■£.
STUDY  OF  MEDICINE.
WITH A
VOTOSlIOILOffilCOAlL BTSIPMM
        NOSOLOGY.

              BY

JOHN MASON GOOD, M.D. F.R.S
             Uk
  MEM. AM. PHIL. SOC. AND F.L.S. OF PHILADELPHIA.

     IN FIVE VOLUMES.

           VOL.111.        /0(><j()5.

       SECOND AMERICAN EDITION.
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      J. GRIGG, E. PARKER, AND T. DESILTER.
               AND
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          J. V. SEAMAN, NEW-YORK.
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I
CLASS IV.
i


i

1
* 
          CLASS IV.

     NEUROTICA.

  DISEASES OF THE NERVOUS FUNCTION.

ORDER I.
          PHRENICA.
              AFFECTING THE INTELLECT.
iESTHETICA.			* A
AFFECTING	THE	SENSATION	- t
III.			
CINETICA.			
AFFECTING	THE	MUSCLES.	
IV.			
SYSTATICA.			
AFFECTING SEVERAL OR ALL THE SENSO-
  RIAL POWERS SIMULTANEOUSLY. 

        CLASS  IV.

PHYSIOLOGICAL  PROEM.
 1 he numerous and complicated train of diseases we are now enter-
 ing upon appertains to the highest function of visible beings ;  the
 possession of which emphatically distinguishes animals from plants,
 and the perfection of which as emphatically distinguishes man from
 all other animals : these are the diseases of the nervous function ;
 —which, in the sphere of its activity, embraces the powers of intel-
 lect, sensation, and muscular motion.  Each of these powers evinces
 diseases of  its own,  and will consequently lay a foundation for a
 distinct orderi under the class before us.   While, as there are also
 ot .er diseases that affect several of them simultaneously, we become
 furnished with a fourth order, which will complete the  series.
  All these  diversities of vital energy are now well  known to be
 dependent on the organ of the brain, as the instrument of the intel-
 lectual powers, and the source of the sensific and motory.  Though,
 from the close connexion and synchronous action of  various other
 organs with the brain, and  especially the thoracic and abdominal
 viscera, such diversities were often referred to several of the latter
 in earlier ages and before anatomy had  traced them satisfactorily
 to the brain  as their fountain-head. And of so high an antiquity is
 this erroneous hypothesis, that it has not only spread itself through
 every climate on the globe,  but still keeps a hold on the colloquial
 language of every people; and hence the heart, the liver, the spleen,
 the reins, and the bowels generally, are, among all nations, regard-
 ed either literally or figuratively, as so many seats of mental facul-
 ties or moral feeling.  We trace this common and popular creed
 among the Hebrews and Arabians, the Egyptians and Persians, the
 Greeks and Romans; among every savage, as well as every civilized
 tribe; nor is there a dialect of the present day  that is free from it:
 and we have hence an incontrovertible  proof that it existed as a
 doctrine of  general belief at a time when mankind, few in num-
ber, formed a common family> and were regulated by common no-
 tions. 
li
PHYSIOLOGICAL PROEM.
[CL. IV.
    The study of anatomy, however, has  corrected  the loose and
  confused ideas of mankind upon this subject; and while  it distinctly
  shows us that many of the organs popularly referred to as the seat
  of sensation, do and  must, from the peculiarity of their nervous
  connexion with the brain, necessarily participate in the feelings and
  faculties thus generally ascribed to them, it also demonstrates that
  the primary source of these attributes, the quarter in which  they
  originate, or which chiefly influences them, is the brain  itself.
    We are speaking, however, of man and the higher classes  of
  animals alone; for, as the scale in animal life descends, the organ of
  a brain is perpetually diminishing in its bulk, till at length it  totally
  disappears, and its  place is supplied by other fabrications,  as we
  shall have occasion to observe in the sequel of this introduction :
  which will lead us to take a brief notice of the following subjects :
      I. THE GENERAL NATURE OF THE BRAIN, ITS RAMIFICATIONS AND
          SUBSTITUTES.
    II. THE PRINCIPLE OF SENSATION AND MOTION.
   III. THE INTELLECTUAL PRINCIPLE.

