AN
INAUGURAL DISSERTATION
ON
INSANITY:
Submitted to the Examination
OF THE
REV. JOHN EWING, S.T.P. PROVOST;
THE
TRUSTEES AND MEDICAL PROFESSORS
OF THE
UNIVERSITY OF PENNSYLVANIA;
FOR THE
DEGREE OF DOCTOR OF MEDICINE,
ON THE NINETEENTH DAY OF MAY, A.D. MDCCXCIV.
By EDWARD CUTBUSH, of Philadelphia,
HONORARY MEMBER OF THE PHILADELPHIA MEDICAL AND CHEMICAL
SOCIETIES, AND MEMBER OF THE AMERICAN MEDICAL SOCIETY.
"—————— MOODY MADNESS, OF WILD PASSIONS BORN,
"MUSES, RECLIN'D IN GHASTLY STATE, FORLORN;
"OR WEEPS, OR LAUGHS, OR DESULTORY SINGS, 
"TOTTERS ALONG, AND SPEAKS UNMEANING THINGS; 
"OR WITH FIERCE EYE, LANK JAW, AND HORRENT BROW,
"LOUD RAVING CLANKS HIS IRON CHAINS.——————"
PHILADELPHIA:
PRINTED BY ZACHARIAH POULSON, JUNIOR,
No. 80, CHESNUT-STREET.
MDCCXCIV. 



TO
WILLIAM SHIPPEN, JUN. M. D.
CASPAR WISTAR, M. D.
Professors of Anatomy, Surgery and Midwifery;
ADAM KUHN, M. D.
Professor of the Practice of Physic;
BENJAMIN RUSH, M. D.
Professor of the Institutes and of Clinical Medicine;
JOHN FOULKE, M. D.
Lecturer on Anatomy, Surgery and Midwifery;
AND
THOMAS PARKE, M. D.
Physicians and Surgeons to the Pennsylvania Hospital.
Gentlemen,
IT affords me the highest degree of satisfaction, to be
able, in this public manner, to offer you my sincere
acknowledgments, for the instructions I have received from
your valuable lectures, and judicious prescriptions and ob-
servations, in the Hospital of Pennsylvania. It would be
presumptive in me, to attempt, in this dedication, to en-
hance the value of your characters as men of science and
professional abilities; Fame has already proclaimed them
abroad, and the echoes have long since been heard in this
western world, where Liberty and Science embrace each
other.
To whom can I inscribe the following pages with more
propriety, than to the Physicians and Surgeons of the
Pennsylvania Hospital? under whose direction I have had
the honor of prosecuting my medical studies. Accept,
therefore, this small tribute of respect for the many favors
I have received; and of the politeness, with which you
have always honored me, I shall ever retain an heart-felt
remembrance.
I am, Gentlemen,
Yours, affectionately,
May 5th. 1794. THE AUTHOR. 

TO
JOSIAH HEWES,         
OWEN JONES,          
JOSEPH PASCHALL,     
SAMUEL CLARK,        
THOMAS PENROSE,     
WILLIAM M'MURTRIE,  
Managers,
LAWRENCE SECKEL,
PATTISON HARTSHORNE,
ELLISTON PEROT,
BARTHOLOMEW WISTAR,
SAMUEL COATES,
THOMAS MORRIS,
AND
MORDECAI LEWIS, Treasurer,
OF THE
PENNSYLVANIA HOSPITAL.
Gentlemen,
TO you, also, I am under many obligations, for the
numerous marks of friendship, with which you have
been pleased to honor me, during my residence in the insti-
tution over which you preside. In this asylum of human
misery you have long exercised, in a conspicuous manner,
that benevolent principle which Providence has implanted
in you——namely, Humanity. May it continue to be the
most prominent trait in your characters, and may it shine
forth like a brilliant luminary, to guide your successors,
which I hope time will not obscure; also, may your present
undertaking,* be the means, by which many worthy mem-
bers of the community will be again enabled to enjoy, in
this land of liberty and charity, the blessings of a healthful
body and a sound mind.
I am, with gratitude,
Yours, affectionately,
THE AUTHOR.
May 5th. 1794.
* The Managers of the hospital are now building a large and com-
modious addition for the reception of lunatics only. 

PREFACE.
MAN, the noblest work of the Creator, is
endowed with intellectual faculties, by
which he is capable of being exalted to attainments
the most refined; but, the numerous vicissitudes
that the body and mind undergo, from the impulse
of the passions and other various occurrences, in
this great theatre of the world; those heaven-born
blessings by which we claim the first link in the
great chain of animated beings, are frequently so
much perverted, as to level us with the brute
creation.
"That innate reason we so greatly boast,    
"Is oft by ignorance dull'd, by passions cross'd, 
"In winding doubts, and mazing errors lost." 
DRYDEN.
Of all the mental powers with which it pleased
the Supreme Governor of the universe to implant
in man; none appear to be more essential to his
happiness, or to the tranquility of those around him,
than an uninterrupted use of his reason: this sub-
lime power is absolutely necessary for the well-being
of all societies, both civil and religious, its absence
constitutes a direful disease, which frequently eludes
all the powers of medicine, and at length sets the
goddess Hygeia at defiance.
Seeing that the possession of the intellectual facul-
ties, is so nearly connected with the happiness of
mankind; and having been a frequent witness to
the horrid situation of many of my fellow crea-
tures, laboring under a total or partial loss of them;
induced me, to make insanity the subject of the
following pages. As there are many hypothetical
assertions, and little to boast of, in my composition,
and less in judgment, I submit the following sheets
with peculiar diffidence, but as I write not from
choice but necessity, I beg the candid indulgence
of my readers——the whole dissertation being little
more than a mere skeleton.
THE AUTHOR. 

INTRODUCTION.
AMONG the numerous train of diseases,
with which the human race is afflicted, there
are none, which more deserve the attention of
medical men, than those of the mind: and none,
I am sorry to add, have been so little attended
to. Notwithstanding the rapid accumulation
of medical knowledge, the disease, which is the
subject of the present Thesis, still remains in great
obscurity, and in part the opprobrium medico-
rum: but I hope the time is not far distant,
when the veil that obscures our researches, will
be boldly drawn aside by some rising Harvein,
who will penetrate the untrodden wilderness of
the brain, and explore the host of morbid foes,
that, at times, infest it. Permit me to add, that,
in this glorious æra which I anticipate, I pre-
sume every faculty and operation of the mind
will be found to possess different parts, in this
great receptacle or repository of the soul. 

