the unity of 
 its cause, and the necessity of renouncing all pre- 
 scriptions for its names, and of constantly and 
 closely watching the disease, in order to vary our 
 remedies with its varying forms. 
 
 I shall now make a few remarks, which are alike 
 applicable to all the forms of general madness. 
 
 1. Great regard should be had to cleanliness in 
 the persons and apartments of mad people. This 
 is indispensably necessary, not only for their com- 
 fort, but their cure. A deranged man, with a 
 ragged dress, a dirty skin, long nails and beard, 
 and uncombed hair, or with his dress and person 
 in neat order, in a filthy room, loses his conscious- 
 ness of his personal identity ; and until this be re- 
 stored, it is in vain to expect a return of the na-
 
 236 ON THE DISEASES 
 
 tural habits of his mind. A close stool, with a 
 pan half filled with water, in order to suffocate the 
 fojtor of his evacuations, should be fixed in his 
 room, with a cover, which should fall down of 
 itself upon the stool after it is used. 
 
 2. Mad people should never be visited, nor 
 even seen by their friends, and much less by stran- 
 gers, without being accompanied by their physi- 
 cian, or by a person to whom he shall depute his 
 power over them. The dread of being exposed 
 and gazed at in the cell of a hospital by an un- 
 thinking visiter, or an unfeeling mob, is one of the 
 greatest calamities a man can anticipate in his 
 tendency to madness. The apprehension of it was 
 so distressing to a young gentleman in this city 
 in a fit of low spirits, that he prevented it, by dis- 
 charging the contents of a loaded musket through 
 his brain. But there is another advantage from 
 concealing the persons of mad people from the 
 eyes of visiters and the public. The disease is sup- 
 posed to fix something of a repelling nature upon 
 persons and families, and hence it is often con- 
 cealed or denied. Now, by rendering the place 
 in which mad people are confined, private I had 
 almost said sacred members of families may be 
 sent there without its being known. Nay, they 
 will be sent there upon the first appearance of the
 
 OP THE MIND. 
 
 237 
 
 disease, in order to prevent its being known, and 
 the disease thereby be more frequently cured. 
 This privacy would act with peculiar force upon 
 the female sex. The obliquity and convulsions of 
 the moral faculties, which sometimes take place 
 in madness, would in this way never be known, or 
 if known, would be forgotten, or never divulged. 
 To render a hospital still more agreeable, or less 
 the object of aversion by the female sex, they 
 should be carefully separated from the men, and 
 they should be nursed only by women. 
 
 3. In the history of all the forms of general 
 madness, it was remarked that they were all at- 
 tended, now and then, with the cheerfulness of 
 amenomania, but oftener with the distress of hypo- 
 chondriasm. In the latter case, it will be necessa- 
 ry to use all the precautions to prevent suicide 
 that were recommended in treating upon that dis- 
 ease. 
 
 4. We should be careful to distinguish between 
 a return of reason and a certain cunning, which 
 enables mad people to talk and behave correctly 
 for a short time, and thereby to deceive their at- 
 tendants, so as to obtain a premature discharge 
 from their place of confinement. To prevent the 
 evils that might arise from a mistake of this kind,
 
 238 ON THE DISEASES 
 
 they should be narrowly watched during their 
 convalescence, nor should they be discharged, 
 until their recovery had been confirmed by weeks 
 of correct conversation arid conduct. Three in- 
 stances of suicide have occurred in patients soon 
 after they left the Pennsylvania Hospital, and 
 while they were receiving the congratulations of 
 their friends upon their recovery. The disease, 
 in these cases, was probably revived by two 
 causes, 
 
 1. By means of association, from the sight of 
 persons or objects that first excited it, or that 
 were first connected with it ; and, 
 
 2. By exchanging the large and noisy society 
 of the hospital, for the comparative solitude and 
 silence of a private family. 
 
 The madness of Dr. Zimmerman, which had 
 been suspended for three months by traveling, 
 returned on the day he entered his own house. 
 To prevent this fatal or distressing recurrence of 
 madness, it would be a good practice to send pa- 
 tients abroad, or to reside for some time among 
 strangers, before they returned to their families. 
 All the means of destroying themselves, should, 
 at the same time, be kept out of their way.
 
 OP THE MIND. 239 
 
 The recurrence of madness, after it has been 
 cured, is no objection to the power of medicine 
 over it. There are frequent returns of catarrh, 
 pleurisy, and intermitting fever, after they have 
 been cured, and yet we do not ascribe them to 
 the uncertainty or imperfection of our science. 
 Of twenty-five persons that were cured of mad- 
 ness, by Mr. Pinel, but two relapsed in the course 
 of five years, which is probably much less than 
 the relapses which occur from the other diseases 
 that were mentioned. 
 
 I can not conclude this part of the subject of 
 these Inquiries, without lamenting the want of 
 some person of prudence and intelligence in all 
 public receptacles of mad people, who should live 
 constantly with them, and have the exclusive di- 
 rection of their minds. His business should be 
 to divert them from conversing upon all the sub- 
 jects upon which they had been deranged, to tell 
 them pleasant stories, to read to them select pas- 
 sages from entertaining books, and to oblige them 
 to read to him; to superintend their labours of 
 body and mind; to preside at the table at which 
 they take their meals, to protect them from rude- 
 ness and insults from their keepers, to walk and 
 ride with them, to partake with them in their 
 amusements, and to regulate the nature and mea-
 
 240 ON THE DISEASES 
 
 sure of their punishments. Such a person would 
 do more good to mad people in one month, than 
 the visits, or the accidental company, of the pa- 
 tient's friends would do in a year. But further. 
 We naturally imitate the manners, and gradually 
 acquire the temper of persons with whom we live, 
 provided they are objects of our respect and af- 
 fection. This has been observed in husbands and 
 wives, who have lived long and happily together, 
 and even in servants, who are strongly attached 
 to their masters and mistresses. Similar effects 
 might be expected from the constant presence of 
 a person, such as has been described, with mad 
 people, independently of his performing for them 
 any of the services that have been mentioned. 
 We render a limb that has been broken, and bent, 
 straight, only by keeping it in one place by the 
 pressure of splints and bandages. In like man- 
 ner, by keeping the eyes and ears of mad people 
 under the constant impressions of the counten- 
 ance, gestures, and conversation of a man of a 
 sound understanding, and correct conduct, we 
 should create a pressure nearly as mechanical 
 upon their minds, that could not fail of having a 
 powerful influence, in conjunction with other re- 
 medies, in bringing their shattered and crooked 
 thoughts into their original and natural order.
 
 
 OF THE MIND. 24 1 
 
 In reviewing the slender and inadequate means 
 that have been employed for ameliorating the 
 condition of mad people, we are led further to 
 lament the slower progress of humanity in its 
 efforts to relieve them, than any other class of 
 the afflicted children of men. For many centu- 
 ries they have been treated like criminals, or 
 shunned like beasts of prey; or, if visited, it has 
 been only for the purposes of inhuman curiosity 
 and amusement. Even the ties of consanguinity 
 have been dissolved by the walls of a mad-house, 
 and sons and brothers have sometimes languished 
 or sauntered away their lives within them, with- 
 out once hearing the accents of a kindred voice. 
 Happily these times of cruelty to this class of our 
 fellow creatures, and insensibility to their suffer- 
 ings, are now passing away. In Great Britain, a 
 humane revolution, dictated by modern improve- 
 ments in the science of the mind, as well as of 
 medicine, has taken place in the receptacles of 
 mad people, more especially in those that are of 
 a private nature. A similar change has taken 
 place in the Pennsylvania Hospital, under the 
 direction of its present managers, in the con- 
 dition of the deranged subjects of their care. 
 The clanking of chains, and the noise of the 
 whip, are no longer heard in their cells. They 
 now taste of the blessings of air, and light, and 
 
 31
 
 242 ON THE DISEASES 
 
 motion, in pleasant and shaded walks in summer, 
 and in spacious entries, warmed by stoves, in 
 winter, in both of which the sexes are separated, 
 and alike protected from the eye of the visitors 
 of the hospital. In consequence of these advan- 
 tages, they have recovered the human figure, 
 and, with it, their long forgotten relationship to 
 their friends and the public. Much, however, 
 remains yet to be done for their comfort and re- 
 lief. To animate us in filling up the measure of 
 kindness which has been solicited for them, let us 
 recollect the greatness of its object. It is not to 
 feed nor clothe the body, nor yet to cure one of 
 its common diseases : it is to restore the disjoint- 
 ed or debilitated faculties of the mind of a fellow 
 creature* to their natural order and offices, and 
 
 * The following short extract, taken down by Mr. Coats, 
 from the constant conversation of a young man of a good edu- 
 cation, and respectable connexions, now deranged in the Penn- 
 sylvania Hospital, will exhibit an affecting specimen of this 
 disjointed state of the mind, and of the incoherence of its ope- 
 rations. " No man can serve two masters. I am King Philip 
 of Macedonia, lawful son of Mary Queen of Scots, born in 
 Philadelphia. I have been happy enough ever since I have 
 seen General Washington with a silk handkerchief in High 
 Street. Money commands sublunary things, and makes the 
 mare go ; it will buy salt mackerel, made of ten-penny nails. 
 Enjoyment is the happiness of virtue. Yesterday cannot be 
 recalled. I can only walk in the night-time, when I can eat
 
 OF THE MIND. 243 
 
 to revive in him the knowledge of himself, his 
 family, and his god. 
 
 But in performing this achievement of skill and 
 humanity, we not only confer a positive good, but 
 we remove a positive evil, which has no parallel 
 in the list of human sufferings. If there were no 
 other reason to believe this was the case, than 
 the distress which takes place from a slight ir- 
 regularity in the circulation of the blood in the 
 
 pudding enough. I shall be eight years old to-morrow. They 
 say R. W. is in partnership with J. W. I believe they are 
 about as good as people in common not better, only on cer- 
 tain occasions, when, for instance, a man wants to buy chin- 
 copins, and to import salt to feed pigs. Tanned leather was 
 imported first by lawyers. Morality with virtue is like vice 
 not corrected. L. B. came into your house and stole a coffee- 
 pot in the twenty-fourth year of his majesty's reign. Plum- 
 pudding and Irish potatoes make a very good dinner. Nothing 
 in man is comprehensible to it. Born in Philadelphia. Our 
 forefathers were better to us than our children, because they 
 were chosen for their honesty, truth, virtue and innocence. 
 The Queen's broad R. originated from a British forty-two 
 pounder, which makes too large a report for me. I have no 
 more to say. I am thankful I am no worse this season, and 
 that I am sound in mind and memory, and could steer a ship 
 to sea, but am afraid of the thiller. ****** *#*#** gon Q f 
 Mary Queen of Scots. Born in Philadelphia. Born in Phila- 
 delphia. King of Macedonia.
 
 244 ON THE DISEASES 
 
 brain in a great majority of our dreams, it would 
 be sufficient to render their assertion probable ; 
 but we have many proofs of its being strictly true. 
 The tearing of clothes, so common in this dis- 
 ease, was one of the instituted signs of deep dis- 
 tress among the' Jews, and it was so probably, 
 from its being one of its natural signs among the 
 nations of the East. The hallooing, stamping 
 with the feet, and the rattling of chains, so gen- 
 erally practised by mad people, are all resorted 
 to, in order to excite such counter-impressions 
 upon their ears, as shall suspend or overcome, by 
 their force, the anguish of their minds. They 
 wound and mangle their bodies for the same pur- 
 pose. Even in those solitary cases of general 
 madness which are accompanied with singing 
 and laughter, there is good reason to believe the 
 heart is depressed with sadness. Nor are the 
 silence, and seeming apathy of manalgia, always 
 signs of the absence of misery. The " willow 
 weeps," says the poet, "but cannot feel; the tor- 
 pid maniac feels, but cannot weep." In main- 
 taining the general existence of misery in all the 
 forms of derangement, I am supported, not only 
 by the acts that have been mentioned, but by the 
 authority of Shakspeare, in the following view of 
 the images and feelings that usually harrow up 
 the imaginations of mad people.
 
 OP THE MIND. 245 
 
 " Who gives any thing (says Edgar) to poor Tom, 
 
 Whom the foul fiend has led through fire, 
 
 And through flame, through ford, and whirlpool, 
 
 Over bog and quagmire, that hath laid 
 
 Knives under his pillow, and halters in his pew, 
 
 Set rat's-bane by his porridge, and made him to 
 
 Ride upon a bay trotting horse, over four-inch 
 
 Bridges, and to course his own shadow for a traitor." 
 
 And again, Lear, in a language still more ex- 
 pressive of suffering, complains, 
 
 I am bound 
 
 Upon a wheel of fire, that mine own tears 
 Do scald like molten lead." 
 
 It is no objection to the correctness of this de- 
 scription of the distress and horror which dis- 
 tracts the mind of mad people, that they often 
 have no recollection of them after their recovery. 
 Happily for them! this is prevented, by derange- 
 ment affecting the memory as well as the under- 
 standing. Even in those cases of manalgia in 
 which the mind loses its sensibility to misery, and 
 the subjects of it cease to be objects of our sym- 
 pathy, they do not forfeit their claims to our good 
 offices. Though insensible of mental pain, they 
 are still sensible of kindness, and of corporeal 
 pleasure. A pleasant look, a kind word, an 
 orange, an apple, or even a flower, presented to
 
 246 ON THE DISEASES 
 
 them in an affectionate manner, are cordials and 
 donations of inestimable value. With these tran- 
 sient and casual favours should be united savoury 
 food. This is the more necessary to them, as 
 their senses of smell and touch, and often of hear- 
 ing, are so much impaired as to cease to afford 
 them any pleasure. Perhaps their food is more 
 enjoyed by them upon that account. 
 
 I shall now mention the signs of a favourable 
 and unfavourable issue of madness, in all the forms 
 of it which have been described. 
 
 The longer its remote and predisposing causes 
 have acted upon the brain, and mind, the more 
 dangerous the disease, and vice versa. 
 
 General madness, which succeeds tristimania, 
 or that comes on gradually, is more difficult to 
 cure, than that which comes on suddenly. Here 
 we see its affinity to fever. 
 
 Madness, which arises from a hereditary pre- 
 disposition, is said to be more difficult to cure, 
 than that which follows a predisposition to it that 
 has been acquired. It is certainly excited more 
 easily, and is more apt to recur when cured, but
 
 OF THE MIND. 247 
 
 in general, its paroxysms yield to medicine as rea- 
 dily as madness from an acquired predisposition. 
 
 Madness from corporeal causes is more easily 
 cured than from such as are mental. 
 
 The younger the subject, the more easy the cure. 
 Of 467 persons cured in Bethlehem Hospital, be- 
 tween the years 1784 and 1794, who were between 
 20 and 50 years of age, 200 of them were between 
 20 and 30. 
 
 It is rarely cured in old people. Mr. Halsam 
 says, of 31 persons in advanced life, who were ad- 
 mitted into Bethlehem Hospital, but four were 
 cured in the course of ten years. 
 
 Persons who have children are more difficult to 
 cure than those who are childless. 
 
 It is more easily cured in women than in men. 
 Mania yields more readily to medicine than ma- 
 nicula, or manalgia. A hundred patients in mania 
 in its furious state, and the same number in its 
 chronic state, were selected in the Bethlehem Hos- 
 pital, in order to determine their relative danger 
 and obstinacy. Of the former 62 were cured, and 
 of the latter but twenty-seven.
 
 
 OX THE DISEASES 
 
 A paroxysm of mania succeeding manicula, or 
 manalgia, is favourable. 
 
 A fever succeeding bleeding is favourable. It 
 shows a suffocated disease to be changed into a 
 diffused one. A malignant fever, I remarked for- 
 merly, once cured a number of maniacs in our 
 hospital. 
 
 Remissions and intermissions of violent mental 
 excitement, are always favourable. 
 
 Lucid intervals in manicula and manalgia are 
 likewise favourable. They show that torpor has 
 not completely taken possession of the brain. 
 
 Abscesses in any part of the body are favourable. 
 I formerly mentioned instances of recoveries which 
 succeeded them. 
 
 A running from, or moisture in the nose, after it 
 has been long dry, is favourable. 
 
 Warm and moist hands, after they have been long 
 cold and dry, are favourable. 
 
 A cessation of burning in the feet is favourable.
 
 
 OP THE MIND. 249 
 
 General anasarca is favourable, provided it has 
 been preceded by bleeding. It was followed by a 
 recovery in two cases in the Pennsylvania Hospi- 
 tal in the year 1811. 
 
 The continuance of hysterical symptoms, or 
 their revival, after being long absent, is always 
 favourable. The latter shows the disease to be 
 passing from its seat in the blood-vessels to the 
 nerves. 
 
 A moderate degree of obesity occurring during 
 a remission of the disease is favourable. A 
 greater degree of it is unfavourable. 
 
 A return of one regular stool daily, and at an 
 habitual hour, is favourable. 
 
 A diarrhrea, when moderate, is favourable. 
 
 Madness, from the common causes of fever, 
 from parturition, and from strong drink, generally 
 yield to the power of medicine. 
 
 Madness, from laesions of the brain, is seldom 
 cured. 
 
 32
 
 250 ON THE DISEASES 
 
 Madness which succeeds epilepsy, or that is 
 alternated with it, is, I believe, always incurable. 
 