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

    •  See Sir Everard Home's Croonian Lecture, Phil. Trans, for 1818. 
CL. IV.]
PHYSIOLOGICAL PROEM.
t
  Sir Everard Home from these microscopic disclosures, endeavours
to show that muscular fibres are minute chains formed by an attach-
ment of one globule of blood to another: and that vascularity in
coagula or extravasated blood, or in granulations produced by pus,
is effected by the escape of minutebubbles of carbonic acid gas from
the living fluid; which hereby opens a path to a certain extent into
the tenacious blood or pus that is extravasated or secreted.
  From this general organ arises a certain number of long, whitish,
pulpy, chords, composed of bundles of fibres,  capable  of  being
divided and  subdivided  into  minuter bundles of fibrils, or still
smaller fibres as far as  the power of glasses can carry the eye.
These chords are denominated nerves;  they are surrounded, to
their extremities, by one or more of the common membranes of the
brain, and, by their various ramifications, convey different kinds or
modifications of living power to different parts of the body, keep  up
a  perpetual  communication with its  remotest  organs,  and give
motivity to the muscles.
  As the brain consists of three  general divisions, it  might, at first
sight, be supposed that each of  these  is allotted  to  some distinct
purpose ; as, for example, that  of  forming the seat of intellect or
thinking;  the seat of the local  senses of sight, sound, taste, and
smell,  and the seat of general feeling or motivity.   But  the nice
hand of the anatomist has confounded  all such speculations  by
tracing up to each of these divisions both nerves of general, and
nerves of particular purposes.  Thus the cerebrum, which gives
;ise to the  olfactory and optic nerves, (serving the purpose of pure
sensations) gives rise also to the oculorum motorii,  apparently
serving the purpose of muscular motion.  So the cerebellum gives
rise to the  trochleatores and the trigemini, the first chiefly employed
in producing motive power, the second sensile power: while from
the medulla oblongata originate  the auditory,  the par vagum, and
the lingual;  the first a nerve of  hearing, the second of feeling, and
the third of motivity: at the same time that many parts of the brain
maintain an  interunion with other parts by  means  of  ganglions,
commissures and decussations of nerves; whence injuries on one
side are often  accompanied  with loss of motion or feeling in the
organs of the other side.  So the curious and ingenious, but, I fear,
scarcely justifiable experiments  lately instituted by Dr. Philip,*
and to which we shall have occasion to return presently, sufficiently
prove that stimuli of a certain kind, as spirit of wine, applied to the
posterior part of the naked brain of an animal, produce the same
 effect on the heart, and equally  increase  its action as if applied  to
 the anterior  part.   To affect the heart,  however, it seems  neces-
 sary that the stimulus should spread  over a pretty large extent of
the brain;  so as to  take in, by  the  range of its excitement, some
of the ganglions of the brains, whose office, as Dr. Philip conceives,
 is " to  combine the influence of the various parts of the nervous
* Phil. Trans, 1815. p. 5—90. 
8
PHYSIOLOGICAL PROEM.
[CL.IV.
 system, from which they receive nerves, and to send off nerves en-
 dowed with the combined influence of those parts."* He hence ac-
 counts for some organs of the frame being affected by every part
 of the nervous system, and others by only certain small parts of it;
 and the wide influence possessed by the great sympathetic nerve,
 which  is less a single nerve than a string of ganglions.  We are
 also hereby shown why the intestines, like the heart, sympathize with
 every portion of the nervous system.
   From all this, however, it  is clear that  we know nothing of the
 reason of the actual arrangement of the brain or of its partition into
 three divisions, nor of the respective share which the different parts
 take in producing a common effect: and consequently it seems to be
 altogether a wild  and idle attempt to  subdivide  these perceptible
 regions of the brain into still smaller and merely imaginary sections,
 and to allot  to each of them a determinate function and faculty.
   That a sensorial communication, however, is maintained between
 some part or other of the brain and every part of the  body, and that
 this communication is conducted by the nerves, is unquestionable
 from the following facts :
   If we divide, or  tie, or merely compress a nerve of any kind, the
 muscle with which it communicates becomes almost instantly paraly-
 tic; but upon untying or removing the compression the muscle re-