AN
INAUGURAL DISSERTATION
ON
INSANITY.
INSANITY has (with few exceptions)
been considered from the earliest periods
of medical science, down to the present age,
as consisting of two kinds, viz. mania, and
melancholia: but in the present inquiry, I
shall consider melancholy as an inferior degree
or state of mania, depending on the same
exciting causes, only varied with regard to
their force, and the condition of the brain or
system in general. I infer that they are diffe-
rent states of the same disease, from their
frequently alternating with each other, of
this I have seen various instances, and many
more may be found in the records of medi-
cine.
Insanity generally attacks young men more
frequently than old, and more frequently
men than women. Males and females from
the 

(8)
the age of fifteen to forty-five, generally
speaking, are most frequently attacked with
that state of Insanity, in which all the facul-
ties and operations of the mind are more or
less deranged; while those from the age of
forty-five to seventy, are subject to the lowest
state, or that, in which the understanding is
most commonly perverted. Insanity after
this time of life, is a rare occurrence; at this
age the memory and the other faculties begin
to fail; from this we may date second child-
hood, and even descend sometimes to a "se-
cond infancy."*
It has been observed that children are not
subject to Insanity. The fact is true and I
presume the reason obvious——The faculties of
the mind, are evolved in a certain regular
succession, and I believe, with this evolution,
the consistence of the brain is altered. In
two children, one of nine months old, the
other of six, whom I examined, I found the
brain
* I met with an instance of a woman between eighty and
ninety, says Dr. Rush, who exhibited the marks of a second
infancy, by such a total decay of her mental faculties as to
lose all consciousness in discharging her alvine and urinary
excretions. Med. observ. and inq. by Dr. Rush, vol. 2d.
page 311. 

(9)
brain much softer* than the brain of an adult,
and probably, the firmness of the latter was
acquired, as the faculties were disclosed;
which firmness, is in some measure lost by
the time we arrive to the age of eighty; after
this period it assumes its primitive state.
Hence, Insanity is uncommon in either of
those states. Further, Dr. John Gregory
remarks; in childhood the mind can attend
to nothing but what keeps its active powers
in constant agitation, nor can it take in all
the little discriminating circumstances which
are necessary to the forming a true judgment
either of persons or things. For this cause,
it is very little capable of entering into abstract
reasoning of any kind, till towards the age
of manhood.† This is undoubtedly true,
and daily observation fully evinces the fact;
therefore——as Insanity in part depends on a
false judgment of either persons or things,
B and
* Query. May not this softness of the brain in chil-
dren be one reason, why they are more subject to hydro-
cephalus internus after blows, &c. than adults? and not
from the size of the brain and the quantity of blood circu-
lating therein.
† See a comparative view of the state and faculties of
man with those of the animal world. By John Gregory,
M. D. F. R. S. vol. 2d. pages 75 and 76.

(10)
and children do not possess the power of
judgment and reasoning, consequently they
are strangers to the disease. I have in a for-
mer part of this essay observed, that Insanity
generally takes place between the ages of
fifteen and seventy; this I believe to be varied
in the same manner, as the uterine system
is, by climate and situation in life.
I have not been able to find but one case
of Insanity under ten years of age, and this
was extracted from the Bedlam Register*
by Dr. Black, who gives us the following
account: during fifteen years, from 1772 to
1787, of two thousand eight hundred and
twenty-nine insane males and females, their
respective ages and numbers in each inter-
val of life, when classed, were as follow:
under ten years of age, one; from ten to
twenty, one hundred and thirty-two; from
twenty to thirty, eight hundred and thirteen;
from thirty to forty; nine hundred and eight;
from
* I am sorry it has not been customary to insert the ages
of the insane, in the register of the Pennsylvania Hospital;
if it had, the number of patients admitted since the year
1755 to the present time, would have furnished us with an
instructive table. I beg leave to suggest to the Managers
of that charitable institution, the propriety of inserting the
age of every patient on admission. 

(11)
from forty to fifty, six hundred and thirty-
two; from fifty to sixty, two hundred and
sixty-six; from sixty and upwards, seventy-
eight. It appears, from this table, that when
the mind arrives to its acme, which is between
thirty and forty; there is a greater probabi-
lity of its being affected, by the causes which
produce Insanity: hence the number that are
affected is greater between those periods,
than in early, or the decline of life.
When there is an hereditary diathesis, it
makes its appearance commonly between the
ages of thirty and fifty: General Montgo-
mery wished to die in early life, suddenly,
and, if married, childless; this extraordinary
wish, says Dr. Rush, appears truly proper,
when the reason is shown.——His family was
subject to an hereditary madness, which
generally attacked them about the age of
fifty; to escape it, he wished to die before
that age; he wished a sudden death, for the
same reason that many others do, that he might
avoid pain; and depart childless, that he
might not entail so dreadful a malady on a
successor.* The celebrated Dr. Gregory, in
* See Dr. Rush's manuscript lectures. 

(12)
his advice to his daughters, wisely suggests
the impropriety of a connection with a per-
son thus predisposed——He says, avoid a com-
panion that may entail any hereditary disease
on your posterity, particularly (that most
dreadful of all human calamities) madness.
It is the height of imprudence to run into
such a danger, and, in my opinion, highly
criminal.*
Having offered a few cursory remarks, I
shall now (for the sake of perspicuity) pro-
ceed to consider the two different states of
Insanity under the appellation of "tonic and
atonic mania."†
These states of Insanity, sometimes make
their appearance without any premonitory
signs, but, in general, tonic mania is preceded
days, weeks, and even months by the follow-
ing symptoms: quick motion of the eyes and
eye-lids, attended frequently with a disten-
tion of the vessels of the adnata, pupils con-
tracted,
* Works of Dr. John Gregory, late professor of medi-
cine in the university of Edinburgh. Vol. I.
† So called by Dr. Rush. 

(13)
tracted,* head-ach, vertigo, instability in all
pursuits, unusual extravagance, by high or
low spirits, loquacity and watchfulness, and
commonly a voracious appetite. The pre-
cussors or premonitory symptoms of atonic
madness are——languor and inactivity with
regard to all undertakings, indifference with
respect to external things, love of solitude,
watchfulness, uncommon taciturnity, costive
habit of body, and lastly, a great propensity
to be starved. But from the known tendency
that both these states have to alternate with
each other, it is difficult to predict, which
the patient will be attacked with, the pre-
cussors of both making their appearance, at
different times in the same person. Having
now described the premonitory signs of tonic
and atonic mania, I shall proceed to deliver
a general definition of the disease; and here,
I am met with almost an insurmountable
difficulty, as the poet justly observes——
"Great wit to madness sure is near allied,
"And thin partitions do their bounds divide."
DEFINITION.
* This symptom I have observed uniformly to take
place about the accession of a paroxysm. 