 Madness which succeeds headach, palsy, and 
 fatuity, is generally incurable. 
 
 Madness from emotions of the mind, such as 
 anger, joy and terror, is more easily cured than 
 when it arises from the passions. From the for- 
 mer causes it comes on suddenly, from the latter 
 gradually. 
 
 Madness is difficult to cure, when it arises from 
 the revival of an old and dormant passion, ex- 
 cited by association, especially when that passion 
 is love or grief. It is remarkable, that the love 
 which causes madness, does not revive with its 
 cure. 
 
 Gaiety, timidity, and good humour, are favour- 
 able. Ill-temper is favourable. 
 
 Weeping is favourable, when the disease has 
 been preceded by hypochondriasm. It shows it 
 to be changing into the less dangerous and dis- 
 tressing disease of hysteria. 
 
 Pensiveness and taciturnity often accompany
 
 OP THE MIND. 251 
 
 and succeed a recovery from this disease. This 
 is elegantly described in Orlando Furioso, after 
 his recovery from madness induced by the un- 
 faithfulness of his beloved Angelica. 
 
 Slow recoveries are most favourable. 
 
 A discharge of blood from the haemorrhoidal 
 vessels, and the return of the menses, where they 
 have been obstructed, are always favourable. 
 
 In three cases of madness that have occurred 
 during pregnancy, within my knowledge, parturi- 
 tion did not cure nor even mitigate them. 
 
 A return of spelling correctly, after it had been 
 suspended, is favourable : so is a return of deli- 
 cacy, more especially in the female sex. 
 
 The return of an habitual disease or appetite, 
 shows an abatement of the violence of madness, 
 and is always favourable. The return of an ha- 
 bitual employment, or of any of the habits of the 
 understanding or the affections, that had been 
 suspended, is still more favourable. I shall men- 
 tion instances of each of them. 
 
 Sir George Baker declared the king of Great
 
 252 ON THE DISEASES 
 
 Britain to be convalescent from his first attack of 
 madness, as soon as he heard him speak with a 
 rapidity that had always been natural to him, and 
 which he had lost during his insanity. 
 
 I attended a young man of the name of Wilki- 
 son, in the Pennsylvania Hospital, in whom a 
 habit of stammering was suspended during his 
 derangement, but which returned as soon as he 
 began to mend. 
 
 The return of diseases that are painful, such 
 as headach, the rheumatism, the piles, or cough, 
 also of tremors, and cutaneous eruptions, is still 
 more favourable than the two cases of disease 
 that have been mentioned. 
 
 A revival of an appetite for gingerbread, in a 
 young man in our hospital, who had been fond of 
 it when in health, was soon afterwards followed 
 by his complete recovery. 
 
 A young lady in the neighbourhood of Phila- 
 delphia, who had been my patient for several 
 weeks in an attack of madness from a fever, was 
 observed by her family to call for her pen, ink, 
 and common-place book, upon a Sunday. She 
 had been in the practice of copying select pieces
 
 
 OP THE MIND. 253 
 
 of poetry into it, for many years, upon that day 
 of the week. At this time she discovered none 
 of the common signs of the return of reason by 
 her conduct or conversation. Trifling as this in- 
 
 o 
 
 cident appeared, I encouraged her parents to ex- 
 pect from it a favourable change in her disease. 
 It took place as I expected, and she recovered 
 perfectly in the course of a few weeks. 
 
 A female patient of mine, who had acquired 
 pious habits when a child, practised them with 
 great regularity during her derangement. Her 
 recovery was marked by the gradual neglect of 
 her devotion, and by a return of the gay and dis- 
 sipated practices of her middle life. 
 
 A Mrs. D- , whom I supposed, for several 
 
 months, had recovered from madness, under my 
 care, said to me one day, in passing by her in 
 our hospital, upon my asking her how she was, 
 " that she was perfectly well, and that she was 
 sure this was the case, for that she had at last 
 ceased to hate me." 
 
 A similar instance of a perfect recovery suc- 
 ceeding the revival of domestic respect and af-. 
 fection, occurred in a Miss H. L. who was con- 
 fined in our hospital in the year 1800. For
 
 254 ON THE DISEASES 
 
 several weeks she discovered every mark of a 
 sound mind except one. She hated her father. 
 On a certain day she acknowledged, with plea- 
 sure, a return of her filial attachment and affec- 
 tion for him; soon after she was discharged cured. 
 
 Spontaneous recoveries now and then occur, 
 after the disease has continued 18 and 20 years. 
 A recovery after the former period has lately 
 taken place in a German farmer, in the county of 
 Montgomery, in this state. 
 
 Maniacal patients sometimes die of its tonic 
 or acute state, but in its chronic forms they more 
 commonly die of some one of the following dis- 
 eases. 
 
 1. Atrophy. Dr. Greding says 68 out of 100 
 patients die of this wasting disease. 
 
 2. Pulmonary consumption. It is remarkable 
 that this disease does not so often suspend mad- 
 ness, as madness does pulmonary consumption. 
 
 3. Dropsy, particularly hydrothorax and ana- 
 sarca, where they have not been preceded by 
 bleeding. The latter disease aided madness in 
 putting an end to the miserable life of Mr. Cowper.
 
 
 OF THE MIND. 255 
 
 4. A single convulsive fit, epilepsy, palsy, and 
 apoplexy. 
 
 5. Fevers. 
 
 6. The disease induced by fasting. 
 
 It has been remarked, that patients who have 
 long been confined in mad-houses, sometimes 
 lose their hearing, but seldom their sight. I re- 
 marked formerly, that the ears are oflener af- 
 fected with false perceptions than the eyes, in 
 mad people; and from the nature of the disease 
 which produces those false perceptions, it is easy 
 to conceive that the sense of hearing must sooner 
 perish than the sense of sight. 
 
 Most of mad people discover a greater or less 
 degree of reason in the last days or hours of 
 their lives. Cervantes therefore discovers both 
 observation and judgment, in bringing Don Quix- 
 ote to his senses just before he dies. Thus the 
 sun, after a cloudy day, sometimes darts a few 
 splendid rays across the earth just before he de- 
 scends below the horizon. I have ascribed this 
 resuscitation of reason in the paroxysm of death 
 to the diseased blood-vessels relieving themselves
 
 256 ON THE DISEASES 
 
 by an effusion of water in the ventricles of the 
 brain, or to the remains of the excitement of the 
 system, awakened by fever, or pain, taking re- 
 fuge in the mind.
 
 OF THE MIND. 257 
 
 CHAPTER IX. 
 
 Of Demence, or Dissociation. 
 
 RELATED to intellectual madness is that dis 
 ease of the mind, which has received from Mr. 
 Pinel the name of DEMENCE. The subjects of 
 it in Scotland are said to "have a bee in their 
 bonnets." In the United States, we say they are 
 " flighty," or " hair-brained," and, sometimes, a 
 " little cracked." I have preferred naming it, 
 from its principal symptoms, DISSOCIATION. It 
 consists not in false perception like the worst 
 grade of madness, but of an association of unre- 
 lated perceptions, or ideas, from the inability of 
 the mind to perform the operations of judgment 
 and reason. The perceptions are generally ex- 
 cited by sensible objects; but ideas, collected 
 together without order, frequently constitute a 
 paroxysm of the disease. It is always accompa- 
 nied with great volubility of speech, or with 
 bodily gestures, performed with a kind of convul- 
 sive rapidity. We rarely meet with this disease 
 
 33
 
 258 ON THE DISEASES 
 
 in hospitals ; but there is scarcely a city, a vil- 
 lage, or a country place, that does not furnish one 
 or more instances of it. Persons who are afflict- 
 ed with it are good tempered and quarrelsome, 
 malicious and kind, generous and miserly, all in 
 the course of the same day. In a word, the mind 
 in this disease may be considered as floating in a 
 balloon, and at the mercy of every object and 
 thought that acts upon it. It is constant in some 
 people, but it occurs more frequently in parox- 
 ysms, and is sometimes succeeded by low spirits. 
 The celebrated Lavater was afflicted with it ; and 
 although he wrote with order, yet his conversation 
 was a mass of unconnected ideas, accompanied 
 with bodily gestures, which indicated a degree of 
 madness. I shall insert an account of a visit paid 
 to him at Zurich by the Rev. Dr. Hunter, an Eng- 
 lish clergyman, in which he exemplified the state 
 of mind I wish to describe. 
 
 " I was detained," says he, " the whole morn- 
 ing by the strange, wild, eccentric Lavater, in 
 various conversations. When once he is set a 
 going there is no such thing as stopping him till 
 he runs himself out of breath. He starts from 
 subject to subject, flies from book to book, from 
 picture to picture ; measures your nose, your eye, 
 your mouth, with a pair of compasses; pours
 
 OP THE MIND. 259 
 
 forth a torrent of physiognomy upon you ; drags 
 you, for a proof of his dogma, to a dozen of clo- 
 sets, and unfolds ten thousand drawings ; but will 
 not let you open your lips to propose a difficulty ; 
 crams a solution down your throat, before you 
 have uttered half a syllable of your objection. 
 
 " He is as meagre as the picture of famine ; his 
 nose and chin almost meet. I read him in my 
 turn, and found little difficulty in discovering, 
 amidst great genius, unaffected piety, unbounded 
 benevolence and moderate learning, much caprice 
 and unsteadiness; a mind at once aspiring by 
 nature, and groveling through necessity; an end- 
 less turn to speculation and project ; in a word, a 
 clever, flighty, good natured, necessitous man." 
 
 I said formerly, that hysteria consisted in mo- 
 bility of the nervous and muscular system. Dis- 
 sociation seems to be occasioned by a similar 
 mobility of that part of the brain which is the seat 
 of the mind. 
 
 The remedies for it, when it is attended with 
 great excitement, as it generally is, should be, 
 bleeding, low diet, purges, and all the other reme- 
 dies for reducing morbid excitement in the brain,
 
 260 ON THE DISEASES 
 
 recommended formerly for the cure of intellectual 
 madness. 
 
 When the disease is periodical, bark, and other 
 tonics, should be given in its intervals.
 
 OP THE MIND. 261 
 
 CHAPTER X. 
 
 On Derangement in the Will. 
 
 Two opinions have divided philosophers and 
 divines upon the subject of the operations of the 
 will. It has been supposed by one sect of each 
 of them to act freely ; and by the others to act 
 from necessity, and only in consequence of the 
 stimulus of motives upon it. Both these opinions 
 are supported by an equal weight of arguments ; 
 and however incomprehensible the union of two 
 such opposite qualities may appear in the same 
 function, both opinions appear to be alike true. 
 
 The will is affected by disease in two ways. 
 
 I. When it acts without a motive, by a kind of 
 involuntary power. Exactly the same thing takes 
 place in this disease of the will, that occurs when 
 the arm or foot is moved convulsively without 

 
 262 ON THE DISEASES 
 
 an act of the will, and even in spite of it. The 
 understanding, in this convulsed state of the will, 
 is in a sound state, and all its operations are per- 
 formed in a regular manner. When the will be- 
 comes the involuntary vehicle of vicious actions, 
 through the instrumentality of the passions, I 
 have called it MORAL DERANGEMENT. For a more 
 particular account of this moral disease in the 
 will, the reader is again referred to a printed lec- 
 ture, delivered by the author in the University of 
 Pennsylvania, in November, 1810, upon the study 
 of Medical Jurisprudence, in which the morbid 
 operations of the will are confined to two acts, 
 viz. murder and theft. I have selected those two 
 symptoms of this disease (for they are not vices) 
 from its other morbid effects, in order to rescue 
 persons affected with them from the arm of the 
 law, and to render them the subjects of the kind 
 and lenient hand of medicine. But there are 
 several other ways, in which this disease in the 
 will discovers itself, that are not cognizable by 
 law. I shall describe but two of them. These 
 are, LYING and DRINKING. 
 
 1. There are many instances of persons of sound 
 understandings, and some of uncommon talents, 
 who are affected with this LYING disease in the 
 will. It differs from exculpative, fraudulent and
 
 
 OP THE MIND. 263 
 
 malicious lying, in being influenced by none of the 
 motives of any of them. Persons thus diseased 
 can not speak the truth upon any subject nor tell 
 the same story twice in the same way, nor describe 
 any thing as it has appeared to other people. 
 Their falsehoods are seldom calculated to injure 
 any body but themselves, being for the most part 
 of a hyperbolical or boasting nature, but now and 
 then they are of a mischievous nature, and injuri- 
 ous to the characters and property of others. 
 That it is a corporeal disease, I infer from its 
 semetimes appearing in mad people, who are re- 
 markable for veracity in the healthy states of their 
 minds, several instances of which I have known in 
 the Pennsylvania Hospital. Persons affected with 
 this disease are often amiable in their tempers and 
 manners, and sometimes benevolent and charita- 
 ble in their dispositions. 
 
 Lying, as a vice, is said to be incurable. The 
 same thing may be said of it as a disease, when it 
 appears in adult life. It is generally the result of 
 a defective education. It is voluntary in child- 
 hood, and becomes involuntary, like certain mus- 
 cular actions, from habit. Its only REMEDY, is, 
 bodily pain, inflicted by the rod, or confinement,
 
 264 ON THE DISEASES 
 
 or abstinence from food ; for children are incapa- 
 ble of being permanently influenced by appeals to 
 reason, natural affection, gratitude, or even a 
 sense of shame. 
 
 2. The use of strong drink is at first the effect 
 of free agency. From habit it takes place from 
 necessity. That this is the case, I infer from per- 
 sons who are inordinately devoted to the use of 
 ardent spirits being irreclaimable, by all the con- 
 siderations which domestic obligations, friend- 
 ships, reputation, property, and sometimes even 
 by those which religion and the love of life, can 
 suggest to them. An instance of insensibility to 
 the last, in an habitual drunkard, occurred some 
 years ago in Philadelphia. When strongly urged, 
 by one of his friends, to leave off drinking, he said, 
 " Were a keg of rum in one corner of a room, and 
 were a cannon constantly discharging balls be- 
 tween me and it, I could not refrain from passing 
 before that cannon, in order to get at the rum." 
 
 The REMEDIES for this disease have hitherto 
 been religious and moral, and they have some- 
 times cured it. They would probably have been 
 more successful, had they been combined with
 
 OP THE MIND. 265 
 
 such as are of a physical nature. For an account 
 of several of them, the reader is referred to the 
 first volume of the author's Medical Inquiries and 
 Observations. To that account of physical reme- 
 dies I shall add one more, and that is, the esta- 
 blishment of a hospital in every city and town in 
 the United States, for the exclusive reception of 
 hard drinkers. They are as much objects of 
 public humanity and charity, as mad people. 
 They are indeed more hurtful to society, than 
 most of the deranged patients of a common hos- 
 pital would be, if they were set at liberty. Who 
 can calculate the extensive influence of a drunken 
 husband or wife upon the property and morals of 
 their families, and of the waste of the former, and 
 corruption of the latter, upon the order and hap- 
 piness of society? Let it not be said, that con- 
 fining such persons in a hospital would be an 
 infringement upon personal liberty, incompatible 
 with the freedom of our governments. We do 
 not use this argument when we confine a thief in 
 a jail, and yet, taking the aggregate evil of the 
 greater number of drunkards than thieves into 
 consideration, and the greater evils which the 
 influence of their immoral example and conduct 
 introduce into society than stealing, it must be 
 obvious, that the safety and prosperity of a com- 
 
 34
 
 266 ON THE DISEASES 
 
 munity will be more promoted by confining them, 
 than a common thief. To prevent injustice or 
 oppression, no person should be sent to the con- 
 templated hospital, or SOBER HOUSE, without being 
 examined and committed by a court, consisting 
 of a physician, and two or three magistrates, or 
 commissioners appointed for that purpose. If the 
 patient possess property, it should be put into the 
 hands of trustees to take care of it. Within this 
 house the patient should be debarred the use of 
 ardent spirits, and drink only, for a while, such 
 substitutes for them, as a physician should direct. 
 Tobacco, one of the provocatives of intemper- 
 ance in drinking, should likewise be gradually 
 abstracted from them. Their food should be 
 simple, but for a while moderately cordial. They 
 should be employed in their former respective 
 occupations, for their own, or for the public 
 benefit, and all the religious, moral, and physical 
 remedies, to which I have referred, should be em- 
 ployed at the same time, for the complete and 
 
 radical cure of their disease. 
 
 f 
 
 2. Besides the disease in the will, which has 
 been described, it is subject to such a degree of 
 debility and torpor, as to lose all sensibility to the 
 stimulus of motives, and to become incapable of
 
 OP THE MIND. 267 
 
 acting either freely or from necessity. In this 
 respect it resembles a paralytic limb. We some- 
 times say of persons who are governed by their 
 friends, or a favourite, that they have no will 
 of their own." This is strictly true. If left to 
 themselves, they would neither buy nor sell, nor 
 transact any kind of business. They will, and 
 prefer nothing, and they do nothing, but what is 
 closely connected with their animal existence. It 
 is from the habitual want of exercise in the will 
 in slaves, that it is so apt to acquire this paralytic 
 state; and it is because we are deprived of its 
 co-operation with our medicines in the desire of 
 life, that we are less successful in curing their 
 diseases under equal circumstances, than the dis- 
 eases of freemen. Animal magnetism, Mr. Bris- 
 set informed me, performed many cures of light 
 diseases, upon the white people in the West In- 
 dies, but not a single slave was benefited by it, 
 and probably from the cause that has been men- 
 tioned. 
 