 covers its appropriate  feeling and  irritability.   If the compression
 be made on any particular part of the  brain, that part of the body
 becomes motionless which derives nerves from the part compress-
 ed.   And if the cerebrum, cerebellum, or medulla oblongata be ir-
 ritated, convulsions take  place all over the body: though chiefly
 when the irritation is applied to the last of these three parts.   For,
 according to the laws  of the  nervous action as collected from a va-
 riety  of  experiments  by Dr. Philip,t and  stated in  a subsequent
 paper to that just referred to, " Neither mechanical  nor chemical
 stimuli  (irritating  the brain by a knife, or pouring spirits  of wine
 upon it) applied to the nervous system,  excite the muscles of volun-
 tary motion, unless they are applied near to the origin of the nerves,
 and spinal marrow."
   The nerves issue in  pairs, one of each pair being allotted to either
 side of the  body.  The whole number of pairs is thirty-nine; of
 which nine rise immediately from  the great divisions of the brain
 under which we have just contemplated it, and are chiefly,  though,
 as already observed, not wholly appropriated to the four local sen-
 ses ; and thirty from the spinal marrow  through the foramina of the
bone that encases  it,  and are  altogether distributed over the body
to produce the fifth or general sense of touch and feeling, which,
however, by some physiologists are regarded as distinct from each
other, and to communicate, in an especial degree, irritability to the
muscles.
* Phil. Trans. 1815, p. 436.
t Phil. Trans. 1815. p. 444. 
CL.IV.]
PHYSIOLOGICAL PROEM.
9
    We have thus far represented the spinal marrow as issuing from
  the brain, in conformity with the general doctrine that has hitherto
  been held upon the subject.  It has of late years, however, been
  contended by various physiologists, and particularly  by Drs. Gall
  and Spurzheim, that the spinal marrow itself is the origin or trunk
  of the nervous system, and that, instead of issuing from the brain, it
  gives birth to it.  The argument is derived from the  existence of a
  spinal marrow alone in acephalous monsters, and of a nervous chord
  without a brain, answering  the purpose of a spinal marrow,  in most
  invertebral animals.  Whence it is inferred that the nervous column
  is the radical part of the system, and that the brain is an increment
  Irom it in the more perfect  classes.*
    The question is not of much  importance, though there is  some-
  thing ingenious in thus tracing  animal life from its simpler  forms.
  Yet  the opinion seems to be in direct opposition to a well-ascertain-
  ed fact we shall have to advert to presently, namely, that the mag-
  nitude of the brain and the extent of its intellectual powers hold an
  inverse proportion to the size of the spinal marrow, and consequent-
  ly, upon this hypothesis, to  their apparent  means of supply.  Nor
 is it  the mode of induction usually adopted by physiologists on like
 occasions ;  sincfe they generally describe the arteries as issuing from
 the heart, instead of giving rise to it, notwithstanding that the heart,
 like  the brain, has been found totally wanting in some monsters, and
 the circulation carried on by an  artery and a vein alone, of  which
 Mr.  Hewson gives a very singular instance ;t and that most  of the
 worm genera are equally without a heart though they are in posses-
 sion of circulatory vessels.   We  only see in these arrangements that
 neither a brain  nor a heart are essentially necessary to animal life :
 and that the great Author of nature is the lord, and not the slave, of
 his own laws  ; and is capable of effecting the same general principle
 by a  ruder as well as by a more elaborate design.
   There is one part, however, of the system of nervous  power  in
 the more perfect classes of animals that is particularly worthy of our
 attention, as furnishing a  rule peculiar  to itself, and being without
 a parallel in  any other part: and that is  the origin, structure, and
 extensive influence of the great  sympathetic  or intercostal nerve,
 which forms a kind of system in  itself, an epicycle within  the two
 cycles of cerebral and vertebral influence.  It is connected both with
 the brain  and  spinal marrow,  and may  be said to arise  from
 either.   Admitting the brain to be its source, it is an offset from the
 sixth  pair of  nerves, on either side, and in its course receives  a
 small tributary twig from tne fifth, and branches from all the verte-
 brae, fron> whose union and decussation it is studded with numerous
 ganglions or  medullary enlargements, of which  there are not less
 than three in the neck alone tinted by an addition of cineritious sub-