(14)
DEFINITION.
I AM aware of the difficulty of circum-
scribing the limits between the insane, and
the multitude of others, who are said to
be truly rational. Dr. Black observes, that
it is not confined within the porticoes of
bedlam and madhouses: we might find it
sprinkled over the earth, not only among the
fanaticks of Asia, &c. but through every
rank and station of civilized communities.*
The ingenious Dr. Gregory also remarks——
"Nullus tamen existit limes accuratus inter
"sanam mentem et vesaniam. Omnis prœ-
"ter solitum hilaritas ad insaniam vergit; et
"mœstus et meticulosus animus ad melan-
"choliam appropinquat."† And I may add,
every extravagance in human affairs and
pursuits, borders on Insanity; but madness
in so extensive a sense, I shall exclude from
the present dissertation.
That insanity of which I about to treat,
is defined to be "a false perception of truth;
with conversation and actions contrary to
right reason, established maxim, and order."‡
* See Black on the human species.
† Vid. Conspectus medicinœ theoreticœ. Auctore
Jacobo Gregory, M. D.
‡ See Dr. Rush's manuscript lectures. 

(15)
Symptoms of Tonic Mania.
On the ebullition of tonic mania (which
may be considered the monarch of all mental
diseases) the looks, voice and gestures are
impetuous and wild; in many, audacious and
ferocious; irascible, impatient, and extremely
violent when contradicted or restrained; great
increase of strength.
Madmen, if suffered to have their liberty,
resemble beasts, rather than men; they tear
their cloaths, besmear their faces with their
excrement, and fly from human society;
they ramble with wonderful rapidity from
one object to another, with shouting, singing,
and laughing; some, while they roam through
the lofty regions of fancy, count the stars,
and mark in their imagination, the revolu-
tion of the planetary system——others are
personating every being and object terrestrial
and celestial; while others are spreading their
vent'rous wings and flying to different parts
of the earth, and from earth to heaven.
These symptoms are varied in different tem-
peraments, and by the number of the powers
of the mind affected. Insane persons endure
hunger,

(16)
hunger, cold, nakedness, and want of sleep
with astonishing degree of impunity; they
are very insensible to the operation of conta-
gion, vomits, purges, &c. During the pa-
roxysm, they obstinately refuse food and
medicine; in the decline, they become stupid
and mournful, and when they come to be
acquainted with their situation, they are much
dejected, and oftentimes burst into tears.*
A madman in the hospital, a few years ago,
could always inform his keeper, when a
paroxysm was coming on, and would request
to be chained and handcuffed, to prevent
him from doing mischief. This was a happy
circumstance, as the management of him was
always attended with difficulty if his request
was not complied with; but from what symp-
tom he knew of the accession of the parox-
ysm, I could never learn.
Shakespear, in his tragedy of king Lear,
has given us a striking picture of Insanity, in
the characters of Lear and Edgar.——
Edg.
* I have always observed a gradual recovery to take
place after this symptom; a return of former habits is also
a sign of returning health. The recovery of the king of
England was predicted by Dr. Baker, from his resuming
his former mode of talking.


( 17 )
" Edg. —— And am bethought
To take the basest and the poorest shape
That ever penury in contempt of man
Brought near to breast: my face I'll grime with
filth,
Blanket my loins, put all my hair in knots,
And with presented nakedness out-face
The winds and perfections of the sky.
The country gives me proof and precedent
Of bedlam beggars, who with roaring voices
Strike in their numb'd and mortify'd bare arms
Pins, wooden pricks, nails, sprigs of rosemary;
And with this horrible object, from low farms,
Poor pelting villages, sheep-coats and mills,
Sometimes with lunatic bans, sometimes with
pray'rs,
Inforce their charity.* ____"
SHAKESPEAR.
The Demoniacs, we read of in Sacred
Writ, no doubt possessed the true tonic spe-
cies of Insanity ; they were affected various
ways, according to the condition of their
excitability; sometimes they rent their gar-
ments, and ran about naked, striking ter-
ror in all those they met, and even wound-
ing their own bodies; so very furious, that
C though
* See Pope's edition of Shakespear's works, vol. 6th. 

( 18 )
though bound in chains and fetters, they
broke their bonds, and rambled in the most
lonely places, and among the sepulchres of
the dead.* It also appears that they were
cured by the presence of our Saviour, or by
the twelve persons, whom he sent forth:†
their presence probably acted similar to fear
on the system, which produced a change in
the constitution; this, in all latter ages, has
been considered as a very essential step to-
wards curing Insanity.‡
In atonic madness, the mind is generally
fixed to one subject ; many are cogitative,
silent, morose, and fixed like statues; others
wander from their habitations in search of
solitary places, they neglected cleanliness, their
bodies are generally cold, with a change of
color and dry skin ; all the different secretions
are much diminished, the pulse slow and
languid.
The disease of king Saul appears to have
been of this kind, and David removed it by
playing
* See Mead's works; also, see Matthew, chap. 8, ver.
28, et seq. Mark, chap. v. ver. 2, 3, 4, et seq.
† Mark, chap. vi. ver. 7.
‡ We are not informed whether there were any relapses. 

( 19 )
playing on his harp;* Nebuchadnezzar the
king also labored under this state of Insanity;
pride appears to have been the remote cause
of his disease.† In like manner the daugh-
ters of Proeteus were said, by Virgil, to be
insane, when they ran into the fields lowing
like cattle—
" Implerunt salsis mugitibus agros."
Virgil.
It is not a little surprising, that if patients,
when laboring under other diseases, become
insane, they are freed from their former com-
plaint, and vice versa.
Dr. Mead relates a case of a young lady
about twenty years of age, of a lively cheer-
ful temper, but weakly constitution, who,
from a bad habit of body, fell into a dropsy
of the abdomen, with great wasting of flesh.‡
The doctor tried all the usual remedies for
dropsical complaints without any good effect;
she was, on a sudden, "seized with mad-
ness;" this cured her of her disease, and
some
* Samuel, chap, xviii.
† Daniel, chap. iv.
‡ Mead's works, page 486.