 I have never been consulted in this disease of 
 the will, but I have no doubt stimulating and tonic 
 remedies, preceded by depletion, would be useful 
 in it. Persons afflicted with this disorder of the 
 mind should be placed in situations, in which they
 
 
 268 ON THE DISEASES 
 
 will be compelled to use their wills, in order to 
 escape some great and pressing evil. A palsy of 
 the limbs has been cured by the cry of fire, and 
 a dread of being burned. Why should not a 
 palsy of the will be cured in a similar way?
 
 OF THE MIND. 269 
 
 CHAPTER XL 
 
 Of Derangement in the Principle of Faith> or the 
 Believing Faculty. 
 
 As this faculty has not yet found its way into 
 our systems of physiology, I shall briefly remark, 
 that I mean by it that principle in the mind, by 
 which we believe in the evidence of the senses, 
 of reason, and human testimony. It is as much 
 a native faculty as memory or imagination. The 
 objects of human testimony are extensive and 
 important. Saint Paul alludes to them in the 
 following passage of the eleventh chapter of his 
 Epistle to the Hebrews. " Through faith we un- 
 derstand that the worlds were framed by the word 
 of God, so that things which are seen were not 
 made of things which do appear." The greatest 
 part of all we believe of history, geography, and 
 public events, and all that we believe of our rela- 
 tion to our parents, brothers, and sisters, by the 
 tics of consanguinity, are derived from it. Hap-
 
 270 ON THE DISEASES 
 
 pily for us ! its operations are involuntary in its 
 sound state. Happily for us, likewise ! a source 
 of knowledge, so necessary to individual comfort 
 and social existence, has not been made depend- 
 ant upon our senses, nor left to the slow induc- 
 tions of reason. The world could not exist in its 
 present circumstances without it. It is no objec- 
 tion to its necessity and usefulness, that we are 
 sometimes deceived by it. The same objection 
 applies with equal force to our senses and reason, 
 as sources of knowledge. 
 
 Persons affected with this disease in the prin- 
 ciple of faith, as far as relates to human testi- 
 mony, believe and report every thing they hear. 
 They are incapable of comparing dates and cir- 
 cumstances, and tell stories of the most improba- 
 ble and incongruous nature. Sometimes they 
 propagate stories that are probable, but false; 
 and thus deceive their friends and the public. 
 There is scarcely a village or city that does not 
 contain one or more persons affected with this 
 disease. Horace describes a man of that cha- 
 racter in Rome, of the name of Apella. The pre- 
 disposition of such persons to believe what is 
 neither true, nor probable, is often sported with 
 by their acquaintances, by which means their sto- 
 ries often gain a currency through whole com- 
 munities.
 
 , 
 
 OP THE MIND. 271 
 
 It is probable the confinement of persons af- 
 flicted with this malady, immediately after they 
 hear any thing new, might cure them. Perhaps 
 ridicule might assist this remedy. I think I once 
 saw it effectual in -an old quidnunc during the 
 revolutionary war. 
 
 This faculty of the mind is subject to disorder 
 as well as to disease ; that is, to an inability to be- 
 lieve things that are supported by all the evidence 
 that usually enforces belief. Mr. Burke has de- 
 scribed the conduct of persons affected with the 
 disorder in the following words : " They believe 
 nothing that they do not see, or hear, or measure 
 by a twelve inch rule." An Indian once express- 
 ed the state of mind in which this torpor in the 
 principle of faith takes place, by saying, when a 
 truth was proposed to his belief, " that it would 
 not believe for him." This incredulity is not con- 
 fined to human testimony. It extends to the evi- 
 dence of reason, and (it has been said) of the 
 senses. The followers of Dr. Berkley either felt, 
 or affected, the last grade of this disorder in the 
 principle of faith. That it is often affected, I 
 infer from persons who deny their belief in the 
 utility of medicine, as practised by regular bred 
 physicians, believing implicitly in quacks; also
 
 272 ON THE DISEASES 
 
 from persons who refuse to admit human testi- 
 mony in favour of the truths of the Christian reli- 
 gion, believing in all the events of profane history; 
 and, lastly, from persons who contradict the evi- 
 dence of their senses in favour of matter, being as 
 much afraid of bodily pain from material or sen- 
 sible causes as other people. 
 
 The remedy for this palsy of the believing 
 faculty, should consist in proposing propositions 
 of the most simple nature to the mind, and, after 
 gaining the assent to them, to rise to propositions 
 of a more difficult nature. The powers of oratory 
 sometimes awaken the torpor of the principle of 
 faith. This was evinced, in a remarkable manner, 
 in the speech which king Agrippa made to St. 
 Paul, after he had heard his eloquent oration in 
 favour of Christianity : " almost thou persuadest 
 me to be a Christian." Perhaps great bodily 
 pain would have the same, or a greater effect in 
 curing this disorder of the mind. It has often 
 cured paralytic affections of the body, and of 
 other faculties of the mind. 
 
 Sometimes a strong passion, or emotion, by 
 preoccupying the mind, prevents the exercise of 
 belief. Thus we read, that the disciples of our
 
 
 OF THE MIND. 273 
 
 Saviour could not believe the news of his resur- 
 rection, "for joys." In such cases the predomi- 
 nating passion, or emotion, should be abstracted, 
 or weakened before an appeal is made to the 
 principle of faith. 
 
 35
 
 274 ON THE DISEASES 
 
 CHAPTER XII. 
 
 Of Derangement in the Memory. 
 
 THIS disease is attended with the following 
 grades : 
 
 1. There is an oblivion of names, and voca- 
 bles of all kinds. 
 
 2. There is an oblivion of names and vocables, 
 and a substitution of a word no ways related to 
 them. Thus I knew a gentleman, afflicted with 
 this disease, who, in calling for a knife, asked for 
 a bushel of wheat. 
 
 3. There is an oblivion of the name of sub- 
 stances in a vernacular language, and a facility of 
 calling them by their proper names in a dead, or 
 foreign language. Of this Wepfer relates three 
 instances. They were all Germans, and yet they 
 called the objects around them only by Latin
 
 OP THE MIND. 275 
 
 names. Dr. Johnson, when dying, forgot the 
 words of the Lord's prayer in English, but at- 
 tempted to repeat them in Latin. Delirious per- 
 sons from this disease in the memory often ad- 
 dress their physicians in Latin, or in a foreign 
 language. 
 
 4. There is an oblivion of all foreign and ac- 
 quired languages, and a recollection only of a 
 vernacular language. Dr. Scandella, an inge- 
 nious Italian, who visited this country a few years 
 ago, was master of the Italian, French, and Eng- 
 lish languages. In the beginning of the yellow 
 fever, which terminated his life in the city of New 
 York, in the autumn of 1798, he spoke English 
 only; in the middle of his disease, he spoke 
 French only; but on the day of his death, he 
 spoke only in the language of his native country. 
 
 5. There is an oblivion of the sound of words, 
 but not of the letters which compose them. I 
 have heard of a clergyman in Newburyport, who, 
 in conversing with his neighbours, made it a 
 practice to spell every word that he employed to 
 convey his ideas to them. 
 
 6. There is an oblivion of the mode of spelling 
 the most familiar words. I once met with it as a
 
 276 ON THE DISEASES 
 
 premonitory symptom of palsy. It occurs in old 
 people, and extends to an inability, in some in- 
 stances, to remember any more of their names 
 than their initial letters. I once saw a will sub- 
 scribed in this manner, by a man in the eightieth 
 year of his age, who, during his life, always wrote 
 a neat and legible hand. 
 
 7. There is an oblivion of the qualities or num- 
 bers of the most familiar objects. I know a man 
 in this city, who has never been able to remem- 
 ber the difference between a jug and a pitcher; 
 and I know a physician who for many years could 
 not recollect that the umbilical cord consisted of 
 two arteries and one vein, without associating the 
 former with the double a in the last, syllable of 
 the name of Dr. Boerhaave. 
 
 There appears to be something like a palsy in 
 the memory quoad these specific objects. 
 
 8. There is an oblivion of events, time and 
 place, with a perfect recollection of persons and 
 names. This is the case with the Rev. Dr. Ma- 
 gaw, formerly minister of St. Paul's church, in 
 this city. This disease in his memory was in- 
 duced by a paralytic affection.
 
 ' 
 
 OF THE MIND. 277 
 
 9. There is an oblivion of names and ideas, 
 but not of numbers. We had a citizen of Phila- 
 delphia, many years ago, who, in consequence of 
 a slight paralytic disease, forgot the names of all 
 his friends, but could designate them correctly by 
 mentioning their ages, with which he had pre- 
 viously made himself acquainted. 
 
 10. However strange it may appear, it has 
 been remarked, that there is sometimes an obli- 
 vion of the most recent, the most important-, and the 
 most interesting events. Of this I could mention 
 several instances that have come within my own 
 knowledge. One of them occurred to Dr. Priest- 
 ley. I have ascribed the oblivion of such events, 
 to the memory being over stimulated from an un- 
 due effort to retain them. Something similar to 
 it occurs in the inability of lovers to dream of 
 each other. 
 
 The objects of knowledge either perish, or 
 sleep, only in the mind. In the latter case, they 
 are revived by means to be mentioned presently. 
 
 Wepfer takes notice of the following symp- 
 toms occurring with the loss or suspension of 
 memory.
 
 278 ON THE DISEASES 
 
 A sense of pain or heaviness in the forehead, a 
 disposition to rub it with the hand, a formication, 
 that is, a sense of something creeping up the left 
 arm, and the fingers of both hands, a disposition 
 to weep, and an involuntary flow of urine. 
 
 The causes of the weakness and loss of memory 
 are corporeal and mental. To the first belong, 
 
 1. Intemperance in eating. Suetonius tells us, 
 the Roman emperor Claudius lost his memory so 
 entirely from this cause, that he not only forgot 
 the names and persons to whom he wished to 
 speak, but even what he wished to say to them. 
 
 2. Intemperance in drinking. It was from the 
 effect of strong drink, in weakening or destroying 
 the memory, that an old Spanish law refused to 
 admit any person to be a witness in court that 
 had been convicted of drunkenness. 
 
 3. Excess in venery. 
 
 4. Fevers, particularly such as are of a malig- 
 nant nature, or that affect the brain. The Rev. 
 Wm. Tennent, formerly the pastor of a Presbyte- 
 rian church at Freehold, in New Jersey, forgot 
 every thing he had learned, even the letters of the
 
 OF THE MIND. 279 
 
 alphabet, in consequence of an attack of a fever 
 when he was about eighteen years of age. 
 
 5. Vertigo, epilepsy, palsy and apoplexy. 
 
 6. Drying up an issue. Lsesions of the brain. 
 
 7. The use of snuff. It was induced by this 
 cause in Sir John Pringle. 
 
 II. The mental causes are, 
 
 1. Grief. I once met with a woman, who had 
 recently lost her husband and several children, 
 who told me she forgot, at times, even her own 
 name. 
 
 2. Terror. Artemidorus, a celebrated gram- 
 marian, was so terrified with the sight of a croco- 
 dile, that he immediately lost all the knowledge 
 that he had treasured up in his memory in the 
 course of his life. 
 
 3. Oppressing the memory in early life with 
 words and studies disproportioned to its srtength. 
 The Latin and Greek languages, and the prema- 
 ture application of the mind to mathematics, I
 
 280 
 
 ON THE DISEASES 
 
 believe, have weakened or destroyed not only 
 memory, but even intellect, in many young minds. 
 
 4. The undue exercise of the memory upon any 
 one subject often weakens it upon all others. The 
 famous African calculator, Thomas Fuller, of Vir- 
 ginia, whose memory was exercised exclusively 
 upon numbers, had so little recollection of faces, 
 that he was unable to recognise the persons who 
 had spent hours in conversing with him, and list- 
 ening to his calculations, the next day after he saw 
 them. Overcharging the memory with words has 
 the same effect. A celebrated player in London, 
 his son informed me, lost the recollection of the 
 names of all his children from this cause. 
 
 5. Neglecting to exercise the memory. 
 
 6. Cessation from study. Sir Isaac Newton 
 forgot the contents of his " Principia," by ceas- 
 ing to exercise his mind in study. 
 
 The famous Mr. Hude had spent several years 
 in close application to conic sections. Leibnitz, 
 in returning from his travels called to see him, 
 and expected to have been highly entertained by 
 conversing with him upon the subject of his stu-
 
 OF THE MIND. 281 
 
 dies. "Here," said Mr. Hude, sighing, "look 
 over this manuscript. I have forgotten every 
 thing in it since I became burgomaster of Amster- 
 dam." 
 
 The remedies for this disease are corporeal 
 and mental. 
 
 To the First, or corporeal remedies, belong, 
 
 1. Abstracting all its exciting causes. Sir John 
 Pringle's memory was restored, in a great degree, 
 by leaving off the use of snuff. 
 
 2. Depleting remedies, if plethora attend, and 
 the pulse be tense or oppressed. These should 
 be bleeding, purges, and low diet. After the re- 
 duction of the system, the remedies should be, 
 
 3. Blisters. Wepfer speaks in high terms of 
 their efficacy, when applied to the elbows and 
 calves of the legs, in this disease. 
 
 4. Issues in the arms. 
 
 5. Errhmes. 
 
 36
 
 282 ON THE DISEASES 
 
 6. Certain aromatic medicines. Etmuller says, 
 when a young man, he greatly improved his me- 
 mory by swallowing three or four cubebs every 
 day. The cardamon seeds are said to have the 
 same effect. Lavender and rosemary, or cloves, 
 may be substituted for both of them. 
 
 7. The cold bath and cold weather. Milton's 
 memory was always improved by the latter. 
 
 8. EXERCISE. Mr. Pope commends a trotting 
 horse above all things, in order to excite dormant 
 ideas. It is from the motion excited in the brain, 
 by means of a fever, that persons, in that disease, 
 often recollect events and speak languages, which 
 appeared to have perished in their memories. 
 The late Mr. Frederic A. Muhleriberg informed 
 me that his father, who was for many years minis- 
 ter of the Lutheran church in Philadelphia, in 
 visiting the old Swedes, who inhabited the south- 
 ern district of the city, upon their death beds, was 
 much struck in hearing some of them pray in the 
 Swedish language, who, he was sure, had not 
 spoken it for 50 or 60 years before, and who had 
 probably entirely forgotten it. It was revived by 
 the stimulus of the fever in their brains which at-
 
 OP THE MIND. 283 
 
 tended the close of their lives. The Rev. Dr. 
 Muhlenberg of Lancaster, has furnished me with 
 a fact from his own observation, similar to that 
 which was communicated to me by his brother, 
 in the following extract of a letter which I lately 
 received from him. " That people generally 
 pray in their last hours in their native language, 
 is a fact which I have found true, in innumerable 
 cases, amongst my German hearers, although 
 hardly one word of German was spoken by them 
 in common life and in days of health." Dr. 
 Hutchinson, in his Biographia Medica, relates an 
 anecdote of a physician of the name of Connor, 
 who had renounced the principles of the church 
 of Rome in early life, who, in the delirium of a 
 fever which preceded his death, prayed only in 
 the forms of that church. His fever had excited 
 those forms, while those of the protestant reli- 
 gion, which he had embraced, were obliterated 
 by the same fever from his mind. 
 
 
 In some cases, time performs a cure of the loss 
 
 of memory. This oftenest occurs, when it has 
 been induced by a fever. I have known one in- 
 stance of it, and have heard of several others. 
 One of the latter was in the Rev. Mr. Tennent, 
 whose name was just now mentioned, who stand-
 
 284 ON THE DISEASES 
 
 ing one day, at the feet of his master, suddenly 
 threw down his grammar, and called for one of 
 the Latin Classics, which he had begun to read 
 previously to the attack of his fever. At that in- 
 stant all that he had ever learned before, revived 
 in his mind. The fever which deprived him of 
 his memory was attended with apparent death 
 for two or three days. 
 
 II. The mental remedies for the loss, or decay 
 of memory, should be, 
 
 1. Frequently repeating what we wish to re- 
 member. The benefits of repetition are strik- 
 ingly illustrated in the history of a printer in Lon- 
 don, who, after working seven years in com- 
 posing the Bible, was able to repeat every chap- 
 ter and verse in it by memory. We see the ad- 
 vantages of this mode of strengthening the me- 
 mory, in persons who repeat questions or whole 
 sentences that are proposed to them, before they 
 can answer them. The door of the mind in such 
 people requires two knocks before it can be 
 opened, one by the person who asks, the other by 
 the person who answers the questions,- or, to 
 speak more simply, the mind requires a double 
 impression from words, before it is able to con- 
 vert them into thoughts.
 