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

            In man from    .     .     ^ to -^ part
              Several simiae ...    ^
              Dog          .     .     .    T*T
              Elephant     ...     ^
• Diss, de basi Encephali. Gotting. 1778.4to. 
CL. IV.]
PHYSIOLOGICAL PROEM.
u
           Sparrow       ...     -',
           Canary Bird   ...     JL
           Goose         •     •     •    h-sts
           Turtle (smallest)    .     .    tfa

 M. Sommering has hence endeavoured to correct the rule of Aristo-
 tle by a modification under which it appears to hold  universally;
 and, thus corrected, it runs as follows: " man has the largest brain
 of all animals in proportion to the  general mass of nerves that issue
 from it."  Thus the brain of a horse gives only half the weight of
 that of a man, but the nerves it sends forth are ten times as bulky.
 The largest brain which M. Sommering ever dissected in the horse
 kind, weighed only lib. 4oz. while the smallest he has met with in
 an adult man  was 2lb. 5|oz.
   But the remark applies farther than to man :  for this acute phy-
 siologist has been able to trace a direct  proportion between the de-
 gree of intelligence in  every class of animals, and  the bulk of the
 brain, where  the latter bears an inverse proportion to the nerves
 that arise from it.  And, we may hence observe, in passing, as in-
 deed,  we have already hinted, that the  nerves seem rather to be a
 product of the brain  than the brain of  the nerves: for it is much
 more easy to conceive how a fountain may become exhausted in pro-
 portion to the magnitude of its streams,  than how a reservoir can be
 augmented in proportion to the minuteness of its channels.
   Upon a general survey, I may observe that the nervous structure
 of all vertebral animals, comprising the  first four classes of the Lin-
 nean classification, mammals, birds, amphibials, and fishes, is charac-
 terized by the two following properties.   Firstly, the organ of sense
 consists of a gland with a long chord or spinal marrow descending
from it; and, secondly, that both are securely inclosed in a bony case
 or covering.
   In man, as I have already observed, this gland is (with a few ex-
 ceptions) larger than in any other  animal in proportion to the size
of the  body; and, without any  exception whatever, in proportion to
 the size of its dependent column.
   In other animals, even of the vertebral classes, or those  imme-
diately before  us, we meet with every variety of proportion, from
the ape which, in this respect, approaches nearest to that of man, to
tortoises, and fishes, in  which  the  brain does  not much exceed  the
diameter of the spinal marrow itself.
   It is not, therefore, to be wondered at that animals of a still lower
description and without a vertebral column, should exhibit proofs of
a nervous chord or spinal marrow without a  gland or brain of any
kind at the top; and that this chord should even be destitute of its
common bony defence.   And  such is actually the.conformation of
the nervous system  in insects, and, for  the most part, in  worms;
neither of which are possessed either of a cranium or a spine; and
in none of which we are able  to trace more than a slight enlarge-
ment of the superior part of the nervous  chord, or spinal  marrow 
12                 PHYSIOLOGICAL PROEM.            [CL. IV.