( 20 )
some months after she recovered perfect health
of both mind and body. He also relates ano-
ther case, of a young lady, who labored
under pulmonary consumption.* It appears
she was in the last stage of the disease, but
from the interposing power of Insanity, the
disease was arrested, and her whole habit of
body increased, as the mind grew less capable
of governing it.
A circumstance similar to the former, oc-
curred in the Pennsylvania Hospital: A man
who had been insane for some years, was sud-
denly attacked with ascites and anasarca, at-
tended with " excess of action in the arterial
system."† As the bulk of his body increased
from the water, his Insanity was relieved;
but on drawing off twenty-nine pints by
means of the operation of paracentesis, his
Insanity returned; on the evening following
he complained of a great heat in his abdomen,
which was succeeded by violent vomiting;
on the third day after he expired. ‡
How
* Mead's works, page 487. Also, Dr. Rush's med. obs.
vol. 2d. page 90.
† Dr. Rush makes two states of action in dropsy.
‡ See dissection, No. 5. 

( 21 )
How did the dropsy operate to procure him
relief from his Insanity? Was it from disten-
tion? If so— Why are women not relieved
from it during pregnancy?*
I beg leave to trouble my reader, with a
fact of a man, who recovered perfectly from
his Insanity, by an attack of an intermittent
fever, which proved very obstinate; he, how-
ever, was discharged from the hospital, cured
of both his complaints. I have since heard
that his mind remains in perfect health, two
years having elapsed since his discharge.†
It was the opinion of the ancients, that
Insanity was under the particular influence
of the moon, and many medical men of this
enlightened century, still entertain ideas,
similar to those of their worthy predecessors.
But without entering into a minute detail of
the supposed influence of the moon on ma-
niacs, and, at the same time, paying the
greatest
* Margagni has also taken notice of this fact; also Dr.
Black, in his treatise on the human species, page 239.
† It is particularly common to meet with people in inter-
mittents, who possess a clearness of ideas and facility of
expression, which is not usual to them at other times.—
Valli's experiments, page 239. 

( 22 )
greatest deference to those worthy characters,
that support the opinion, I must candidly
acknowledge, that from the observations I
have been able to make, during my residence
in the hospital, I never found the maniacs
to be in the least under the direct action of
the moon: If it were the case - Would not
all the maniacs be more or less affected at the
same time?
REMOTE CAUSES.
ALL our mental operations, all our
thoughts, passions, sensations, and exertions,
are accompanied with corresponding motions
or vibrations,* of which, though the nature
is obscure, the existence cannot be doubted.†
Slight and transitory thoughts, passions, and
sensations, produce but feeble impressions on
the sensorium, consequently they excite but 
a gentle motion, and no permanent change
is induced. Close application to any object
or pursuit, or strong and lively passions,
generally produce motions, corresponding
with the force of their impression ; these
frequently
* Hartley on man, vol. I. page 114.
† Arnold on Insanity. 

( 23 )
frequently induce violent commotions in the
brain, and are often productive of serious
consequences.
I. Intense application of the mind.
INTENSE Study is generally accompa-
nied with an increased action of the vessels
of the brain; this appears obvious, from the
heat and sense of fulness, with a giddiness
of the head, which more or less are attendant
on men, whose minds have been attentively
engaged in the investigation of any abstruse
subject. This close attention will produce
indirect debility of the brain, and its opera-
tions will become languid, unsteady, and
undecisive. Should not this intense applica-
tion of the mind be neutralized, by some
other pursuit, Insanity will sway her power,
and Reason be dethroned.
II. Passions of various kinds, when sudden
and violent or habitual.
THERE is no doubt, but what the boun-
tiful Parent of mankind implanted the pas-
sions in us, for wise and beneficent purposes;
but man, ever prone to folly, frequently
perverts 

( 24 )
perverts them to the most absurd and perni-
cious
As every passion, as I before observed, is
attended with more or less motion, so a vigor-
ous vibration or motion may obscure a slight
impression. This superior force of impres-
sion, continued any length of time, will, if
not overcome, produce an habitual motion
in the brain, which will render it less suscep-
tible of receiving impressions of a weaker
force; or, in other words, the first impression
produces so great a commotion in the brain,
that it will exclude, or draw into the vast 
vortex, every other motion, and Insanity
with her numerous train of attendants, will
usurp her sway over sovereign Reason.
I shall now proceed to consider such pas-
sions as frequently produce Insanity.
I. JOY.
THE sudden acquisition of riches, has
been a fruitful source of Insanity. Dr. Mead,
in his treatise on madness, says, that he for-
merly heard Dr. Hale, physician to the Beth-
lehem Hospital, and of great experience in
these

( 25 )
these matters, say, more than once, that in
the year 1720, ever memorable for the ini-
quitous South-sea scheme, he had more pati-
ents committed to his care, whose heads were
turned by the immense riches which fortune
had thrown in their way, than of those who
had been completely ruined by that abomi-
nable bubble.* Dr. Goldsmith relates a fact
of lord Molyneaux, who unexpectedly com-
ing to a large estate, was so overjoyed, as to
hang himself in the madness it occasioned.†
The rapid accumulation of the value of
bank scrip, in the year 1791, by which many
of our citizens became wealthy, produced
Insanity in many instances.‡
D A
* Mead's works. Joy, however, has contributed to
restore the understanding. Alex. Trallianus relates a story
of a woman, who being depraved in her understanding by
concern for the long absence of her husband, was instantly
restored to her senses by his unexpected return. See a note
in a dissertation on the influence of the passions upon disorders
of the body. By William Falconer, M. D. F. R. S.
page 32. It is probable she labored under the lowest state
of Insanity, and the stimulus of joy raised her system to the
healthy point.
† Dr. Rush's manuscript lectures.
‡ Dr. Kuhn has informed me that there were exceptions
to this observation, some became insane in consequence of
losses. 

A certain nobleman, on being made go-
vernor of New York, which he had long
solicited, was so rejoiced, that he made a large
entertainment, called all his friends together,
and after retiring into another room, cut his
throat.*
If joy takes place very sudden, it will
frequently produce immediate death; of this
we have many instances on record: one in
particular occurred in this city. The door-
keeper of Congress, an aged man, died sud-
denly, immediately after hearing of the cap-
ture of lord Cornwallis's army.†
II. LOVE.
LOVE, says Dr. Arnold, between the
sexes, when reciprocal and uncontaminated
with appetite, consisting in the most exalted
feelings of the tenderest friendship, without
having yet excited a desire, or even a thought
of any sensual gratification, is the sweetest,
gentlest and most amiable of the passions;
and produces the same effects as temperate
joy.
* See Dr. Rush's manuscript lectures.
† Dr. Rush's med. obs. vol. I. page 224. 