 OP THE MIND. 285 
 
 2. Calling in the aid of two or more of the 
 senses, to assist in the retention of knowledge. 
 We seldom forget what we have handled, or tast- 
 ed, as well as seen or heard. It is for this reason 
 that physicians, who are educated in an apothe- 
 cary's shop, never forget the sensible qualities or 
 doses of medicines. The eyes assist the ears, 
 and the ears the eyes. We are seldom satisfied 
 in hearing a newspaper read ; hence, when it is 
 thrown down, we take it up, and convey to our 
 minds, through the medium of our own eyes, the 
 facts we have just before heard. Children and 
 the vulgar, whose memories are alike weak, are 
 unable to retain what they read, unless they re- 
 ceive it at the same time through their eyes and 
 ears : hence the practice by both of them of read- 
 ing when alone, with an audible voice. In some 
 cases they are unable to remember even their own 
 thoughts without rendering them audible, hence 
 we so often hear them talking to themselves. We 
 observe the same thing in the low and chronic 
 state of madness, and in part from the same cause. 
 Where the eyes and ears cannot both be employ- 
 ed in acquiring knowledge, the use of the ears 
 should be preferred. Julius Csssar says the rea- 
 son why the ancient Druids did not commit their 
 instructions to writing, was, that their pupils 
 might, by receiving them through their ears, more
 
 286 ON THE DISEASES 
 
 easily acquire, and more durably retain, them in 
 their memories. The ear is less apt to be dis- 
 tracted than the eye by the obtrusion of surround- 
 ing objects, the one being more constant than the 
 other. The mind moreover is more concentrated 
 in hearing than in seeing. The truth of all these 
 remarks is confirmed, by few of the sayings or 
 songs learned by the ear only, and in the nursery, 
 being ever forgotten. 
 
 3. The memory is restored and strengthened 
 by means of association. The principal circum- 
 stances which influence this operation of the 
 mind are, time, place, pleasure, pain, sounds, 
 words, letters, habit, and interest. 
 
 4. Filling the mind with that kind of know- 
 ledge only, which is supposed, or admitted, to 
 be true. The errors and falsehoods which are 
 crowded into the memories of boys, in our modern 
 systems of education, are calculated ever after- 
 wards to weaken their retentive powers to such 
 subjects as are true, and of a useful and practical 
 nature. 
 
 5. The memory is improved by using it. Its low 
 state among savages is occasioned by the small 
 number of objects upon which they exercise it.
 
 OF THE MIND. 287 
 
 6. The memory is aided in hearing, and after 
 reading, by shutting the eyes. In this way Mr. 
 Woodfall received and retained the speeches of 
 the members of the British parliament until he 
 committed them to paper, after which he pub- 
 lished and forgot them. 
 
 7. Ideas, and even words, that have been for- 
 gotten, are often recalled by conversation upon 
 subjects that are related to them. This is effect- 
 ed by some incidental word, or idea, awakening 
 by association the word or idea we wish to revive 
 in our minds. 
 
 8. Dr. Van Rohr, a Danish physician, who 
 visited this city in the year 1793, informed me 
 that he could at any time excite the remembrance 
 of words, by committing two or three lines of 
 poetry to memory. 
 
 9. Singing aids the memory in acquiring a 
 knowledge of words, and of the ideas connected 
 with them. A song is always learned sooner 
 than the same number of words not to set music. 
 
 10. Reading, or repeating what we wish to 
 commit to memory, the last thing we do before 
 we go to bed.
 
 288 ON THE DISEASES 
 
 11. Learning a number of technical or arbi- 
 trary terms, and associating ideas with them. 
 The rules for making syllogisms, are taught in 
 our systems of logic in this way. Dr. Gray's 
 Memoria Technica may be read, with advantage, 
 for much useful knowledge under this head.
 
 OF THE MIND. 289 
 
 CHAPTER XIII. 
 
 Of Fatuity. 
 
 THIS affection of the mind consists in a total 
 absence of understanding and memory. It has 
 different grades from the lowest degree of ma- 
 nalgia, down to that which discovers itself in 
 a vacuity of the eye and countenance, in silence 
 or garrulity, slobbering, lolling of the tongue, and 
 ludicrous gestures of the head and limbs. 
 
 It differs further, in being accompanied with 
 activity in the will, or a total paralysis of it, and 
 with active passions, or the total absence of them. 
 The passions which most commonly appear in 
 idiots are, anger, fear, and love. They moreover 
 sometimes feel an inordinate degree of the sexual 
 appetite, and are generally great feeders. Lastly, 
 they are innocent, or extremely vicious. 
 
 37
 
 290 ON THE DISEASES 
 
 Fatuity, or idiotism, is, 
 
 1. Congenial. In these cases the skull is less, 
 and inferior in height to the skulls of maniacs, and 
 there is a great disproportion between the face 
 and head, the former being much larger than the 
 latter. The bones of the head are preterna- 
 turally thick. This is the case we are told with' 
 the Cretins. Dr. Fodere, who has written an in- 
 teresting account of them, says they have no 
 knowledge of their parents, nor are they able to 
 feed themselves until they are eight or ten years 
 of age. All their senses are torpid. The vene- 
 real appetite exists in them with great force, and 
 they gratify it after puberty by the practice of 
 onanism. They are generally inoffensive, but 
 now and then very mischievous. There is a case 
 of congenial idiotism in a boy at Kensington, in 
 the neighbourhood of this city, in which the 
 powers of the body and mind are in a still lower 
 state than in the Cretins. He was born on the 
 5th of August, 1792, and is at this time unable to 
 walk or speak. He has the head of a man, 
 but all the parts of his body below it resemble 
 those of a child of two or three years old, particu- 
 larly his genitals and his pulse ; the latter beats 
 from 90 to 120 strokes in a minute. He has shed 
 his teeth twice, and now exhibits a third set, in
 
 OP THE MIND. 291 
 
 three distinct rows in his upper jaw. With all 
 this furniture for mastication, he is unable to 
 chew his food, and all that he takes of a solid 
 nature is first chewed for him by his sister. His 
 ears are very large. He cries when hungry and 
 in pain, but oftener laughs for hours, and some- 
 times for whole nights together, and so loud as 
 to disturb the sleep of his family. He discovers 
 mind in but three things, viz : in an affection for 
 his mother and sister, and in a love for a dog, and 
 for money. His father sometimes comes home 
 from his work in a state of intoxication, at which 
 time he abuses his mother and sister. During this 
 time he appears pensive, and refuses to eat any 
 thing. He discovers distress when his dog is out 
 of his sight, or his place in the family occupied 
 by the dog of any of the neighbours. Of his love 
 of money the following is a striking proof. I 
 threw a piece of silver into his lap. He instantly 
 laughed and showed other signs of pleasure. I 
 found upon inquiry that he was fond of ginger- 
 bread, and that he had just memory enough to 
 associate the pleasure of eating it with the sight 
 of the means of procuring it. 
 
 Fatuity is induced by all the causes which bring 
 on mania, particularly by chronic fevers. It some-
 
 292 ON THE DISEASES 
 
 times succeeds protracted manalgia. In com- 
 plete fatuity, every part of the brain is torpid or 
 paralytic, but where it exists with any of the pas- 
 sions we have mentioned, it is accompanied with 
 partial diseased action in the brain. 
 
 3. Fatuity is induced by old age, in conse- 
 quence of the brain becoming so torpid and in- 
 sensible, as to be unable to transmit, impressions 
 made upon it to the mind. It is partial, or gene- 
 ral, according to the greater or less extent of the 
 palsy of the brain. 
 
 Fatuity, whether a partial disease, or a disor- 
 der, has been cured, 
 
 1. By another disease. The author has men- 
 tioned, in his Introductory Lecture upon the 
 Study of Medical Jurisprudence, a curious in- 
 stance of a young woman, who was an idiot from 
 her childhood, and continued so until her 35th 
 year, at which time she was affected with pulmo- 
 nary consumption. The impetus of the blood in 
 the hectic fever of this disease, acting upon her 
 brain, awakened her long dormant mind, and pro- 
 duced in her such marks of reason, that she asto- 
 nished all her attendants by her conversation.
 
 OP THE MIND. 293 
 
 2. It has been cured by accidents, such as 
 burns and falls, and particularly when they affect 
 the head. Dr. Haller relates a case of this kind. 
 Dr. Nicholas Robinson mentions another, in 
 which the cure was effected by a fall from a 
 horse. After the disease induced by this fall 
 ceased, the fatuity returned. 
 
 3. Time has sometimes cured fatuity. This 
 has frequently been observed in that form of it 
 which succeeds a chronic fever. 
 
 4. From the accidental effects of the remedies 
 that have been enumerated, it is reasonable to 
 expect, that powerful stimulants, which act alike 
 upon the whole body and the brain, might be use- 
 ful in fatuity. These remedies should be the 
 same that were recommended formerly for the 
 cure of manalgia. That form of fatuity, which 
 sometimes follows a fever, generally yields to the 
 most lenient of these remedies. 
 
 In order to assist all the remedies that have 
 been mentioned, it will be useful, as soon as our 
 patients begin to discover any marks of the re- 
 vival of mind, to oblige them to apply their eye to 
 some simple and entertaining book. They will 
 much sooner acquire ideas in this way, than by
 
 294 
 
 ON THE DISEASES 
 
 our conversing with them, in consequence of the 
 longer impressions of words upon the eyes than 
 upon the ears, when they are pronounced in the 
 ordinary rapid manner of common conversation. 
 Dull boys are sometimes by this means made 
 scholars, and, on the contrary, boys of active 
 minds are sometimes made dull by it. The forci- 
 ble impressions of words in the latter case over- 
 stimulates the mind. Such boys learn more easily 
 and rapidly by oral instruction. 
 
 Fatuity from old age can not be cured, but it 
 may be prevented, by employing the mind con- 
 stantly in reading and conversation, in the even- 
 ing of life. Dr. Johnson ascribes the fatuity of 
 Dean Swift to two causes; 1, to a resolution he 
 made in his youth, that he would never wear 
 spectacles, from the want of which he was unable 
 to read in the decline of life ; and, 2, to his ava- 
 rice, which led him to abscond from visiters, or 
 deny himself to company, by which means he de- 
 prived himself of the only two methods by which 
 new ideas are acquired, or old ones renovated. 
 His mind from these causes languished from the 
 want of exercise, and gradually collapsed into 
 idiotism, in which state he spent the close of his 
 life in a hospital, founded by himself for persons 
 afflicted with the same disorder, of which he 
 finally died.
 
 OF THE MIND. 295 
 
 Country people, who have no relish for books, 
 when they lose the ability to work, or of going 
 abroad, from age, or weakness, are very apt to 
 become fatuitous, especially as they are too often 
 deserted in their old age by the younger branches 
 of their families, in consequence of which their 
 minds become torpid, from the want society 
 and conversation. Fatuity is more rare in cities 
 than in country places, only because society and 
 conversation can be had in them upon more easy 
 terms ; and it is less common among women than 
 men, only because they seldom survive their 
 ability to work, and because their employments 
 are of such a nature, as to admit of their being 
 carried on by their fire-sides, and in a sedentary 
 posture. 
 
 The illustrious Dr. Franklin exhibited a strik- 
 ing instance of the influence of reading, writing, 
 and conversation, in prolonging a sound and 
 active state of alhhe faculties of his mind. In his 
 eighty-fourth year he discovered no one mark, in 
 any of them, of the weakness or decay usually 
 observed in the minds of persons at that advanced 
 period of life. 
 
 I can not dismiss this subject without remark- 
 ing that the moral faculties, when properly regu-
 
 296 ON THE DISEASES 
 
 lated and directed, never partake of the decay of 
 the intellectual faculties in old age, even in per- 
 sons of uncultivated minds. It would seem as if 
 they were thus placed beyond the influence, not 
 only of time, but often of diseases and accidents 
 from their exercises being so indispensably ne- 
 cessary to our happiness, more especially in the 
 evening of life. 
 
 The Rev. Dr. Magaw, I said formerly, had lost, 
 with his memory for events, his consciousness 
 of place and time, by a paralytic disease, and 
 yet in this situation he retained, for several years, 
 so high a sense of religious obligation, that he 
 performed his devotions morning and evening, 
 and at his meals, with as much regularity and 
 correctness, as ever he did in the most vigorous 
 and healthy state of his mind. 
 
 There is a state of fatuity, related to that which 
 has been described, in which there exists, with 
 great feebleness of mind, a species of low wit and 
 cunning, accompanied at times with mimickry. 
 Shakspeare has described this grade of idiotism 
 in his character of the fool, in the tragedy of King 
 Lear. Such persons were formerly in demand 
 at courts, as jesters, in order to dissipate, by their
 
 OF THE MIND. 297 
 
 buffoonery, the ennui which is created by a super- 
 fluity of the enjoyments of life. 
 
 It is possible this mental disease might be re- 
 lieved by the same remedies that have been 
 recommended for common fatuity. 
 
 38
 
 298 ON THE DISEASES 
 
 CHAPTER XIV. 
 
 Of Dreaming, Incubus, or Night Mare, and 
 Somnambulism. 
 
 To enumerate all the phenomena of dreams, 
 and to attempt an explanation of their proximate 
 cause, would require a previous account of the 
 theory of sleep, and this would render it necessary 
 to introduce several physiological principles, all 
 of which would be foreign to the practical ob- 
 jects of this work ; for which reason I shall barely 
 remark, that dreaming is the effect of unsound or 
 imperfect sleep. That this is the case is obvious, 
 from its being uncommon among persons who 
 labour, and sleep soundly afterwards, and from 
 its causes to be mentioned presently. It is 
 always influenced by morbid or irregular action 
 in the blood-vessels of the brain, and hence it is 
 accompanied with the same erroneous train, or 
 the same incoherence of thought, which takes place 
 in delirium. This is so much the case, that a 
 dream may be considered as a transient parox- 
 ysm of delirium, and delirium as a permanent
 
 OP THE MIND. 299 
 
 dream. It differs from madness in not being at- 
 tended with muscular action. 
 
 As dreams are generally accompanied with dis- 
 tress, and are often the premonitory signs of acute 
 diseases, their cure is an important object of the 
 science of medicine. Their remote causes are an 
 increase, or diminution, of stimuli upon the brain. 
 
 I. The increased stimuli are corporeal, and 
 mental. 
 
 1. The corporeal stimuli are, an excessive 
 quantity of aliments or drinks, or of both, of an 
 offensive quality to the stomach, a position of the 
 head not habitual to the patient, cold, heat, noises, 
 a tight collar or wrist-bands, a fever, opium, a full 
 bladder, inclination to go to stool, and, lastly, 
 light. It is from the stimulus of the last cause 
 that we dream most after daybreak in the 
 morning. 
 
 2. The mental stimuli are, all disquieting pas- 
 sions, difficult studies begun at bed time, and an 
 undue weight of business. 
 
 II. Dreams are induced by the diminution of 
 habitual stimuli, such as customary food, drinks,
 
 300 ON THE DISEASES 
 
 exercise, labour, studies, and business. They are 
 sometimes terrifying, or distressing, and not only 
 detract from the happiness of life, but, when ne- 
 glected, become the cause of more serious dis- 
 eases in the brain. The remedies for them, when 
 they are induced by an increase of stimuli, whe- 
 ther corporeal or mental, should be, 
 
 1. Bleeding, or gentle purges, and low diet. 
 The famous pedestrian traveller, Mr. Stewart, in- 
 formed me that he never dreamed when he lived 
 exclusively upon vegetable food. 
 
 2. Exercise, or labour, which reduces excite- 
 ment, and wastes excitability down to the point 
 of natural and sound sleep. Persons who work 
 hard during the day seldom dream. 
 
 3. Avoiding all its remote and exciting causes 
 more especially such of them as act upon the 
 mind in the evening. 
 
 4. When dreaming arises from a diminution of 
 customary stimuli, a light supper, a draught of 
 porter, a glass of wine, or a dose of opium, gene- 
 rally prevent them. Habitual noises, when sus- 
 pended, should be restored.
 
 OP THE MIND. 301 
 
 Of the Incubus, or Night Mare. 
 
 This disease is induced by a stagnation of the 
 blood in the brain, lungs, or heart. It occurs 
 when sleep is more profound than natural. Its 
 remote causes are the same as of dreams. To 
 these may be added sleeping upon the back, by 
 which means the blood is disposed to stagnate in 
 the places above-mentioned, from an excess or 
 diminution of the force that moves it. Persons 
 who go to bed in good health, and are found 
 dead in their beds in the morning, it is supposed, 
 generally die of this disease. 
 
 Its remedies should be the same as for dreams, 
 with the additional one of sleeping alternately on 
 each side. 
 
 Of Somnambulism. 
 
 I shall introduce my remarks upon this disease 
 by copying Dr. Hartly's correct and perspicuous 
 account of its cause, in his " Observations upon 
 Man."
 
 302 ON THE DISEASES 
 
 " Those who walk and talk in their sleep (says 
 the doctor) have evidently the nerves of the mus- 
 cles concerned so free, as that vibrations [or ner- 
 vous influence] can descend from the internal 
 parts of the brain, the peculiar residence of ideas, 
 into them. At the same time, the brain itself is 
 so oppressed, that they have scarce any memory. 
 Persons who read inattentively, that is, see and 
 speak almost without remembering: also those 
 who labour under such a morbid loss of memory, 
 as that though they see, hear, speak and act, pro 
 ne wa/a, from moment to moment, yet forget all 
 immediately, somewhat resemble the persons 
 who walk and talk in their sleep." 
 