as it is called in animals possessing a spine often consisting of one,
and sometimes of two ganglions designed apparently, to correspond
with the  organ of a brain;  the descending  column chiefly taking
the course of the  oesophagus and surrounding it.  The nervous
chord, however, in these animals is  proportionally larger than in
those of a superior rank; and, though sometimes simple, as in mol-
luscous worms, in other cases, as in insects, is possessed at various
distances of minuter ganglions or little knots, from which fresh ra-
mifications of nerves shoot  forth  like branches from the trunk of a
tree, and which may perhaps be regarded as so many distinct cere-
bels or little brains: having a close resemblance to the subordinate
system of the intercostal nerve in man, as we have already traced it
in its various ramifications and connexions.
  In worms of apparently the simplest make, as zoophytes and in-
fusory animals, no  distinct structure can be discerned, and particu-
larly nothing like  a nervous system.  The hydra or nearly  trans-
parent polypus found so frequently in  the stagnant  waters of our
own country, with  a body of an inch long, and arms or tentacles in
proportion, seems, when examined by the largest magnifying  glass-
es, ito consist of a congeries of granular globules or molecules, not
unlike boiled sago  surrounded by a gelatinous substance; in  some
tribes solitary, in others catenated.   And hence, whatever degree
of sensation or voluntary motion exists in such animals, can only be
conceived as issuing from  these molecules acting the part of ner-
vous ganglions detached, or connected.   And  on this account M.
Virey has elegantly divided all animals into three classes according
to the nature of their nervous configuration ; as first, animals with
two nervous systems, a cerebral and sympathetic,  including  mam-
mals and birds, amphibials and fishes.  Secondly, animals with a
sympathetic nervous system alone, surrounding the oesophagus as
molluscae and shell-fishes, insects and proper worms.  And, thirdly,
animals with nervous molecules, as  echini, polypes, and infusory
animalcules, corals, madrepores, and sponges:  all which in M. Vi-
rey's classification are included under the term zoophytes.
  The only sense which seems common to animals, and which per-
vades almost the whole surface  of their bodies,  is that of general
touch or feeling; whence M. Cuvier supposes that the material of
touch is the sensorial power in its  simplest and uncompounded state;
and  that the other senses  are only modifications of this  material,
though peculiarly  elaborated by peculiar organs, which are also ca-
pable of receiving more delicate  impressions.*  Touch, however,
has its peculiar local organ, as well as the other senses, for particu-
lar purposes, and purposes in which unusual delicacy and precision
are  required; in man this  peculiar power of touch is  well known
to be seated in the nervous papillae of  the tongue, lips, and  extre-
mities of the fingers.  Its situation in other animals I shall advert
to presently.
* Anatom. Comparat, I. 25. 
CL. IV.]
PHYSIOLOGICAL PROEM.
> n
   The differences in the external senses of the different orders and
 kinds of animals consist in their number and degree of energy.
   All the classes of vertebral animals possess the same number of
 senses as man.  Sight is wanting in zoophytes, in various kinds of
 molluscous,  and articulated  worms, and  in  the larves  of several
 species of insects.  Hearing  does not exist, or at least has not been
 traced to exist,  in many molluscous worms and several insects in a
 perfect state.  Taste and smell, like the general and simple sense
 of touch, seem seldom to be wanting in any animal.
   The local  sense of touch,  however, or that which is of a  more
 elaborate character and capable of being exercised  in a higher de-
 gree, appears to be confined to the three classes of mammals, birds,
 and insects:  and even in the  last two it is by  no means common to
 all them, and less so among insects than among birds.
   In apes and macaucoes, constituting the quadrumana of Blumen-
 bach. it resides  partly in the  tongue, and tips of the fingers  as in
 man, but equally, and in  some species even in a superior degree, in
 their toes.   In the raccoon (ursus lotor) it exists chiefly in the  under
 surface of the front toes.  In the horse, and cattle orders, it is sup-
 posed by most naturalists to exist conjointly in  the tongue, and snout,
 and in the pig and mole to be confined to  the snout alone; this how-
 ever is uncertain; as it is also, though there seems to be more rea-
 son for such  a belief, that in  the elephant it  is seated in the pro-
 boscis.  Some physiologists  have supposed the bristly hairs of the
 tiger, lion, and  cat, to be an organ of the same  kind;  but  there
 seems little ground for such an opinion.   In the opossum (and es-
 pecially the  Cayenne opossum) it  exists  very  visibly in the tail;
 and  M. Cuvier suspects that it has a similar existence in all the pre-
 hensil-tailed  mammals.
   Blumenbach supposes the same sense to have a place in the same
 organ in the  platypus or  ornithorhyncus as he  calls it,  that most
 extraordinary duck-billed quadruped which has lately been disco-
 vered in Australasia, and, by  its intermixture  of organs,  confounds
 the different classes of animals and sets all natural arrangement at
 defiance.
   The local organ of touch or feeling in ducks and  geese and some
 other genera of  birds, appears to be situated in the integument
 which covers the extremity of the mandibles,  and especially the
 upper mandible, with which apparatus they are well known to feel
 for their food in the midst of mud in which they can neither see nor
 perhaps smell it.
   We do not know that  amphibials, fishes, or worms, possess any
 thing like a local sense of touch ; it has been  suspected in some  of
 these and especially in the arms of the cuttle-fish, and in the ten-
 tacles of worms that possess this organ, but at present it is suspicion
 and nothing more.
   In the insect tribes, we have much reason for believing such a
 sense to reside in the antennas or in the tentacles ; whence the for-
mer of these are  denominated  by the German naturaHsts/»AMom<?r 
14