( 27 )
joy.* Love softens the manners and tem-
per, inspires courage, sharpens and animates
every faculty of the mind. But, alas! if it
increases, and the furious flame is not extin-
guished by the possession of the object beloved,
it will consume its votary. This passion is
the least governable by reason, and is fre-
quently productive of Insanity, of which,
I have seen many instances. An immode-
rate indulgence of the appetite, connected
with this delightful affection, produced Insa-
nity in a man of fifty years of age; and I have
been informed, by a gentleman of veracity,
that an inability to perform the duties of a
husband, in a man aged seventy, after mar-
riage with a young healthy woman, produced
the atonic state of Insanity. When old men
are thus unfortunately addicted to venereal
desires and gratifications; they not only injure
the mind and body, but they abstract one of
the stimuli, which in part, would prolong
their lives: and Dr. Gardiner justly observes,
that they consult their passions rather than
their abilities. It may be said of them what
Virgil
* See Arnold on Insanity, vol. 2d. 

( 28 )
Virgil mentions of the bees when they sting:
"Animasque in vulnera ponunt."*
III. GRIEF.
THIS when carried to a certain point, and
attended with tears, is not oftentimes suc-
ceeded by ill consequences. Grief, on its
first attack, if the cause be great, produces
violent agitation in the brain and nervous
system, and if it be sudden as well as great,
its effects are exceedingly aggravated, which,
if not relieved, as I before observed, by tears,
will frequently terminate in Insanity. The
effect of grief in suddenly changing the
color of the hair is well known.
IV. TO these may be added anger, jealousy,
&c. The last affection of the mind, though
not least important, is that anxious apprehen-
sion of eternal punishment in the life to come,
or "religious fear." I think it ought rather
to be termed a false idea of religion; it is a
fruitful origin of Insanity,† of which there
are
* Observations on the animal œconomy, by John Gar-
diner, M. D. page 42.
† Two cases occurred in the Pennsylvania Hospital of
this kind; one, in consequence of taking an oath, which was
said 

( 29 )
are numerous grades; an account of them
would far exceed the limits of the present
thesis. Those who wish to be particular on
the subject, I beg leave to refer to Dr. Ar-
nold's treatise on Insanity.
V. INSANITY has been also produced
by the suppression of the menses, lochia,
and hæmorrhoidal flux. The French suppose
it sometimes to be produced by a translation
of the milk to the brain ; they term it "depot
laiteux fur le cerveau."
So great is the sympathy between the
brain, uterus, and mammæ, that diseases of
them frequently affect each other in a reci-
procal manner. A young woman was admit-
ted into the Pennsylvania Hospital sometime
ago, who became insane in consequence of
being disappointed in matrimonial affairs.
I was informed, that her disappointment
happened to be made known to her, during
her
said to be false; he was so much agitated in mind, that he
expected to suffer eternal punishment, and was continually
crying out for "water to cool his tongue." He was cured
by coercion and hard labor. The other was in a state of
despondency; and said, that he had been guilty of self-
pollution, for which he expected to suffer violent punishment.
He was relieved from this state by depriving himself of
his manhood. 

( 30 )
her menstrual period; the shock was so great
as to produce a sudden cessation of the dis-
charge.*
VI. OPIUM, and other narcotics and
poisons, have produced temporary Insanity.
VII. INTEMPERANCE in the use of
ardent spirits. This frequently produces
Insanity. It generally affects the understand-
ing first after intoxication. This sublime
power of the mind, says Dr. Rush, is first
debilitated in hard drinkers; they discover a
torpor in every mental exertion. To this
debility in the understanding, succeed the
loss of memory and the perversion of all the
intellectual powers, in melancholy and mad-
ness, and in some cases the total extinction
of
* This unfortunate girl remained sometime in a deplor-
able situation; at length she was attacked with violent pains
in her bark, extending down her thighs, also, pains in her
head. From these, I judged it to be her menstrual period,
and accordingly administered tinct. melampod. ℥ss. at bed
time. This medicine having been highly recommended
for producing immediate effects; it had also been lately
used by Dr. Kuhn with success in the hospital, in a case of
obstructed menses. The next morning I found her free
from pain, her mind calm, and was informed her menses
had appeared: she gradually recovered her senses, and at
the expiration of a few weeks, I had the happiness to find
her so far recovered, that her friends were able to remove
her from the hospital. 

( 31 )
of them in idiotism.* In short, to give a
description of the pernicious effects of this
liquid fire in producing diseases, would require
many more pages than I have allotted for this
dissertation; but, happily for mankind, that
Insanity from intemperance, opium, &c. is
more under the management of the physician,
than any that I have yet treated of.
Lastly, CAUSES which operate on the
brain in a mechanical manner.
Numerous dissections have been presented
to the world by many accurate observers; all
of them prove more or less the ossification of
different parts of the brain and its meninges,
polypi in the sinuses, adhesions of the dura
and pia mater, serum in a preternatural
quantity in the ventricles, hydatids, ossifi-
cation of the internal carotids, with many
others that my reader may consult in the
works of the celebrated Morgagni, Lieutaud,
Bonetus, Haller, or in Arnold on Insanity.
All these appearances are, probably, the
effects of the disease; but from these effects,
we
* Medical observations and inquiries, by Benjamin Rush,
M. D, &c. 

( 32 )
we may judge of the propriety of admini-
stering remedies known to remove obstruc-
tions in other parts of the body; and, in
my opinion, we are justifiable in using doubt-
ful remedies, rather than abandon our pati-
ents, by consigning them to confinement in
a cell for life, where they suppose themselves
" haunted with all the horrors of Tartarus,
or even chained within the gloomy dungeons
and inexorable bars of Cerberus." With
this I finish the remote causes, and, I think,
may justly conclude, that the avenues and
symptoms of Insanity, are almost as numer-
ous, as the gurgling rills that empty them-
selves into the majestic stream of the Dela-
ware.
PROXIMATE CAUSE.
THE Proximate cause of Insanity, con-
sists in an excess or defect of motion, in one
or more parts of the brain. It remains now
to be considered in what manner these mo-
tions are produced, whether they are from
the circulation of the blood simply? Whether
from the inconceivable fine fluid which Boer-
haave supposed was secreted in the brain? Or
whether 

( 33 )
whether from the subtle æther, which is said
by Sir Isaac Newton to pervade all the mate-
rial creation? but as these are not proven by
experiment, may I not with more propriety
assert, that all our motions, either of body
or mind, depend on an electric or electroid*
fluid; this has been emphatically called "the
enlivening spirit and soul of nature;" who
knows but the intricate structure of the brain
was wisely intended for its peculiar modifi-
cation and common receptacle, and that the
dura and pia mater, with the tunica arach-
noides, were intended by the provident Au-
thor of the creation, to prevent this fluid from
being dispersed among the surrounding parts;
and destined it to be conveyed only by the
nerves, through the different parts of the
body, to answer the purposes of the animal
œconomy? And may not the periodical at
tacks of Insanity be owing to a want or to
an accumulation of this electricity in the
brain. It may be asked, Where are your
proofs of the existence of this fluid, which
bids so fair to unravel the numerous mysteries
E in
* A name given it by Dr. Rush. 