 Dreaming, I have said, is a transient paroxysm 
 of delirium. Somnambulism is nothing but a 
 higher grade of the same disease. It is a tran- 
 sient paroxysm of madness. Like madness it is 
 accompanied with muscular action, with inco- 
 herent, or coherent conduct, and with that com- 
 plete oblivion of both, which takes place in the 
 worst grade of madness. Coherence of conduct 
 discovers itself, in persons who are affected with 
 it undertaking, or resuming, certain habitual ex- 
 ercises or employments. Thus we read of the 
 scholar resuming his studies, the poet his pen, 
 and the artisan his labours, while under its influ-
 
 OP THE MIND. 303 
 
 ence, with their usual industry, taste and correct- 
 ness. It extended still further in the late Dr. 
 Blacklock, of Edinburgh, who rose from his bed, 
 to which he had retired at an early hour, came 
 into the room where his family was assembled, 
 conversed with them, and afterwards entertained 
 them with a pleasant song, without any of them 
 suspecting he was asleep, and without his retain- 
 ing, after he awoke, the least recollection of what 
 he had done. 
 
 Persons who are affected with this disease, 
 sometimes appear pale, and covered with profuse 
 sweats. 
 
 Its REMEDIES should be the same as for dream- 
 ing, when it arises from an increase of corporeal 
 or mental stimuli. I have read an account of 
 two cures being performed, by placing a tub of 
 water in the bedroom of the persons who were 
 afflicted with it.
 
 304 ON THE DISEASES 
 
 CHAPTER XV. 
 
 Of Illusions. 
 
 BY this term I mean that disease, in which 
 false perceptions take place in the ears and eyes 
 in the waking state, from a morbid affection of 
 the brain or of the s-ense which is the seat of the 
 illusion. It may be considered as a waking 
 dream. Persons affected with it, fancy they hear 
 voices, or see objects that do not exist. These 
 false perceptions are said, by superstitious peo- 
 ple, to be premonitions of death. They sometimes 
 indicate either the forming state or the actual 
 existence of disease, which being seated most 
 commonly in a highly vital part of the body, that 
 is, the brain, now and then ends in death, and 
 thus administers support to superstition. They 
 depend, like false perception in madness, upon 
 motion being excited in a part of the ear or the 
 eye, which does not vibrate with the impression
 
 OF THE MIND. 305 
 
 made upon it, but communicates it to a part upon 
 which the impression of the noise heard, or of the 
 person seen, was formerly made, and hence the 
 one becomes audible, and the other visible. 
 
 The deception, when made upon the ears, con- 
 sists most commonly in hearing our own names, 
 and for this obvious reason ; we are accustomed 
 to hear them pronounced more frequently than 
 any other words, and hence the part of the ear, 
 which vibrates with the sound of our names, 
 moves more promptly, from habit, than any other 
 part of it. For the same reason the deception, 
 when made upon the eyes, consists in seeing our 
 own persons, or the persons of our intimate 
 friends, whether living or dead, oftener than any 
 other people. The part upon the retina, from 
 which those images are reflected, moves more 
 promptly, from habit, than any other of that part 
 of the organ of vision. 
 
 The voice which is supposed to be heard, and 
 the objects which are supposed to be seen, are 
 never heard nor seen by two persons, even when 
 they are close to each other. This proves them 
 both to be the effect of disease in the single per- 
 son who hears, or sees, the supposed voice or ob- 
 ject. I am aware that this explanation of illu- 
 
 39
 
 306 ON THE DISEASES 
 
 sions may be applied to invalidate the accounts 
 that are given in the Old and New Testaments 
 of the supernatural voices and objects, that were 
 heard or seen by individuals, particularly by 
 Daniel, Elisha, and St. Paul ; but they should no 
 more have that effect, than the cures of diseases 
 that are performed by natural means should in- 
 validate the accounts that are given in those 
 books, of the same diseases being cured in a mi- 
 raculous manner. But, admitting the voices or 
 objects that were heard or seen, by the prophets 
 and apostle above-mentioned, to have been pro- 
 duced by a change in the natural actions of the 
 brain, or of the organs of hearing or seeing that 
 change, considering its design, was no less super- 
 natural, than if the voices or objects supposed to 
 have been heard, or seen, had been real. It is 
 remarkable, that in all those cases, where mira- 
 cles were necessary to establish a divine com- 
 mission, or a new doctrine, every circumstance 
 connected with them was distinctly heard, or 
 seen, not by an individual only, but by two or 
 three, and sometimes by several hundred wit- 
 nesses, in all of whom it is scarcely possible for 
 an illusion to have existed at the same time from 
 natural causes. 
 
 The remedies for illusions should be, bleeding,
 
 OP THE MIND. 307 
 
 purges, and low diet, when the pulse indicates 
 undue excitement in the arterial system. A cer- 
 tain Mr. Nicholai, a member of the Academy of 
 Sciences in Berlin, was much relieved of this 
 disease by the application of leeches to the 
 haemorrhoidal vessels. 
 
 In a reduced state of the system, the remedies 
 should be cordial diet and tonic medicines. Mr. 
 Nicholai heard the voices of his friends only 
 when he was alone, and in a state of inaction. 
 This fact suggests the advantages of company 
 and exercise, as additional remedies in this dis- 
 ease.
 
 308 ON THE DISEASES 
 
 CHAPTER XVI. 
 
 Of Revery, or Absence of Mind. 
 THIS disease is induced by two causes, 
 
 1. By the stimulus of ideas of absent subjects 
 being so powerful, as to destroy the perception 
 of .present objects ; and, 
 
 2. By a torpor of mind so great as not to feel 
 the impressions of surrounding objects upon the 
 sense. It is an inferior or feeble grade of ca- 
 talepsy. 
 
 It is more common from the latter than the 
 former cause. It is no objection to this asser- 
 tion, that it sometimes occurs in scholars, and in 
 men celebrated for their great literary attain- 
 ments. A capacity for acquiring knowledge is a 
 cheap endowment, and differs widely from that 
 capacity, which enables a man not only to ac- 
 quire knowledge from books, but to create it by 
 observation and reflection, and to apply it to the
 
 OP THE MIND. 309 
 
 useful purposes of life. The following account of 
 a clergyman, who died a few years ago in En- 
 gland, extracted from a late periodical work, will 
 serve to exhibit the nature and extent of this in- 
 tellectual disease, from the latter cause that was 
 mentioned. 
 
 "Mr. George Harvest, minister of Thames 
 Ditton, was one of the most absent men of his 
 time ; he was a lover of good eating, almost to 
 gluttony; and was further remarkable as a great 
 fisherman; very negligent in his dress, and a be- 
 liever in ghosts. In his youth he was contracted 
 to a daughter of the bishop of London ; but on 
 his wedding day, being gudgeon fishing, he over- 
 staid the canonical hour; and the lady, justly 
 offended at his neglect, broke off the match. He 
 had, at that time, an estate of 300/. per annum, 
 but, from inattention and absence, suffered his 
 servants to run him in debt so much, that it was 
 soon spent. It is said, that his maid frequently 
 gave balls to her friends and fellow servants of 
 the neighbourhood, and persuaded her master 
 that the noise he heard was the effect of wind. 
 
 " In the latter part of his life no one would 
 lend, or let him a horse, as he frequently lost his 
 beast from under him, or at least out of his hand^,
 
 310 ON THE DISEASES 
 
 it being his practice to dismount and lead his 
 horse, putting the bridle under his arm, which 
 the horse sometimes shook off, and sometimes it 
 was taken off by the boys, and the parson seen 
 drawing his bridle after him. 
 
 " Sometimes he would purchase a penny-worth 
 of shrimps, and put them in his waistcoat pocket, 
 among tobacco, worms, gentles for fishing, and 
 other trumpery : these he often carried about him 
 till they stunk, so as to make his presence almost 
 insufferable. I once saw such a melange turned 
 out of his pocket by the dowager lady Pembroke. 
 With all these peculiarities, he was a man of 
 some classical learning, and a deep metaphysi- 
 cian, though generally reckoned a little cracked. 
 
 " Such was his absence and distraction, that he 
 frequently used to forget the prayer days, and to 
 walk to his church with his gun, to see what 
 could have assembled the people there. 
 
 " In company he never put the bottle round, 
 but always filled when it stood opposite to him ; 
 so that he very often took half a dozen glasses 
 running. That he alone was drunk, and the rest 
 of the company sober, is not, therefore, to be 
 wondered at.
 
 
 OP THE MIND. 311 
 
 " One day Mr. Harvest, being in a punt on the 
 river Thames with Mr. Ostow, began to read a 
 beautiful passage in some Greek author, and 
 throwing himself backwards in an ecstacy, fell 
 into the water, whence he was with difficulty 
 fished out. 
 
 " Once, being to preach before the clergy at 
 the visitation, he had three sermons in his pocket: 
 some wags got possession of them, mixed the 
 leaves and sewed them all up as one: Mr. Har- 
 vest began his sermon, and soon lost the thread 
 of his discourse, and got confused : but neverthe- 
 less continued, till he had preached out first all 
 the church-wardens, and next the clergy, who 
 thought he was taken mad." 
 
 It is possible moderate depletion, succeeded 
 by constant and noisy company might produce in 
 the mind a predominance of impressions from 
 present objects, over those of the ideas of absent 
 subjects. Stimulants, particularly such as act 
 upon the brain and nervous system, would pro- 
 bably be useful, when the disorder arises from 
 torpor of mind, or insensibility of the senses.
 
 312 ON THE DISEASES 
 
 CHAPTER XVII. 
 
 On Derangement of the Passions. 
 
 THE passions have been divided into two great 
 classes, 1, such as are intended to impel us to 
 real or supposed good ; and, 2, such as are in- 
 tended to defend us from real, or supposed evil. 
 The former are objects of desire, the latter of 
 aversion. Those of them which are most sub- 
 ject to derangement, or to an unreasonable and 
 morbid excess, are love, grief, fear, and anger. 
 After mentioning the symptoms of their diseases, 
 and their remedies, I shall consider that morbid 
 phenomena of joy, envy, malice, and hatred, and 
 conclude the chapter with a few remarks upon 
 the torpor of the passions. 
 
 Of Love. 
 
 This passion, which was implanted in the hu- 
 man breast for the purpose of bringing the sexes 
 together, and thereby increasing their happiness, 
 becomes a disease only where it is disappointed in
 
 OP THE MIND. 313 
 
 its object. The symptoms of love, when it creates 
 disease, are sighing, wakefulness, perpetual talk- 
 ing, or silence, upon the subject of the object be- 
 loved, and a predilection to solitude. Where 
 these symptoms do not discover its existence, it 
 may be known in a man, by blushing, and an 
 increased frequency of pulse, when the name of 
 the person beloved is mentioned; and in a wo- 
 man, according to La Bruyere, "by her con- 
 stantly looking at the man she loves, when in 
 company, or never looking at him at all." It is 
 known further in a woman, by her retiring to de- 
 corate herself upon the appearance of the man in 
 company whom she loves. It always renders a 
 woman awkward, but it polishes the manners of 
 men. The effects of unsuccessful love are dys- 
 pepsia, hysteria, hypochondriasis, fever, and mad- 
 ness. The last has sometimes induced suicide, 
 while all the others have now and then ended in 
 death. 
 
 The remedies for this disease, when accompa- 
 nied with fever or great excitement, in the brain, 
 or any other part of the system, should be, 
 
 1. Bleeding, blistering, and the other remedies 
 for similar states of the system from other causes. 
 It is remarkable, that persons who have been 
 
 40
 
 314 ON THE DISEASES 
 
 cured of the diseases from love, by these reme- 
 dies, recover without feeling any affection for the 
 persons they have loved. This was the case with 
 one of the princes of Conde. He complained, in 
 this state of mind, that his physicians had drawn 
 off all his love for his mistress by their depleting 
 remedies. 
 
 2. Ovid advises what he calls a " binam ami- 
 cam," that is, a new mistress, for unsuccessful 
 love. I have known this remedy to succeed in 
 several instances. The sincerity of a former 
 attachment is often called in question, by a sud- 
 den translation of the affections to a second mis- 
 tress, but without any foundation. Indeed, it 
 proves its sincerity, for its ardour admits of no 
 other cure. 
 
 3. The same master of the subject of love, 
 Ovid, advises an unsuccessful lover to find out, 
 and dwell upon all the bad qualities, and defects, 
 in person and accomplishments, of his mistress. 
 " If she have a bad voice (says he) press her to 
 sing ; if she touch a musical instrument clumsily, 
 beg her to expose herself by playing upon one of 
 them." 
 
 4. The company of the person beloved should 
 be carefully avoided. A voyage or journey should
 
 OP THE MIND. 3 1 5 
 
 be advised in this case, for absence has been 
 justly styled the tomb of love. The company of 
 strangers, by checking all conversation about the 
 person beloved, prevents the passion being che- 
 rished by it. 
 
 5. Constant employment will aid absence as a 
 remedy for hopeless love. The more that em- 
 ployment interests the understanding, the more 
 completely it will have that effect. The disease 
 is more than half cured when the distressed lover 
 ceases to think of the object of his affections. 
 
 6. As hope and love are born together, so they 
 can only die together. Uncommon pains there- 
 fore should be taken, in curing love, to extinguish 
 every spark of hope in a lover. This advice is 
 given with singular good sense and humanity by 
 Dr. Gregory, in his Legacy to his Daughters, 
 upon the subject of courtship and marriage. 
 
 7. Unsuccessful love is cured by exciting a 
 more powerful passion in the mind. Ambition 
 should be preferred for this purpose. Its efficacy 
 is taken notice of by the duke of Rochefaucalt. 
 " Ambition (he says) may succeed love, but love 
 never cures ambition."
 
 316 ON THE DISEASES 
 
 Of Grief. 
 
 Physicians, in their unsuccessful efforts to save 
 life, are often obliged to witness this passion. It 
 is of consequence for them, therefore, to be well 
 acquainted with its symptoms and cure. 
 
 Its symptoms are acute and chronic. The for- 
 mer are, insensibility, syncope, asphyxia, and apo- 
 plexy; the latter are, fever, wakefulness, sighing, 
 with and without tears, dyspepsia, hypochondri- 
 asis, loss of memory, gray hairs, marks of prema- 
 ture old age in the countenance, catalepsy, and 
 madness. It sometimes brings on sudden death, 
 without any signs of previous disease, either acute 
 or chronic. Dissections of persons who have died 
 of grief, show congestion in, and inflammation of, 
 the heart, with a rupture of its auricles and ven- 
 tricles. But there are instances, in which the 
 sympathy of the heart with the whole system is so 
 completely dissevered by grief, that the subject of 
 it discovers not one mark of it in his countenance 
 or behaviour. On the contrary, he sometimes 
 exhibits signs of unbecoming levity in his inter- 
 course with the world. This state of mind soon 
 passes away, and is generally followed by all the
 
 OP THE MIND. 317 
 
 obvious and natural signs of the most poignant 
 and durable grief. 
 
 There is another symptom of grief, which is 
 not often noticed, and that is profound sleep. I 
 have often witnessed it even in mothers, imme- 
 diately after the death of a child. Criminals, we 
 are told by Mr. Akerman, the keeper of Newgate 
 in London, often sleep soundly the night before 
 their execution. The son of General Custine 
 slept nine hours, the night before he was led to 
 the guillotine in Paris. These facts, and many 
 similar ones that might be mentioned, will serve 
 to vindicate the disciples of our Saviour from a 
 want of sympathy with him in his suffering. They 
 slept during his agony in the garden, because 
 their " flesh was weak," and in consequence of 
 " sorrow having filled their hearts." 
 
 The remedies for grief are physical and moral. 
 To enumerate the latter would be foreign to the 
 design of these inquiries. They belong moreover 
 to another profession. I shall barely glance at 
 them without separating them from those that 
 are of a physical nature. 
 
 The first remedy, that is indicated in recent 
 grief, is opium. It should be given in liberal 
 doses in its first paroxysm, and it should be re-
 
 318 ON THE DISEASES 
 
 peated afterwards, in order to obviate wakeful- 
 
 ness. 
 
 2. From the relief which the discharge of tears 
 affords in grief, pains should be taken to procure 
 it. The means for this purpose are, obtruding 
 upon the mind a sorrow of a less grade than that 
 by which it is depressed. Ancient history fur- 
 nishes us with a pathetic example of the efficacy 
 of this remedy. Psamminitus, one of the kings 
 of Egypt, with his son. daughter and servant, 
 were taken prisoners by Cambysis, king of Persia. 
 Soon after his captivity, he beheld his daughter 
 sent in the habit of a servant to draw water. 
 This sight drew tears from his attendants, but 
 produced no sign of distress in the king of Egypt. 
 Immediately afterwards his son was conducted 
 before his eyes to a place of execution. This 
 sight he likewise saw without an emotion of any 
 kind. His servant next appeared before him, 
 among a number of other captives. This sight, 
 although accompanied with less distress than the 
 two former, overcame him, and he suddenly burst 
 into tears. It has been said, that " sorrows sel- 
 dom come alone." The goodness of heaven is 
 obvious in this dispensation of the evils of life ; 
 for, as sorrows generally differ in their degrees, 
 such of them as are great, by weakening sensi-
 
 OF THE MIND. 319 
 
 bility, lessen the pain from the pressure of suc- 
 cessive lighter ones, while such as are originally 
 light, prepare the mind for the pressure of such 
 as exceed them. 
 
 3. Should the system re-act, and symptoms of 
 great excitement appear in the blood-vessels or 
 brain, bleeding and purges should be prescribed. 
 The latter will be rendered necessary, by the ex- 
 hibition of opium. 
 