PHYSIOLOGICAL PROEM.
[CL. IV
or feeling-horns.   This belief has not been fully established, but it
is highly  plausible from the general possession of the one or the
other of these organs by the insect tribes, the general purpose to
which they apply  them, and the necessity which  there  seems for
some such organ from the crustaceousor horny texture of their ex-
ternal coat.
   The senses of taste and smell in animals bear a very near affinity
to the local sense of touch; and  it is difficult to determine whether
the upper mandible of the duck tribe, with which they distinguish
food in  the mud, may not be an organ of taste or smell as  well as
of touch ; and there are some naturalists that in like manner re-
gard the cirrous filaments or attennules attached  to the  mouths of
insects as organs of taste and  touch equally.   Taste in the more
perfect animals resides jointly in the papillae of the tongue  and the
palate ;  but I have already had occasion to observe that it may ex-
ist, and in full perfection, in  the palate alone, since  it has  been
found so in persons who have completely lost the tongue from ex-
ternal force or disease.
  In animals that possess the organ of nostrils this is always the
seat of smell; and in many quadrupeds, most birds, and perhaps most
fishes, it is a sense far more acute than in man, and that which is
chiefly confided in. For the most part it resides in the nerves dis-
tributed over a pituitary membrane  that lines the interior of the
bones of the nostrils,  and which is called the  Schneiderian  mem-
brane, in honour of M. Schneider, a  celebrated anatomist, who first
accurately described it.  Generally speaking  it will be found that
the acuteness of smell bears a proportion in all animals to the ex-
tent of surface which this membrane displays, and hence in the dog,
and cattle tribes, as well as in several others, it possesses a variety
of folds or convolutions, and in birds is continued to the utmost points
of the nostrils, which in different kinds open in very different parte
of the mandible.
  The frontal sinuses, which are lined with this delicate membrane,
are larger in the elephant than in any other quadruped, and in this
animal the sense is also continued through the flexible organ of its
proboscis. In the pig the smelling  organ is  also very extensive ;
and, in most of the mammals possessing proper horns, it ascends as
high as the processes of the frontal bone from which  the  horns
issue.
  It is not known  that the cetaceous tribes possess any organ  of
smell ; their blowing-holes are generally regarded as such ; but the
point has been by no means fully established.   We are in the same
uncertainty in respect to amphibials and worms; the sense  is sus-
pected to  exist in all the former, and in  several of the latter, espe-
cially in the cuttle-fish ; but  no distinct organ has  hitherto  been
traced out satisfactorily.
   In fishes there is no doubt; the olfactory nerves are very obvi-
ously distributed on an olfactory numbrare, ind in several instances
the snouts are double,  and consequently the  nostrils quadruple, a 
CL. IV.]
PHYSIOLOGICAL PROEM.
13
pair for each snout.  This powerful inlet of pleasure to fishes often
proves  fatal to them from its very perfection; for several kinds are
so strongly  allured by the odour of majorum, assafcetida and other
aromas, that by smearing the hand over with these substances, and
immersing it in the water, they will often flock towards the fingers,
and in their intoxication of delight may easily be laid hold of:  and
hence the  angler frequently overspreads his baits with the same
substances, and thus arms himself with a double decoy.
  There can be no doubt of the existence of the same sense in in-
sects, for they possess  a very obvious power of distinguishing the
odorous properties of bodies even at  a considerable distance be-
yond  the range of their vision: but the organ in which this sense
resides  has not been satisfactorily pointed out;  Rcimar supposes it
to exist in their stigmata, and Knoch in their anterior pair of feel-
ers.
  The general organ of hearing is the ear, but not always so; for
in most of  those who hear  by  the  Eustachian  tube only, it is the
mouth ;  in the whale  tribe it is the nostrils or blow-hole.   It is so,
however, in all the more perfect animals,  which usually for this
purpose possess two distinct entrances into the organ, a larger and
external surrounded by  a lobe;  and a smaller and internal opening
into the mouth.  It is this last which is denominated the Eustachian
tube.   The shape  of the lobe  is seldom found even in mammals
similar to that in man, excepting among the monkey and the porcu-
pine tribes.  In many kinds there is neither external lobe nor external
passage.  Thus in  the Irog, and most amphibious animals, the only
entrance is the internal  or that from the mouth;  and in the cetace-
ous  tribes the only effective entrance is probably the same kind;
for though  these may be said to possess an external aperture, it is
almost  imperceptibly minute.   It  is a curious fact that among the
serpents, the  blind-worm, or  common harmless snake, is the only
species that appears to possess  an aperture of either sort; the rest
have a  rudiment of the organ within, but we are not acquainted with
its being pervious to sound.
  Fishes are  well known to possess a hearing organ, and the skate
and shark have the rudiment  of an external ear; but like other
fishes  they seem  chiefly to receive  sound by the internal tubule
alone.
   That insects in  general  hear is unquestionable, but it is highly
questionable by what organ  they obtain the sense of hearing.  The
antennas, and perhaps merely because we do not know their exact
use, have been supposed by  many naturalists to furnish the means ;
it appears  fatal, however,  to  this  opinion to observe that spiders
hear though they have no true antennas, and that other insects which
possess them naturally  have seemed to hear as correctly after they
have been  cut off.
  The  sense of vision exhibits perhaps more variety in the different
classes of animals than any of the external senses.   In man, and the
greater number of quadrupeds it is guarded by an upper and lower 
 16                 PHYSIOLOGICAL PROEM.             fCL. IV.