( 34 )
in Physiology? Although I have not yet made
the experiments necessary, it is with pleasure
I can answer, that its existence has been prov-
ed by the ingenious Galvani,* Valli,† and
Fowler,‡ whose observations I must beg leave
to recommend to the perusal of those, who wish
to be particular on the subject ; as the recital
of their experiments, would far exceed the
limits of this dissertation.
CURE OF INSANITY
WE are informed by physiologists that one
eighth part of the blood circulates through
the brain ; therefore every increase of circu-
lation, must be the cause of a greater quan-
tity of electric or electroid fluid being sepa-
rated therein;§ consequently from my former
position,
* The extraordinary discovery of the existence of ani-
mal electricity, was, like many others, the effect of accidents
for an account of it, see the New London medical journal,
part 4, page 376.
† Experiments on animal electricity, by Eusebius Valli,
M. D. &c.
‡ Experiments and observations relative to the influence
lately discovered by M. Galvani, and commonly called
animal electricity, by Richard Fowler.
§ Valli's experiments, page 237.

( 35 )
position, its motions must be increased and
vice versa.
Previous to my entering on the treatment
of tonic mania, it may not be improper to
remark, that the patient should be removed,
if possible, from his family and dwelling; if
this is not complied with, the apartment
should be stripped of all its furniture; his ac-
quaintance and none of his family, should
have any intercourse with him ; great atten-
tion should be paid to cleanliness, and if con-
fined in a public mad-house, the horrid cus-
tom of satisfying the idle curiosity of visitors
should be prohibited; as their impertinent
questions, frequently aggravate the disease,
especially if they should be on a subject to
which they have an aversion.
REMEDIES.
I. Blood-letting.
THIS remedy I believe only to be useful
in a recent case, and in young plethoric sub-
ject, the fulness of the pulse must be our
guide. When there is a sense of fulness in
the head and face, arteriotomy has been re-
commended, also deep scarifications in the
back part of the head, cold applications to
the 

( 36 )
the head after it has been shaved: Dr. Cul-
len recommends ice and snow, but if these
cannot be procured, the noted clay-cap is
recommended ; as this is a disagreeable ap-
plication, I would prefer the use of æther,
as chemistry teaches us that the evaporation
of it will produce cold sufficient to freeze
water.*
II. Purges.
These should be generally of the drastic
kind; the white hellebore, which was so highly
recommended by the ancients as almost a
specific for the cure of mania, is now found
to possess no other virtues than a drastic
cathartic.
III. Emetics,
WHEN given in full doses, so as to pro-
duce vomiting, are not often attended with
success. I have seen very good effects from
the exhibition of tart. emet. when given in
doses sufficient to produce a nausea ; but from
the trials I have made, I do not think it
deserves the praises bellowed on it by medi-
cal writers.
IV.
* Nicholson's chem. page 18. 

( 37 )
IV. Camphor.
THIS has been esteemed a valuable me-
dicine in maniacal cases ; I have exhibited it
to several patients, but found it to succeed
only in two. It should be given in doses from
forty grains to ʒj and upwards, three or four
times in twenty-four hours, otherwise no
good effect can be expected. In one case, it
had a powerful effect on the pulse, in reduc-
ing the frequency from ninety to sixty-five
strokes in a minute. In Percival's essays, a
case is recorded in which camphor had been
given with success ; the pulse was reduced
from eighty to seventy strokes in a minute.
It was administered in doses of one scruple,
to the amount of three drachms in twenty-
four hours.*
V. Opium.
THIS is a sovereign remedy when the
disease arises from intemperance, also from
parturition, the dose should be always accom-
modated to the excitability of the system.
VI.
* Percival's essays, vol. II.

( 38 )
VI. Digitalis.
MANY cases on record, testify the good
effects of this remedy. Dr. Withering* relates
many cases wherein it was useful, but all of
them appear to be combined with serous
effusions. Dr. Rush prescribed it in one case
in the Pennsylvania Hospital with success.†
HOW does digitalis operate in curing In-
sanity? Is it from the increased secretion of
urine which follows its exhibition? Or may it
not be owing to its direct debilitating power?
I have given it to patients that have been un-
governable merely to quiet their rage, and with
the happiest effect, without a preternatural
quantity of urine being discharged; I have
used it from two to eight grains; the pulse
after its exhibition was diminished in one
case from sixty to forty-five strokes in a
minute, but I have never had the happiness
of seeing it produce a perfect cure.
VII.
* See an account of the medical uses of digitalis, by
William Withering, M. D.
† See manuscript lectures, by Dr. B. Rush. 

( 39 )
VII. Compressing the carotid arteries.
WE are indebted to Dr. Parry of Bath for
this new mode of suspending mania; it is done
by mechanical compression of one or both the
common trunks of the carotid arteries, by means
of the fingers or thumbs.* In many instances,
it is said in recent paroxysms to procure in-
stantaneous relief. I never attempted to try
this remedy but in one case, in which it did
not succeed. The experiment ought to be
made, when the maniac is not under any
restraint, otherwise, we cannot form a true
judgment, on the efficacy of the remedy;
as I received a severe blow at the time I at-
tempted it, I have never repeated the expe-
riment, nevertheless I think it worthy our
particular attention.
VIII. Is mercury proper in mania?
Yes.—It has been used with success by Dr.
Clarke; he supposes it operates "by inducing
and supporting a condition or state of the
system, totally opposite to that of the exist-
ing disease. And on this principle I have
given
* Medical commentaries, by A. Duncan, M. D. &c.
vol. XIII. 