 4. The persons afflicted with grief, should be 
 carried from the room in which their relations 
 have died, nor should they ever see their bodies 
 afterwards. They should by no means be per- 
 mitted to follow them to the grave. It would be 
 useful to inter the body of the deceased as far as 
 possible from the view of the person, who is the 
 subject of grief. Grave-yards in a city, and in 
 places of public resort, are very improper, inas- 
 much as they either renew, and perpetuate grief, 
 or create insensibility to death, and a criminal 
 indifference to human dust. The patriarch Abra- 
 ham understood these principles in the human 
 heart; hence we read, when his wife died, he re- 
 fused to bury her in the sepulchres of the sons of 
 Heth, but entreated them to sell him a piece of 
 ground, that he might bury her out of his sight."
 
 320 ON THE DISEASES 
 
 A similar practice was adopted by the descen- 
 dants of this patriarch, who inhabited ancient 
 Judea. Their grave-yards were always placed 
 2000 cubits from their cities. The sepulchres or 
 vaults of the wealthy were in their gardens, which 
 were situated in the neighbourhood of their cities. 
 These facts will render not only more credible, 
 but more intelligible, the account given in the 
 New Testament of the agony of our Saviour 
 being in a garden, near the city of Jerusalem, and 
 his tomb, a sepulchre in which no man had laid. 
 
 The Chinese, like the Jews, inter their dead 
 out of their cities. The Russians bury their dead 
 after night, probably to prevent unnecessary grief. 
 
 5. As soon as the ceremonies and bustle of 
 the funeral are over, persons afflicted with grief 
 should be advised to receive the visits of their 
 friends, of whom the physician should always be 
 one. In their first visit to persons recently be- 
 reaved of their relations, they should imitate the 
 conduct of Job's friends, who after weeping for 
 his losses and afflictions when they beheld him 
 afar off, the sacred historian tells us, " sat down 
 with him upon the ground, seven days, and seven 
 nights, and none spake a word to him, for the/ 
 saw his grief was very great." Mr. Sterne has
 
 OF THE MIND. 321 
 
 imitated, but not equalled, this delicate and af- 
 fecting passage, in his history of his uncle Toby. 
 In his first visit to his brother, after the death of 
 his son, " he sat down (says Sterne) in an armed 
 chair, at the head of a bed in which his brother 
 
 lay, and said nothing." There is science, 
 
 as well as sympathy in this silence, for in this 
 way, grief most rapidly passes from the bosom of 
 the sufferer into that of his friend. 
 
 As soon as it is proper to begin a conversation 
 with a person under the pressure of recent grief, 
 such consolations should be suggested, as are 
 offered by reason and religion. Dr. Stonehouse, 
 the physician and friend of the pious Mr. Harvey, 
 made it a practice to send a copy of a little work, 
 entitled " The Mourner," written by Dr. Grove- 
 nor, to the friends of every patient he lost. It is 
 an excellent book, and well calculated to com- 
 pose the mind under this kind of affliction. A 
 physician should listen to the history of the last 
 stage of his patient's disease, and to the details 
 of the appearances of the body after death. Much 
 knowledge may be picked up in this way, which 
 would otherwise perish. If any prejudice or mis- 
 take has taken place respecting his opinion of 
 the nature of the disease of which his patient has 
 died, or of the effects of any of his remedies, he 
 
 41
 
 322 ON THE DISEASES 
 
 may remove or correct them. By a visit thus 
 paid, and employed, a physician not only wards 
 off any complaint of his want of skill, but in- 
 creases the confidence of his patients in it, and 
 often secures their attachment to him through 
 his subsequent life. 
 
 6. After the expiration of -the weeks of mourn- 
 ing, care should be taken never to mention the 
 names of the deceased persons to any of their 
 friends, nor to allude to any thing that by means 
 of association can revive their memories. The 
 appearance of mirth and even cheerfulness, should 
 be avoided. They both often give not only pain, 
 but offence, to a mind rendered exquisitely sensi- 
 ble by recent grief. 
 
 Physicians are sometimes called upon to men- 
 tion the deaths of relations to their patients. 
 This should never be done at once. They should 
 be first told that they were sick, and in great 
 danger, and the news of their death should not 
 be communicated until after a second or third visit. 
 
 Of Fear. 
 
 There are so much danger and evil in our 
 world, that the passion of fear was implanted in
 
 OP THE MIND. 323 
 
 our minds for the wise and benevolent purpose 
 of defending us from them. 
 
 The objects of fear are of two kinds. 
 
 I. Reasonable. These are, death, and surgi- 
 cal operations. And, 
 
 II. Unreasonable. These are, thunder, dark- 
 ness, ghosts, speaking in public, sailing, riding, 
 certain animals, particularly cats, rats, insects 
 and the like. 
 
 The effects of fear, when it acts suddenly upon 
 the system, are tremors, quick pulse and respira- 
 tion, globus hystericus, a discharge of pale urine, 
 diarrhoea, and sometimes an involuntary dis- 
 charge of the fa&ces,- aphonia, fever, convulsions, 
 syncope, mania, epilepsy, asphyxia, death. Dr. 
 Brambilla relates the case of a soldier, in whom 
 fear produced not only a fever, but a mortifica- 
 tion from a blister on the leg, which destroyed 
 his life. Besides these general effects of fear, it 
 acts in a peculiar manner upon the hair of the 
 head. 1. In causing it to stand perpendicular. 
 This has been happily described by Virgil and 
 Shakspeare. 2. In converting it suddenly to a 
 gray or white colour, and, 3, in causing it to come
 
 324 ON THE DISEASES 
 
 out by the roots, and to fall off the head. Of this 
 Dr. Huch informed me he knew an instance in a 
 gentleman who was in Lisbon, at the time of the 
 great earthquake in 1755. Other effects of fear 
 have been lately noticed. The earthquake which 
 took place on the shores of the Mississippi, in 
 December 1811, produced silence or great talka- 
 tiveness, and moping stillness or constant mo- 
 tion, in different people. 
 
 The remedies for fear are physical, rational, 
 and moral ; and here, as in the preceding chap- 
 ter, I shall only hint at the moral remedies, and 
 blend them with such as are of a rational and 
 physical nature. 
 
 I. Of the remedies for the reasonable objects 
 of fear. 
 
 The first object of fear under this head is death. 
 Its remedies are, 
 
 1. Just opinions of the divine government, and 
 of the relation we sustain to the great Author of 
 our being. These opinions may be best formed 
 by reading the scriptures, and such other books 
 as derive their arguments for fortifying the mind 
 against this fear from them, particularly the works
 
 OF THE MIND. 325 
 
 of Dr. Sherlock and Mr. Drelincourt, both of 
 which contain a treasure of knowledge and con- 
 solation upon this subject. 
 
 2. As much of the fear of death is produced by 
 the dread of the pains which attend it, let us in- 
 form our patients that these pains are by no 
 means universal, that they are less severe than the 
 pains of many common diseases, from which there 
 are daily recoveries, and that heaven has kindly 
 furnished us with several remedies, which remove 
 or mitigate them. " It is less distressing to die 
 (says Mr. Pascall) than to think of death." This 
 I believe is strictly true in most cases. 
 
 3. The recollection of frequent escapes from 
 death. David met Goliah without fear, when he 
 recollected his escapes from his conflicts with a 
 lion and a bear. Soldiers become brave, in pro- 
 portion to the number of battles they have sur- 
 vived. 
 
 4. The frequent meditation upon death. Dr. 
 Horn mentions an instance of a man, who was 
 not only cured of the fear of death, by setting a 
 portion of time, every day, to meditate upon it, 
 but the subject at length became agreeable to 
 him. In this, as well as in many other instances,
 
 
 326 ON THE DISEASES 
 
 painful impressions upon the mind are upon a 
 footing with painful impressions upon the body, in 
 being converted by repetition into such as are of 
 a pleasurable nature. 
 
 5. CONSTANT employment is an antidote to the 
 fear of death ; for fear, like vice, is the offspring of 
 idleness. 
 
 6. We have an account of a method of obviat- 
 ing the fear of death from a public execution, in 
 Miss Williams's history of the conduct of the 
 Marquis de Chatelet, and General Miranda, du- 
 ring their confinement in Paris, and at a time 
 when they expected every day to be led to the 
 guillotine. They read books of history and sci- 
 ence constantly when alone, and conversed upon 
 no other subjects when together ; and although 
 they were confined for six months in the same 
 apartment, they never spoke to each other of 
 their impending and expected fate, by which 
 means they lessened the fear of it. This account 
 was confirmed to me by General Miranda, in his 
 visit to this city a few years ago. Boys obviate 
 fear, in like manner, by silence in passing by a 
 grave-yard, or by conversing upon subjects uncon- 
 nected with death. It is not peculiar to the pas-
 
 OP THE MIND. 327 
 
 sion of fear to be increased by conversation. All 
 the other passions arc excited by it. 
 
 7. The fear of death is sometimes obviated by 
 company in the last hours of life. " Is is not so 
 difficult a thing to die (said Lewis the Fourteenth, 
 on his death bed) as I expected." Voltaire, who 
 mentions this anecdote, endeavours to account 
 for it, by adding, that all men die with composure 
 or fortitude, who die in company. The courage 
 of soldiers is derived, in a great degree, from be- 
 ing surrounded by persons who will bear a testi- 
 mony in its favour. 
 
 8. Music suspends the fear of death : hence its 
 universal use in battle. Even noise of any kind 
 dissipates fear; hence boys obviate it not only by 
 silence when in company, but by whistling, or hal- 
 looing when they pass by a grave-yard alone after 
 night. 
 
 9. OPIUM has a wonderful effect in lessening the 
 fear of death. I have seen patients cheerful in 
 their last moments, from the operation of this 
 medicine upon the body and mind. 
 
 10. The fear of a surgical operation may be 
 very much lessened by previous company, and a
 
 328 ON THE DISEASES 
 
 large dose of opium. Its pain may be mitigated 
 by the gradual application of the knife, and, in 
 tedious operations, by short intermissions in the 
 use of it. 
 
 II. Of the unreasonable objects of fear. These 
 
 are, 
 
 1. Thunder. The remedies for it are, 
 
 1. Living in a house defended by a lightning 
 rod. 
 
 2. Sitting in the middle of a room, and remote 
 from the doors and windows of a house, not de- 
 fended by a lightning rod. 
 
 3. A citizen of Philadelphia, who was under 
 the influence of this fear, obviated it in a degree 
 by closing the doors and windows of a room, and 
 sitting with a lighted candle in it. By this means 
 he avoided the sight of the lightning, and the 
 anticipation of the noise of the thunder which 
 usually follows it. 
 
 4. A lady of respectable character, formerly of 
 this city, usually fainted with terror during the time 
 of a thunder-gust, and discovered, by a livid coun- 
 tenance, and cold and clammy sweats, the signs of
 
 OP THE MIND. 329 
 
 approaching death. She was apparently kept 
 alive, by pouring into her stomach three or four 
 wine glasses of Jamaica spirits : it was remarka- 
 ble she never was intoxicated by it, and that it 
 was disagreeable to her at all other times. 
 
 5. I crossed the Atlantic Ocean with a lady, in 
 whom an acute headach was always induced by 
 thunder. It left her as soon as the thunder 
 ceased. Her only remedies for it, were quietness 
 and silence. It is probable a large dose of lauda- 
 num, taken upon the appearance of a thunder- 
 gust, would have prevented this headach, as well 
 as obviated the terror mentioned in the two pre- 
 ceding cases, more effectually than a close room 
 artificially lighted, or a large quantity of ardent 
 spirits. 
 
 2. The fear which is excited by darkness, may 
 easily be overcome by a proper mode of educa- 
 tion in early life. It consists in compelling chil- 
 dren to go to bed without a candle, or without 
 permitting company to remain with them until 
 they fall asleep. 
 
 3. The fear of ghosts should be prevented or 
 subdued in early life, by teaching children the ab- 
 
 42
 
 330 ON THE DISEASES 
 
 surdity and falsehood of all the stories that are 
 fabricated by nurses upon that subject. 
 
 4. The fear from speaking in public was always 
 obviated by Mr. John Hunter, by taking a dose of 
 laudanum before he met his class every day. 
 
 5. The fear from sailing, riding, and from cer- 
 tain animals and insects, may all be cured by re- 
 solution. It should be counteracted in early life. 
 The existence of it always shows a defective edu- 
 cation. Peter the Great, of Moscovy, was born 
 with a dread of water. He cured it, by throwing 
 himself headlong into a boat when obliged to 
 cross a river. The horror he felt in doing this 
 often induced syncope. He finally conquered his 
 dread of water, so as to cross seas in pursuit of 
 the great objects which characterized his life and 
 reign. 
 
 In cases of sudden fear from any cause, holding 
 the breath, coughing, or hawking, often give im- 
 mediate relief. They impart tone to the brain, 
 by promoting a determination of blood to it, and 
 thus infuse vigour into the mind. 
 
 To obviate fear from all its causes, great ad- 
 vantages will arise from creating counter motives
 
 OP THE MIND. 331 
 
 in the mind. The fear of death in a battle is 
 overcome by the powerful sense of glory, or 
 shame. The fear of the pain of an operation, 
 such as drawing a tooth in a child, is overcome 
 by the expectation of receiving afterwards a piece 
 of money, and the prospect of all the pleasures it 
 will procure. 
 
 Great advantages may likewise be derived for 
 the cure of fear, by a proper application of the 
 principle of association. A horse will seldom be 
 moved by the firing of a gun, or the beating of a 
 drum, if he hear them for the first time while he 
 is eating; nor will he start, or retire from a 
 wheel-barrow, or a millstone, or any other object 
 of that kind, after being once or twice fed upon 
 them. The same law of association may be ap- 
 plied in a variety of instances to the human mind, 
 as well to the prevention, as cure of fear. 
 
 Of Anger. 
 
 This passion was implanted in the human mind 
 for wise and useful purposes. Its exercises, with- 
 in certain limits, are admitted in the scriptures. 
 It is only when it ascends to rage and fury, or 
 when it is protracted into malice and revenge, 
 that it becomes a sin and a disease.
 
 332 ON THE DISEASES 
 
 A morbid paroxysm of anger appears in a pre- 
 ternatural determination of blood to the brain, a 
 turgescence of the blood-vessels of the face, a 
 redness of the eyes, an increased secretion of 
 saliva, which is discharged by foaming at the 
 mouth, great volubility or a total suppression of 
 speech, agitations of the fists, stamping of the feet, 
 uncommon bodily strength, convulsions, hysteria, 
 bleeding at the nose, apoplexy and death. Some- 
 times this disease appears with paleness, tremors, 
 sickness at the stomach, quick respiration, 
 puking, syncope and asphyxia. It is in this case 
 generally combined with fear, and hence arises 
 the abstraction of blood from the brain, and its 
 determination to other parts of the body. 
 
 The remedies for anger, when it becomes a 
 disease, divide themselves into two classes; I. 
 such as are proper during its paroxysms ; and II. 
 such as are proper in their intervals, to prevent 
 their recurrence. 
 
 I. To the first head belong, 
 
 1. A draught of COLD WATER. This acts in two 
 ways ; I, as a sedative ; and 2, by giving time for 
 reflection.
 
 OF THE MIND. 333 
 
 2. COLD WATER thrown over the whole body 
 has in several instances cured a paroxysm of 
 anger. It never fails to part two angry, contend- 
 ing dogs. 
 
 . i- , , 
 
 3. SILENCE. This should be observed by per- 
 sons, when they are disposed to excessive anger. 
 If this be impracticable, let the angry person 
 repeat the Lord's prayer ; or, if he be indisposed 
 to do this, let him count twenty. The actions of 
 the organs of speech, employed in either, will 
 serve to convey off a portion of excitement from 
 his mind, as well as to give time for the reflux of 
 blood from the brain. 
 
 4. The celebrated general Galvez, formerly of 
 the Spanish army, made it a practice, when he 
 felt himself disposed to be angry, to drink a bot- 
 tle of claret. It instantly composed his mind, pro- 
 bably by overcoming a weak morbid action, and 
 producing agreeable and healthy excitement in 
 his brain. A dose of laudanum would be a better 
 remedy for this purpose. It could not fail of be- 
 ing effectual in anger attended with fear, and a 
 determination of the blood to the stomach and 
 viscera of the thorax.
 
 334 OX THE DISEASES 
 
 II. The means of preventing the recurrence of 
 anger shouldrbe, 
 
 1. A milk and vegetable diet. Dr. Arbuthnot 
 says he has seen an irascible diathesis perfectly 
 cured by this remedy. 
 
 2. Avoiding speaking with a loud voice at all 
 times, and especially when disposed to anger. 
 
 3. Avoiding the use of ardent and fermented 
 liquors. They predispose to anger, even where 
 they do not intoxicate. 
 
 4. Ballonius says, that fatigue and thirst pre- 
 dispose to anger. Hunger certainly has that 
 effect. They should both therefore be carefully 
 avoided by irascible persons. 
 
 5. Opposing to anger other passions which de- 
 stroy it. Thetys, I remarked formerly, eradicated 
 the anger of her son Achilles, by exciting in his 
 mind the passion of love. Fear has had the same 
 effect. The threat and the dread of a severe 
 punishment has often prevented it in school boys 
 and servants.
 
 
 OF THE MIND. 335 
 
 6. The cultivation of the understanding has a 
 great influence in destroying the predisposition to 
 anger. Science of all kinds is useful for this pur- 
 pose, but the mathematics possess this property 
 in the most eminent degree. They produced that 
 effect upon the temper of Sir Isaac Newton, of 
 which the following instance is mentioned by one 
 of his cotemporaries. 
 
 Upon seeing a large collection of papers on fire 
 that contained the calculations of many years, in 
 consequence of his little dog jumping upon his 
 table and oversetting his candle upon them, he 
 barely uttered the following words ; " O ! Dia- 
 mond ! Diamond ! little dost thou know the mis- 
 chief thou hast done thy master." I shall men- 
 tion in another place an instance of one of his 
 appetites being subdued in like manner, by his 
 mind being constantly occupied by mathematical 
 and philosophical studies. I am disposed to 
 ascribe more to those studies than to any others, 
 from their extending a sedative and moral influ- 
 ence to all the passions. The late Rev. Mr. 
 Farmer, one of the ministers of the Catholic 
 church in this city, informed me that demonstating 
 two or three propositions in Euclid, before he 
 retired to his closet for the purpose of devotion, 
 never failed to have that effect upon his mind.
 
 336 
 
 ON THE DISEASES 
 
 7. It will be useful for persons subject to the 
 criminal degrees of this passion, to reflect that it 
 is not only contrary to religion and morals, but 
 to liberal manners. The term gentleman implies 
 a command of this passion, above all others. 
 
 Of Joy. .-..,;,,, 
 
 This emotion is attended sometimes with pain 
 in the region of the heart, a change in the voice, 
 tears, syncope, and death. Mr. Bruce mentions 
 another symptom of excessive joy, and that is 
 thirst, which he felt in a high degree, when he 
 reached the long sought for head of the Nile. He 
 gratified it, he tells us, by drinking the health of 
 his sovereign, George the Third, and of his mis- 
 tress, by a draught from the fountain of that cele- 
 brated river. 
 
 Joy is most intense, when it has been preceded 
 by fear. The Indian Chief, Logan, has desig- 
 nated this form of joy in his eloquent speech, pre- 
 served by Mr. Jefferson, in his Notes upon Virgi- 
 nia, when he declares that " he knew not the joy 
 of fear." 
 
 There are many instances upon record, of death 
 being induced by a sudden paroxysm of joy. The
 
 OF THE MIND. 337 
 
 son of the famous Leibnitz died from this cause, 
 upon his opening an old chest, and unexpectedly 
 finding in it a large quantity of gold. Joy, from 
 the successful issue of political schemes or 
 wishes, has often produced the same effect. Pope 
 Leo the Tenth died of joy, in consequence of 
 hearing of a great calamity that had befallen the 
 French nation. Several persons died from the 
 same cause, Mr. Hume tells us, upon witnessing 
 the restoration of Charles the Second to the Bri- 
 tish throne ; and it is well known the door-keeper 
 of Congress died of an apoplexy, from joy, upon 
 hearing the news of the capture of Lord Corn- 
 wallis and his army, during the American revolu- 
 tionary war. 
 
 During a paroxysm of joy, if it be attended with 
 danger to life, a new emotion or passion should 
 be excited, particularly terror, anger, fear, or grief. 
 Perhaps the affusion of cold water might have 
 that effect. The stimulus of artificial pain should 
 likewise be tried. It should be of a nature calcu- 
 lated to produce the most prompt effects. 
 
 The morbid state of joy should be prevented, 
 by imparting the news which we expect will 
 create it, in a gradual manner, and with the alloy 
 of some unpleasant circumstances. 
 
 43
 
 338 ON THE DISEASES 
 
 Connected with joy, but produced by different 
 causes, is LAUGHTER. It is a convulsive disease, 
 and sometimes induces a rupture of a blood- 
 vessel in the lungs, spleen, or brain. I have seen 
 an instance of haemoptysis induced by it, which 
 had a fatal issue. Two sudden deaths are upon 
 record from it, the one of Chrysippus, an ancient 
 Greek philosopher, the other of a pope. It was 
 induced in the latter, while he was confined to his 
 bed with a light indisposition, by seeing a tame 
 monkey put on a part of his pontifical robes. 
 Excessive laughter, when not attended with these 
 fatal effects, is often followed with a pain in the 
 left side, hiccup, and low spirits. 
 
 The remedies for a paroxysm of laughter 
 should be, fear, terror, or any other counter im- 
 pression. Pinching the body, or the affusion of 
 cold water over it, is calculated to produce the 
 same good effects. Laudanum seldom fails of 
 relieving the pain, hiccup, and low spirits, which 
 sometimes follow it. 
 
 Of the Morbid Effects of Envy, Malice, and 
 Hatred. 
 
 As envy is commonly the parent of malice and 
 hatred, I shall make a few remarks upon it, and
 
 OF THE MIND. 339 
 
 afterwards mention the combined effects of them 
 all upon the body. 
 
 Of this vice it may be truly asserted, that it is 
 deep seated, and always painful; hence it has 
 been said, by an inspired writer, to resemble 
 "rottenness in the bones;" and by Lord Bacon, 
 " to know no holidays." It is likewise a monopo- 
 lizing vice. Alexander envied his successful gene- 
 rals, and Garrick was hostile to all the popular 
 players of his day. It is moreover a parricidal 
 vice, for it not only emits its poison against its 
 friends, but against the persons, who, by the 
 favours it has conferred upon those who cherish 
 it, have become in one respect the authors of 
 their being; and, lastly, it possesses a polypus 
 life. No kindness, gentleness, or generosity, can 
 destroy it. On the contrary, it derives fresh 
 strength from every act which it experienced of 
 any of them. It likewise survives and often for- 
 gives the resentment it sometimes occasions, but 
 without ceasing to hate the talents, virtues, or per- 
 sonal endowments, by which it was originally ex- 
 cited. Nor is it satiated by the apparent extinc- 
 tion of them in death. This is obvious, from 
 its so frequently opening the sanctuary of the 
 grave, and robbing the possessors of those quali- 
 ties of the slender remains it had left them of 
 posthumous fame.
 
 
 340 ON THE DISEASES 
 
 However devoid this vice and its offspring may 
 be of remissions, they now and then appear in the 
 form of paroxysms, which discover themselves in 
 tremors, paleness, and a suffusion of the face with 
 red blood. The face in this case performs the 
 vicarious office which has lately been ascribed to 
 the spleen. But their effects appear more fre- 
 quently in slow fevers, and in a long train of ner- 
 vous diseases. Persons affected with them sel- 
 dom acknowledge their true cause. A single in- 
 stance only of this candour is mentioned by Dr. 
 Tissot. He tells us he was once consulted by a 
 gentleman, who told him all his complaints were 
 brought on by his intense and habitual hatred of 
 an enemy. Many of the chronic diseases of high 
 life, and professional men, I have no doubt, are 
 induced by the same cause. 
 
 I once thought that medicine had not a single 
 remedy in all its stores, that could subdue or even 
 palliate the diseases induced by the baneful pas- 
 sions that have been- described, and that an anti- 
 dote to them was to be found only in religion; but 
 I have since recollected one, and heard of another 
 physical remedy, that will at least palliate them. 
 The first is, frequent convivial society between 
 persons who are hostile to each other. It never 
 fails to soften resentments, and sometimes to pro-
 
 OF THE MIND. 341 
 
 duce reconciliation, and friendship. The reader 
 will be surprised, when I add, that the second phy- 
 sical remedy was suggested to me by a madman 
 in the Pennsylvania Hospital. In conversing with 
 him, he produced a large collection of papers, 
 which he said contained his Journal. " Here 
 (said he) I write down every thing that passes in 
 my mind, and particularly malice and revenge. 
 In recording the latter, I feel my mind emptied of 
 something disagreeable to it, just as a vomit 
 empties the stomach of bile. When I look at 
 what I have written a day or two afterwards, I 
 feel ashamed and disgusted with it, and wish to 
 throw it into the fire." I have no doubt of the 
 utility of this remedy for envy, malice, and hatred, 
 from its salutary effects in a similar case. A gen- 
 tleman in this city informed me, that after writing 
 an attack for the press upon a person who had 
 offended him, he was so struck with its malignity, 
 upon reading it, that he instantly destroyed it. 
 The French nobility sometimes cover the walls 
 and ceiling of a room in their houses with look- 
 ing glasses. The room, thus furnished, is called 
 a boudoir. Did ill-natured people imitate the 
 practice of the madman and the gentleman I have 
 mentioned, by putting their envious, malicious, 
 and revengeful thoughts upon paper, it would
 
 342 ON THE DISEASES 
 
 form a mirror, that would serve the same purpose 
 of pointing out, and remedying, the evil disposi- 
 tions of the mind, that the boudoirs in France 
 serve, in discovering and remedying the defects 
 in the attitudes and dress of the body. 
 
 To persons who are not ashamed, nor disgust- 
 ed, with the first sight of their malevolent effu- 
 sions upon paper, the same advice may be given, 
 that Dr. Franklin gave to a gentleman, who read 
 part of a humorous satire which he had written 
 upon the person and character' of a respectable 
 citizen of Philadelphia. After he had finished 
 reading it, he asked the Doctor what he thought 
 of his publishing it. "Keep it by you," said the 
 Doctor, " for one year, and then ask me that 
 question." The gentleman felt the force of this 
 answer, and went immediately to the printer, who 
 had composed the first page of it, took it from 
 him. and consigned the whole manuscript to 
 oblivion. 
 
 I shall conclude the history of the passions, by 
 remarking, that their symptoms, and force, are 
 varied by a difference in predisposition, age, rank 
 in society, profession, moral and religious habits, 
 duration, and by their acting singly, or in combi- 
 nation with each other.
 
 OF THE MIND. 343 
 
 There is now and then a TORPOR OF THE PAS- 
 SIONS, the reverse of the diseases in them which 
 have been described. Instead of being unduly 
 excited, they are devoid of all sensibility and irri- 
 tability. Persons who are thus affected love and 
 fear nothing. They are strangers to grief and 
 anger; they envy and hate nobody; and they are 
 alike insensible to mental pleasure and pain. 1 
 was once consulted by a citizen of Philadelphia, 
 who was remarkable for his strong affection for 
 his wife and children when his mind was in a 
 sound state, who was occasionally afflicted with 
 this apathy, and when under its influence lost his 
 affection for them all, so entirely, that he said he 
 could see them butchered before his eyes without 
 feeling any distress, or even an inclination to rise 
 from his chair to protect them. 
 
 This paralytic state of all the passions con- 
 tinues during life in some people; a physician of 
 great eminence, who died some years ago in Eng- 
 land, declared, upon his death-bed, that he had 
 never known what it was to love man, woman or 
 child. But we sometimes meet with this disorder in 
 a partial state. Thus, there are men who have 
 never loved, others who have never feared, others 
 who have never shed a tear, and others in whom 
 no injuries have ever excited an emotion of anger.
 
 344 ON THE DISEASES 
 
 In such persons, the mind is in a mutilated state ; 
 for man, without all his passions, is an imperfect 
 being, both as to his duties and happiness. 
 
 The remedies for this torpid state of the pas- 
 sions, whether general or partial, should be suited 
 to the state of the system. Depletion will be pro- 
 per, if the blood-vessels are oppressed. In a 
 contrary state of the system, powerful stimulants 
 particularly pain, labour, the cold bath, and a 
 salivation, are indicated. I mentioned formerly 
 an instance in which mercury restored the affec- 
 tion of a mother for her child in a day or two 
 after it affected her mouth.
 
 
 OF THE MIND. 345 
 
 CHAPTER XVIII. 
 
 Of the Morbid State of the Sexual Appetite. 
 
 THIS appetite, which was implanted in our na- 
 tures for the purpose of propagating our species, 
 when excessive, becomes a disease both of the 
 body and mind. When restrained, it produces 
 tremors, a flushing of the face, sighing, nocturnal 
 pollutions, hysteria, hypochondriasis, and in wo- 
 men the furor uterinus. When indulged in an 
 undue or a promiscuous intercourse with the 
 female sex, or in onanisrn, it produces seminal 
 weakness, impotence, dysury, tabes dorsalis, pul- 
 monary consumption, dyspepsia, dimness of sight, 
 vertigo, epilepsy, hypochondriasis, loss of me- 
 mory, manalgia, fatuity and death. From a num- 
 ber of letters addressed to me, for advice, I shall 
 select but three, in which many of those symp- 
 toms are mentioned, and deplored in the most 
 pathetic terms. The first is from a physician in 
 Massachusetts, dated September 4th, 1793. 
 
 44
 
 346 ON THE DISEASES 
 
 " The gentleman, whose case is now submitted 
 to you, is about twenty-five years of age, meagre, 
 gloomy, and restless, has a bad countenance, and 
 a lax state of bowels. He imputes his indisposi- 
 tion to his excessive devotedness to Venus, which 
 he thinks has been induced by a morbid state of 
 his body. He has been married three years, had 
 no connection with the sex before he married, 
 and, although he feels disgusted with his strong 
 venereal propensities, he cannot resist them. I 
 advised him to separate himself from his wife by 
 traveling, which he did, but without experiencing 
 any relief from his disease. He has earnestly 
 requested me to render him impotent, if I could 
 not give him the command of himself in any other 
 way. I have tried several remedies in his case ; 
 nothing has done him any good except the sugar 
 of lead, which I was soon obliged to lay aside, 
 from its producing a severe nervous cholic. 
 Wishing to know whether his disease was not 
 seated in his imagination only, I asked whether 
 the gratification of his appetite was equal to his 
 desires. Dixit, per annos tres, quinque vices se 
 coitum fecisse in horis viginti quatuor, et semper 
 semine ejecto." 
 
 The second letter, to which I have alluded, is 
 from the miserable subject of the disease that is
 
 OF THE MIXD. 347 
 
 described in it. After acknowledging its cause to 
 be from onanism, he adds, "I rest badly at nights, 
 and am much troubled with dreams. I have fre- 
 quent nocturnal erections, accompanied with a 
 sensation of uneasiness, instead of desire or plea- 
 sure ; and from dreams, frequent emissions take 
 place, which are much more fluid than natural. 
 The external organs of generation have a numb, 
 or dead feeling. The lower part of my back is 
 weak ; my eyes are often painful and my eye-lids 
 swelled and red. I have an almost constant cold, 
 and oppression at my stomach. In short, I had 
 rather be laid in the silent tomb, and encounter 
 that dreadful uncertainty, hereafter, than remain in 
 my present unhappy and degraded situation. 
 These are humiliating concessions, and it is 
 extremely painful for me to make them ; but let 
 my melancholy situation be my apology for 
 them." 
 
 The third and last letter upon this subject is 
 from a physician in Virginia, in which he de- 
 scribes the disease of a patient then under his 
 care, in the following words. " A. B. aged seven- 
 teen, of a cold phlegmatic temperament of body, 
 of a sedentary life, and studious habits, in conse- 
 quence of indulging in the solitary vice of onan- 
 ism, has lately become very much diseased. His
 
 
 348 ON THE DISEASES 
 
 vision is indistinct, and his memory much impair- 
 ed, and he now labours under much muscular 
 relaxation, prostration of strength, atrophy, and 
 depression of spirits. His system is so very irri- 
 table, that the least agitation of mind, or riding 
 on horseback, or gently rubbing his breast, or 
 even combing his hair, seminis ernissionem indu- 
 cunt. Any plan you may suggest for the relief of 
 this truly wretched being will be gratefully re- 
 ceived." 
 
 But these are not all the melancholy and dis- 
 gusting effects of excess in the indulgence of the 
 sexual appetite. They sometimes discover them- 
 selves in the imagination and senses, in a fond- 
 ness for obscene conversation and books, and in 
 a wanton dalliance with women, long after the 
 ability to gratify the appetite has perished from 
 disease or age. 
 
 The remote and exciting causes of this disease 
 in the sexual appetite are, 
 
 1. Excessive eating, more especially of high 
 seasoned animal food. The vices of the cities of 
 the plain were derived in part from their " fulness 
 of bread ;" by which is meant an excess of nour- 
 ishing aliment.
 
 OF THE MIND. 349 
 
 2. Intemperance in drinking. Hence the fre- 
 quent transition from the bottle to the brothel ! 
 It is because it is so common and natural, that the 
 former is generally mentioned as an apology for 
 the disease contracted in the latter, by young 
 men, in their application to physicians for reme- 
 dies for it. The incestuous gratification of the 
 sexual appetite, which was the first sin that re- 
 vived in the world after the flood, was the effect, 
 we are told, of the intemperate use of wine. 
 
 3. Idleness. This was another of the causes 
 mentioned in the Old Testament of the vices of 
 the cities of the plain. It is from the effects of 
 indolence and sedentary habits that the venereal 
 appetite prevails with so much force, and with 
 such odious consequences, within the walls of 
 those seminaries of learning, in which a number 
 of young men are herded together, and lodge in 
 the same rooms, or in the same beds. 
 
 The remedies for this appetite, when inordi- 
 nate, are natural, physical and mental. They are, 
 
 1. Matrimony; but where this is not practica- 
 ble, the society of chaste and modest women. 
 While men live by themselves (says La Brtiyere) 
 they do not view washerwomen or oyster-wenches
 
 350 ON THE DISEASES 
 
 as washerwomen or oyster-wenches, but simply 
 as women. But by mixing with the sex, they 
 lose the habit of associating the idea of the sex 
 of the woman with a cap or a petticoat. I have 
 known few young men of loose morals, who have 
 attached themselves to the society of the ladies. 
 They not only polish their manners, but purify 
 their imaginations. 
 