( 40 )
given it in four cases of recent Insanity with
the most happy effects."* I have used this
remedy in one case of recent Insanity, and
this as attended with the venereal disease,
which probably might have been the re-
mote cause, by inducing a callosity of the
dura or pia mater, which the mercury re-
moved.
IX. Fear.
THROWING a patient suddenly into
the water, has bee practised with relief ; it
always tends to make them more tractable.
Boerhaave recommends throwing them into
the sea and keeping them therein until they
are nearly drowned.† Exposure to cold has
been the means of restoring a maniac: A
man in Maryland, who when mad, ran out
from his friends in the night naked, and spent
the whole night exposed to the cold in a
marsh; in the morning he returned home in
perfect health.‡
X.
* See Clarke, on hot climates, vol. II.
† Boerhaave, aph. 1123.
‡ See Dr. Rush's manuscript lectures. 

( 41 )
X. Hard labor.
THIS has been practiced with success in
the hospital. It has been highly recommend-
ed in Europe.
XI. Query—Would not a paroxysm of
Insanity be considerably relieved, by exposing
the patient to an atmosphere in which one
twelfth part of fixed air, or carbonic acid gas
is contained?*
XII. What would be the effect of a vio-
lent shock of artificial electricity in mania?
F Lastly,
* The muscular force of maniacs being much increased,
this remedy may prove powerful by rendering them more
tractable. 
If the strength of maniacs depends on the stimulus of
the electroid fluid, acting on the oxigenous principle in the
mucles, lately called the principle of irritability, is it not
probable that the carbonic acid gas, by combining with
the oxygene, will decrease the muscular force, and reduce
the motions of the brain also to their primitive state?
An accident that happened some time ago, leads me to
offer the conjecture. A number of lunatics confined in the
hospital, were observed to be very silent; on examining the
cells, some were found apparently dead: the fixed air from
the coal? that were made use of was the cause; the usual
ventilators not being open. Those that were apparently
dead lay near the stoves in which the coals were deposited;
it is remarkable, that as they recovered from this state of
asphyxia, they possessed all their faculties and reasoned well
for some time after.
Mr. Joseph Henszey, who has been fourteen years
Steward of the hospital, informed me, that a similar cir-
cumstance to the above took place some years ago, but that
they spoke rationally only for a short space of time. 

( 42 )
Lastly, Coercion.
THIS will conduce more to the cure
of tonic mania, than any of the remedies
usually prescribed. Celsus recommends stripes,
these are seldom or never necessary; when
they are, they should be practised with lenity,
in the same manner as a parent would cor-
rect a child. It is of great use in practice
to bear in mind that mad-people commonly
are great cowards, and can at times be awed
even by a grim look from the keeper ; they
ought to be immediately impressed with fear
when the curative plan is commenced. The
most proper mode of employing coercion,
is by the* strait waistcoat ; by this, they are
prevented from injuring themselves or attend-
ants. When the waistcoat is put on, the
patient should be laid on his back, his arms
drawn over his chest in such a manner that
his right arm may be secured on the left side
of the beadstead by means of a cord, the
left arm to be secured in the same manner;
his
* Dr. Rush remarked to me, that when maniacs are
restrained by men, they endeavour to resist more than when
by the strait waistcoat ; and they retain great rancour towards
the former and none to the latter. 

( 43 )
his feet should be also secured by means of a
band passed round his ankle and fastened to the
foot of the bedstead. In this manner the patient
is to continue. Nauseating doses of tartar eme-
tic will now be found useful; his diet should
be accommodated to the state of his system.
He will perhaps be much agitated with this
treatment, but in a few hours he will be-
come perfectly calm, and will commonly
express great surprise at the usage; it however
should be continued. This treatment should
never be known or supposed to be the direc-
tion of the Physician; he should always ap-
pear to act the part of a friend, that will
espouse the cause of the maniac in his disputes
with the keeper. If he continues calm he may
be suffered to walk out of his room with his
attendant, who should endeavour to divert his
mind from particular objects; but if there
are any symptoms of a relapse, the former
treatment should be immediately renewed,
and this alternation of confinement and li-
berty ought to be continued, until a perfect
recovery.* This treatment I believe has been
attended
* I saw this remedy first tried under the direction of Dr.
A. Kuhn, and it was attended with the wished for success. 

( 44 )
attended with more success than any that has
hitherto been proposed, and I doubt not, but
what it would be effectual in almost every re-
cent case. It is to be regreted that the rela-
tions of the Insane, in general, are so void of
humanity, that on the first attack of the dis-
ease, they will not suffer this treatment to
be put in practice: I say void of humanity,
because every person, who would prefer see-
ing a relation confined insane for life, rather
than have a remedy tried, which has been
known to be effectual, certainly does not
possess an affection for the relation, or hu-
manity towards his fellow creatures.
Remedies for the atonic fate of Insanity.
IT is evident, from the distinguishing
character of this state of Insanity, that the
management of the mind and passions require
our particular attention.
The great object to be aimed at in the cure,
is to neutralize or interrupt the attention of
the mind ; this requires great delicacy and
caution. The patient should be drawn into
chearful company ; a circle of lively females
should 

( 45 )
should be preferred, as they are known to
have a greater power of animating the de-
jected ; except, when they have been the
cause of the complaint. The allurement in-
to company should not appear to be intenti-
onal. Confinement at all times is extremely
improper.
" Chiefly where solitude, sad nurse of care,
To sickly musing gives the pensive mind:
There madness enters ; and the dim-ey'd fiend,
Sour melancholy, night and day provokes
Her own eternal wound: the sun grows pale,
A mournful visionary light o'erspreads
The chearful face of nature, earth becomes
A dreary desart, and heav'n frowns above:
Then various shapes of curs'd illusion rise:
Whate'er the wretched fears, creating fear
Forms out of nothing, and with monsters teem
Unknown in hell.-"
ARMSTRONG ON HEALTH.
Travelling, either on horse-back or in a car-
riage, induces many pleasing objects and sub-
jects of attention, which, says Dr. Falconer, are
the more pleasing as they have not the appear-
ance of being intentionally introduced.* What
would
* Falconer on the passions. 