 2. A diet, consisting simply of vegetables, and 
 prepared without any of the usual condiments that 
 are taken with them. Dr. Stark found his vene- 
 real desires nearly extinguished by living upon 
 bread and water. They revived upon a diet of 
 bread and milk, and became more active by eat- 
 ing six or eight ounces of roasted goose every 
 day, with a proportionable quantity of bread. 
 Persons afflicted with this disease should use but 
 little salt in their aliment. Plutarch tells us, it 
 was avoided by the priests in his day, from its dis- 
 posing to venery. The birth of Venus from the 
 sea was probably intended to signify the connec- 
 tion between the use of salt and the venereal 
 appetite. In recommending a vegetable diet for 
 the cure of this disease, I would remark, that it 
 is effectual only when it succeeds a full animal 
 diet; for we read not only of individuals, but of 
 whole nations, that live upon vegetables and
 
 OF THE MIND. 351 
 
 other simple food, in whom the sexual appetite 
 exists in its usual and natural force. In such per- 
 sons the appetite should be weakened, by reduc- 
 ing the quantity of their aliment. 
 
 3. Temperance in drinking, or rather the total 
 abstinence from all fermented and distilled liquors. 
 
 4. Constant employment in bodily labour or 
 exercise. They both lessen venereal excitability 
 and promote healthy excitement. Hippocrates 
 tells us, the Scythians, who nearly lived upon 
 horseback, were free from venereal desires. Long 
 journeys on horseback, should therefore be re- 
 commended for the morbid degrees of this appe- 
 tite. The chase would probably serve the same 
 purpose. The connection between this exercise 
 and chastity is happily illustrated by the poets in 
 the character of Diana, who lived by hunting. 
 The Indians owe the weakness of their venereal 
 desires to this, among other invigorating employ- 
 ments. 
 
 5. The cold bath. There is a debility of body 
 which is connected with venereal excitability, and 
 which the cold bath is calculated to remove. 
 This excitability is most apt to occur during the 
 convalescence, or soon after the recovery from
 
 v- 
 
 
 \ 
 
 352 ON THE DISEASES 
 
 malignant or chronic fevers. Twelve marriages 
 took place of the patients who recovered from the 
 yellow fever at Bush-hill, in the neighbourhood of 
 this city, in the year 1793; and a greater num- 
 ber were detected in a criminal intercourse with 
 each other, in the private apartments and tents 
 belonging to the hospital. I have known two in- 
 stances of young clergymen, who married the wo- 
 men who nursed them in chronic fevers, both of 
 whom were in very humble life. The celebrated 
 Mr. Howard did the same thing. These unequal 
 matches appear to have been the effects of a 
 morbid sexual appetite, that suddenly succeeded 
 their fevers, and which they did not dare to gra- 
 tify but in a lawful way. 
 
 6. A salivation, by diverting morbid excita- 
 bility from the genitals to the mouth and throat, 
 would probably be useful in this disease. 
 
 7. Avoiding all dalliance with the female sex. 
 I knew a gentleman in this city, who assured me 
 he had gained a complete victory over his vene- 
 real desires by a strict regard to this direction ; 
 and I have heard of a clergyman, who overcame 
 this appetite by never looking directly in the face 
 of a woman.
 
 
 OP THE MIND. 353 
 
 8. Avoiding the sight of obscene pictures, the 
 reading obscene books, and listening to obscene 
 conversation, all of which administer fuel to the 
 sexual appetite. 
 
 9. Certain tones of music have sometimes sud- 
 denly relieved a paroxysm of venereal desires. 
 
 10. Dr. Boerhaave says a sudden fit of laughter 
 has sometimes had the same effect. 
 
 11. Close application of the mind to business, 
 or study of any kind, more especially to the ma- 
 thematics. Sir Isaac Newton conquered this ap- 
 petite by means of the latter study, and the late 
 Dr. Fothergill by constant application to business. 
 Both these great and good men lived and died 
 bachelors, and both declared, upon their death 
 beds, that they never 'had known, in a single in- 
 stance, a criminal connection with the female sex. 
 
 12. The influence of an active passion, that 
 shall predominate over the sexual appetite. The 
 love of military glory, so common among the 
 American Indians, by combining with the hard- 
 ships of a savage life, contributes very much to 
 weaken their venereal desires. 
 
 45
 
 354 ON THE DISEASES 
 
 13. Several medicines have been recommended 
 to subdue the excess of the sexual appetite ; 
 among these, the caster oil nut, and camphor, 
 have been most commended. The former acts 
 only by opening the bowels, and thereby taking 
 off the tension of the contiguous genital organs. 
 Any other lenient purge would probably have the 
 same effect. If camphor have any virtues, in this 
 disease, it must be by its stimulating powers re- 
 moving that nervous debility upon which vene- 
 real excitability depends. Any other stimulating 
 medicine given in a similar state of the system, 
 would probably have the same, or a greater effect. 
 
 1 have thus mentioned all the remedies for de- 
 rangement in the passions and sexual appetite. 
 While I admit the necessity of their being aided 
 by religious influence, in order to render them 
 successful, I maintain that religious influence is 
 seldom effectual for that purpose, unless it be 
 combined with those physical remedies. This 
 opinion is amply supported by numerous precepts 
 in the Old and New Testament, and it is only by 
 inculcating those physical precepts, with such as 
 are of a religious and moral nature, that the lat- 
 ter can produce their full effects upon the body 
 and mind.
 
 OP THE MIND. 355 
 
 CHAPTER XIX. 
 
 Of Derangement in the Moral Faculties. 
 
 I TOOK notice formerly of moral derangement 
 in the will, and mentioned its symptoms, as they 
 appear in several specific vices. This disease 
 discovers itself only in the moral faculty, and ex- 
 ists with a sound state of the conscience and 
 sense of deity. Under the present head, I shall 
 make a few remarks upon moral derangement, as 
 it appears in all those moral faculties of the mind. 
 
 For an account of the nature and offices of the 
 moral faculty and conscience, and of the differ- 
 ence between them, the reader is referred to an 
 oration delivered by the author before the Ameri- 
 can Philosophical Society, in the year 1786, and 
 published in the first volume of his Medical Inqui- 
 ries and Observations. For proofs of the ex- 
 istence of an innate sense of deity in the human 
 mind, the reader is referred to Lord Kaims* 
 Sketches of the History of Man. All these facul-.
 
 356 ON THE DISEASES 
 
 ties are liable to derangement, partially and uni- 
 versally. 
 
 I. Partial derangement in them is sometimes 
 induced, 
 
 1. By ardent spirits. 
 
 2. By famine, the effects of which, in annihilat- 
 ing the obligations, not only of morality, but of 
 consanguinity, and inducing the grossest acts of 
 cruelty, are recorded in the 56th and 57th verses 
 of the 28th chapter of Deuteronomy. The con- 
 sonance of the prediction contained in those 
 verses with the state of the human mind, in simi- 
 lar circumstances of distress from hunger, has 
 been established in many instances, in the histo- 
 ries of crews who have sought relief from ship- 
 wreck in a boat, or on a desolate shore. 
 
 II. The moral faculty, conscience, and the sense 
 of deity, are sometimes totally deranged. The 
 Duke of Sully has given us a striking instance of 
 this universal moral derangement, in the character 
 of a young man who belonged to his suit, of the 
 name of Servin, who, after a life uncommonly dis- 
 tinguished by every possible vice, died, cursing 
 and denying his God. Mr. Halsam has described
 
 OF THE MIND. 357 
 
 two cases of it in the Bethlehem Hospital, one of 
 whom, a boy of thirteen years of age, was perfect- 
 ly sensible of his depravity, and often asked " why 
 God had not made him like other men." He was, 
 as might be expected, completely miserable, and 
 often expressed a wish for death. An epitome of 
 all that has been recorded, or perhaps seen, of 
 this derangement in the moral faculties, has been 
 given by Edgar of himself, in the tragedy of King 
 Lear, in the following lines. 
 
 4 * I was a serving man, proud in heart and mind, 
 
 That served the lust of my mistress' heart, 
 
 And did the act of darkness with her ; 
 
 Swore as many oaths as I spake words ; 
 
 Wine I loved deeply, dice dearly : 
 
 I was false of heart, light of ear, and bloody of hand ; 
 
 Hog in filth, fox in stealth, wolf in greediness, 
 
 Dog in madness, and lion in prey." 
 
 In the course of my life, I have been consulted 
 in three cases of the total perversion of the moral 
 faculties. One of them was in a young man, the 
 second in a young woman, both of Virginia, and 
 the third was in the daughter of a citizen of Phi- 
 ladelphia. The last was addicted to every kind 
 of mischief. Her wickedness had no intervals 
 while she was awake, except when she was kept 
 busy in some steady and difficult employment.
 
 3.08 ON THE DISEASES 
 
 In all these cases of innate, preternatural moral 
 depravity, there is probably an original defective 
 organization in those parts of the body, which are 
 occupied by the moral faculties of the mind. 
 
 How far the persons whose diseases have been 
 mentioned, should be considered as responsible 
 to human or divine laws for their actions, and 
 where the line should be drawn that divides free 
 agency from necessity, and vice from disease, I 
 am unable to determine. In whatever manner 
 this question may be settled, it will readily be ad- 
 mitted that such persons are, in a pre-eminent 
 degree, objects of compassion, and that it is the 
 business of medicine to aid both religion and law, 
 in preventing and curing their moral alienation of 
 mind. We are encouraged to undertake this 
 enterprise of humanity, by the sameness of the 
 laws which govern the body and the moral facul- 
 ties of man. I shall venture to point out the same- 
 ness of those laws in a few instances, by mention- 
 ing the predisposition and proximate causes, the 
 symptoms, and the remedies of corporeal and 
 moral diseases. 
 
 I. Is debility the predisposing cause of dis- 
 ease in the body ? so it is of vice in the mind.
 
 OF THE MIND. 359 
 
 This debility in the mind consists in indolence, or 
 a want of occupation. Bunyan has justly said, in 
 support of this remark, that "an idle man's brain 
 is the devil's work-shop." The young woman, 
 whose moral derangement I mentioned a little 
 while ago, was always inoffensive when she was 
 busy. The employment contrived for her by her 
 parents was, to mix two or three papers of pins of 
 different sizes together, and afterwards, to oblige 
 her to separate, and sort them. The near rela- 
 tion of debility and vice has been expressed by 
 the schoolmen in the following words, " non 
 posse, est malum posse." To do nothing, is gen- 
 erally to do evil. 
 
 2. Do we prevent disease, by removing the 
 body out of the way of exciting causes acting upon 
 debility? In like manner, we prevent vice, by re- 
 moving the mind, in its debilitated state, out of 
 the way of bad company, and thus abstract it 
 from the stimulus of vicious motives upon the will. 
 
 3. Does bodily disease consist in morbid ex- 
 citement, or irregular action? Vice consists, in 
 like manner, in undue excitement of the passions 
 and will, and in their irregular, or, to use a scrip- 
 tural epithet, in their " crooked" actions.
 
 360 ON THE DISEASES 
 
 4. Is bodily disease a unit? So is vice. All its 
 innumerable forms are derived simply from inor- 
 dinate self-love. 
 
 5. Do high degrees of morbid bodily excite- 
 ment require depleting remedies ? High degrees of 
 vice require remedies of a similar nature, such 
 as the abstraction of company, and the exces- 
 sive or criminal gratification of the passions and 
 senses. 
 
 6. Do we overcome morbid action in a bodily 
 disease in a highly vital part, by exciting it in a 
 part less essential to life? In like mariner we 
 cure the odious vice of avarice, and a debasing 
 love of pleasure, by the less odious and debasing 
 vice of ambition. 
 
 7. Is it impossible to produce two sensations 
 of unequal force, at the same time, in the body? 
 It is equally impossible for the mind to act under 
 the impression of two motives at the same time. 
 Hence the truth of that declaration of our Sa- 
 viour, " that no man can serve two masters, that 
 is, God and Mammon." The predominance of 
 the motive excited by one of them, will always 
 destroy the other.
 
 OP THE MIND. 361 
 
 8. Do we accommodate stimuli to the state of 
 excitability in diseases of the body? The same 
 thing is done in all the successful applications of 
 moral stimuli, or motives, to the will. Our Sa- 
 viour hints at this accommodation of moral reme- 
 dies to the peculiar state of the mind, when he 
 alludes to the practice of not putting new wine, 
 full of an active fermenting principle, into old 
 bottles, which in ancient Judea, were made of 
 leather, and of course, became weak from age. 
 
 9. Is the excessive morbid excitement of a dis- 
 ease worn down by labour? Excessive vicious 
 excitement is reduced in like mariner by the same 
 means, and, in addition to it, by solitude, shame, 
 and certain restraints or pains inflicted upon the 
 body, of a nature calculated to act indirectly 
 upon the mind. I acknowledge the first impres- 
 sions of confinement and bodily pain generally 
 produce a vicious fretfulness, and sometimes im- 
 pious expressions and immoral conduct; but 
 these effects of those moral remedies are general- 
 ly very transient. When continued long enough, 
 they never fail of producing a change in the 
 moral temper of the mind. A remarkable in- 
 stance of the truth of this remark occurred some 
 years ago in the jail of Philadelphia. A noto- 
 rious offender amused himself, for some time 
 
 46
 
 362 ON THE DISEASES 
 
 after his confinement, by drawing pictures, and 
 writing verses of a ludicrous nature, upon the 
 walls of his solitary cell. At the end of several 
 weeks he became silent and pensive, and at the 
 same time the following passage of scripture, 
 written by him, was discovered upon one of the 
 walls of his cells. " Come unto me, all ye who 
 labour and are heavy laden, and I will give you 
 rest." 
 
 10. Are bodily sensibility and irritability weak- 
 ened, or destroyed, by the protracted application 
 of morbid stimuli to sensible and irritable parts ? 
 The same thing takes place from the long appli- 
 cation of vicious impressions to the moral facul- 
 ties of the mind. They become, in such cases, 
 to use the words of one of the apostles, kt dead," 
 and " seared with a red hot iron." A disease re- 
 sembling a palsy affects them all. 
 
 I might go on further, and mention, more par- 
 ticularly, the analogy between bodily and moral 
 diseases, and the propriety of adapting specific 
 remedies to specific vices ; but enough, I hope, 
 has been said to show the truth and importance 
 of the subject, and the practicability of the under- 
 taking, by persons whose professional studies and 
 employments are more nearly related to it than
 
 OF THE MIND. 363 
 
 the author's. However useful the rational and 
 physical remedies that have been mentioned may 
 be to prevent or cure vice, they never can per- 
 form that work completely, without the aid of that 
 supernatural and mysterious remedy which it 
 hath pleased God to unite with them in his moral 
 government of his creatures, and that is, the FOR- 
 GIVENESS of it. In vain have legislators substi- 
 tuted the exterminating axe and halter, and the 
 influence of ignominious or painful corporeal pun- 
 ishments, for this divine mode of curing moral 
 evil. The danger and mortality of the venereal 
 disease were increased, in former times, by the 
 contempt, neglect, and corporeal chastisement, 
 to which persons affected with it were exposed. 
 Since the pain and shame of the disease have 
 been considered as its ample punishments, and 
 the subjects of it restored to public favour, the 
 disease has every where declined, and is now 
 rarely attended with danger, or the loss of life. 
 The abolition of the punishment of death, and of 
 cropping, branding, and public whipping, and sub- 
 stituting for them, confinement, labour, simple 
 diet, cleanliness, and affectionate treatment, as 
 means of reformation and forgiveness, have pro- 
 duced similar moral effects in the jail of Philadel- 
 phia. If this original and humane institution, in 
 which science and religion have blended their re-
 
 364 ON THE DISEASES 
 
 sources together, has not been attended with 
 uniform success, it must be ascribed wholly to 
 the imperfect mariner with which the principles 
 that suggested it have been carried into effect. 
 They have been rendered abortive, chiefly, by the 
 criminals sleeping in the same room, and by the 
 facility and frequency with which pardons are 
 obtained for them. The former prevents the re- 
 suscitation of conscience, and all moral and re- 
 ligious reflection. The latter is opposed to the 
 great axioms upon which the penal law of Penn- 
 sylvania is founded ; that " punishments should be 
 certain, but not severe, and that a pardoning 
 power should not be lodged in any department of 
 a government." 
 
 May this Christian system of criminal jurispru- 
 dence be spread, without any of its imperfections, 
 throughout the world ! and may the rulers of na- 
 tions learn from it, that the reformation of crimi- 
 nals, as well as the prevention of crimes, should 
 be the objects of all punishments, and that the 
 latter can be effected much better by living than 
 by dead examples ! 
 
 Here the reader and the author must take leave 
 of each other. Before I retire from his sight, I 
 shall only add, if I have not advanced, agreeably
 
 OF THE MIND. 365 
 
 to my wishes, the interests of medicine by this 
 work, I hope my labours in the cause of humani- 
 ty will not be alike unsuccessful; and that the 
 sufferings of our fellow creatures, from the causes 
 that have been mentioned, may find sympathy in 
 the bosoms, and relief from the kindness of every 
 person who shall think it worth while to read this 
 history of them. 
 
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