( 46 )
would be the effect of employing certain
passions, such as anger, terror, &c? Shame
has cured the disease. Plutarch relates, that
the virgins of Miletus were seized with an
epidemic madness, that prompted them to
destroy themselves. This was in vain attempt-
ed to be prevented, until it was ordered that
the bodies of those who thus put an end to
their lives, should be dragged naked through
the streets.* The introduction of such sports
and amusements as would moderately exercise
the faculties, may prove useful.
Cælius Aurelianus recommends diverting
the mind of literary men with philosophical
questions ; the farmer with discourses on
agriculture ; the sailor with naval affairs;
others may be diverted with games of
chance:† A woman in Philadelphia county,
was cured by a number of persons playing
cards with her the whole day, one succeeding
the other as they grew tired.‡
Music
* Plutarch de virtutibus mulierum, quoted by Dr.
Falconer, in his treatise on the passions, page 118.
† Cælus. Aurel. I. 5.
‡ Dr. Rush's manuscript lectures. 

( 47 )
Music is considered a powerful remedy,
the tunes should be lively ; the disease of
king Saul was cured by music ; its influence
is very great, and is capable of raising and
soothing every passion and emotion of the
soul.
"Music exalts each joy, allays each grief,
Expels diseases, softens every pain,
Subdues the rage of poison and the plague;
And hence the wife of ancient days ador'd
One power of physic, melody, and song."
ARMSTRONG.
What medicines are proper?
BLOOD-LETTING is seldom necessary
in this disease, except to enlarge the surface
of excitability.
Purges.
THESE are generally necessary as costive-
ness is an usual attendant: the aloetic cathar-
tics, appear to be peculiarly adapted to this
state of Insanity.
Antispasmodics have been found useful;
musk, opium, æther, and assafœtida have
been found beneficial ; the latter of these
remedies 

( 48 )
remedies should be given to the amount of a
ʒ1. or a ʒ1 ss. in twenty-four hours. Peruvian
bark with opium is recommended by Dr.
Ferriar, and cases related of its success.*
The warm bath has proved serviceable ; the
patient is not to be detained two long in the
water, and when taken out, should be well
dried with a cloth; afterwards, the flesh-
brush will be used with advantage.
The cold bath has been recommended;
but if there is not a glow on the skin after
its use, it should be discontinued. The
different metallic tonics have all been used
with apparent success.
Wine may be allowed, also, a generous
diet: cleanliness should be strictly attended to;
the beard frequently shaved, and a frequent
change of clothes should be recommended.
What would be the effect of electricity in this
state of the disease?
DR. RUSH remarks, that dephlogisti-
cated air, when taken into the lungs, pro-
duces
* See medical histories and reflections, by John Fer-
riar, M. D. 

( 49 )
duces cheerfulness, gentleness, and serenity
of mind.* Does not this oxygene gas, or
dephlogisticated air, appear to be a plausible
remedy in atonic mania? I have never tried
it, but from the above fact it deserves our
attention.
DISSECTIONS.
IN the preceding part of this dissertation,
I observed, that by dissection we discover
the effect of a disease, rather than the cause;
nevertheless, they frequently cast forth a glim-
mering light, which enables us to penetrate
the obscure mazes, and assist in the method
of cure.
Many dissections of the brain and abdo-
men of maniacs, have been presented to the
world at various times, sanctioned by the
names of eminent men; therefore, I submit
mine with a greater degree of reluctance.
As I always conceived Insanity to be per-
fectly a local disease when it continued any
length of time, I thought it proper to con-
fine my examination to the brain only, un-
G less
* Medical observations and inquiries, by Benjamin Rush,
M. D. &c. vol. II. 

( 50 )
less it attended, or alternated with another
disease. The rewards of my disagreeable
researches were as follow:
No. I.
Martha P - died February - 1791.
This woman labored under tonic mania for
a considerable time, the consequence of long
continued grief. On examining her head, I
found the dura and pia mater much indurat-
ed, the longitudinal sinus ossified in several
places, the brain more firm than what is
commonly observed.
No. II.
David G - , laboring under tonic
mania, died May - 179I. The proba-
ble cause of this man's Insanity was not
known. On removing his cranium, I found
the dura and pia mater adhering together
on the left side of the longitudinal sinus, the
inferior portion of the septum lucidum by
some means removed, so that there was a
large communication between the lateral
ventricles, which contained a small quantity
of a serous fluid.
No. 

( 51 )
No. III.
Henry O - died November - 
1791. This man had labored under atonic
mania six months, love was said to be the
cause of his disease. He died after three days
illness of cynanche maligna ; on opening his
head, I found many livid spots on the dura
mater, the inferior and superior parts of the
left lateral ventricles adhered together and
appeared to be the consequence of inflam-
mation.
No. IV.
E - B - died February - 
1792. This man had laboured under the
tonic state of Insanity some time, the cause
of his disease not known ; he recovered his
senses in some measure from an abscess which
formed in his groin and extended over his
thigh, which being laid open discharged co-
piously ; in a few weeks after the wound
cicatrized, he was attacked with a violent
cough; in a paroxyam of which, he ruptured
a blood-vessel, which proved instantaneous
death. On examining his thorax, the hæ-
morrhage was found to proceed from one of
the 

( 52 )
the ramifications of the pulmonary artery ;
there were no preternatural appearances in
his brain or its meninges.
No. V.
C - L - died November -
1792. On examining his head, I found his
brain uncommonly hard, with a small quan-
tity of serum in its ventricles. On opening
his thorax I found the left lobe of his lungs
adhering to the ribs, in the right evident
marks of inflammation, and a small quantity
of water in the cavity of the thorax. Hav-
ing laid bare the abdominal viscera, I found
the intestines considerably inflated; the omen-
tum drawn upward and much thickened ; the
liver greatly contracted and indurated (the
whole weighing only one pound nine ounces)
with every appearance of a former ulcera-
tion ; the convex surface adhered to the
diaphragm; the gall bladder filled, as it is
generally observed in debilitated habits.
The spleen enlarged and hardened; pan-
creas and kidneys in a natural state. The
water remaining after the operation of para-
centesis

( 53 )
centesis abd. amounted to nine pints, the
whole making thirty-eight pints.*
No. VI.
John P - died Nov. - 1793.
On opening his head a small quantity of
serum was found between the dura and pia
mater. In the lateral ventricles of the brain,
there were three ounces of a limpid fluid.
The frontal sinuses were filled with a puri-
form matter. He died in convulsions.
With this, I finish my observations on
Insanity ; and as I conceived the probable
remote causes, and the condition of the system
should always be held in view, I have only
troubled my reader, with an account of those
remedies in the method of cure, that have
been used with the most success. If I have
offered a single fact, or conjecture, in the
preceding pages, that will lead to the disco-
very of any new mode of treatment, or in
any manner be servicable to my fellow crea-
tures, I shall think myself well rewarded for
my trouble.
* See page 20.
FINIS.