 eye-lid;  both of which in man, but neither of which in most quad-
 rupeds are terminated by  the additional  defence and ornament of
 cil;a or eye-lashes.   In the elephant, opossum, seal, cat  kind,  and
 various other mammals, all birds, and all fishes, we find a third eye-
 lid, or nictitating membrane, as it is usually called, arising from the
 internal  angle of the  eye and capable of covering the pupil with a
 thin transparent veil either wholly or in part, and hence of defend-
 ing the eyes from danger in their search after food.  In the dog this
 membrane is small,  in oxen and horses it will extend over half  the
 eye-ball; in birds it  will easily cover the  whole; and it is by means
 of this veil, according to Cuvier, that the eagle is capable of look-
 ing directly against the noon-day sun.   In fishes it is almost always
 upon the stretch, as  in their uncertain element they are exposed to
 more dangers than  any other animal.  Serpents have neither this
 nor  any  other eye-lid; nor any kind of external defence whatever
 but the common integument  of the skin.
   The largest eyes  in proportion to the  size of the animal belong
 to the bird tribes;  and nearly the smallest to the whale; the small-
 est altogether to the  shrew  and mole;  in the latter of which  the
 eye is not larger than a pin's head.
   The iris, with but few exceptions, partakes of the colour of  the
 hair, and is  hence  perpetually varying in different species of the
 same genus.  The  pupil  exhibits a very  considerable,  though
 not an equal, variety in its shape.   In man it is circular; in the lion,
 tiger,  and  indeed  all the cat kind, it is oblong; transverse in  the
 horse and in  ruminating animals; and heart-shaped in the dolphin.
   In man, and the monkey tribes, the eyes are placed directly un-
 der the forehead; in  other mammals, birds, and reptiles more or less
 laterally; in  some fishes as  the genus pleuronectes, including  the
 turbot and flounder tribes, both eyes are placed on the same side of
 the head; in the snail they are situated on its horns, if the black points
 on the extremities of the horns of this worm be real eyes, of which,
 however, there, is  some doubt;  in spiders the eyes are distributed
 over different parts of the body, and in different arrangements, usu-
 ally eight in number, and never less than six.   The eyes of the sepia
 have lately been detected by M. Cuvier;  their construction is very
 beautiful, and nearly as complicated as that of vertebrated  animals.
 Polypes and several other zoophytes appear sensible of the presence
 of light,  and  yet have no eyes; as the nostrils are not in every ani-
 mal necessary to the sense of smell; the tongue to that of taste, or the
 ears to that of sound.  A distinct organ is not always requisite for a dis-
 tinct sense. In man himself we have already seen this in regard to the
 sense of touch, which exists both locally and generally ; the distinct
 organ of touch is the tips of  the tongue and of the fingers, but the
 feeling is also diffused, though in a subordinate and less distinct de-
 gree, over  every part of the body.  It  is possible, therefore, in ani-
 mals that appear endowed with particular senses without particular
organs for their residence, that these senses are diffused, like that
 of touch) over the surface generally;  though there can be no boubt 
CL. IV]
PHYSIOLOGICAL PROEM.
n
 that, for want of such  appropriate organs, they be less acute and
 precise than in animals that possess them.
   Whether there be any other than the five senses common toman
 and the higher classes of animals may be reasonably doubted, but
 we occasionally meet with peculiarities of sensation that can hardly
 be resolved into any of them.  Thus  the bat appears to be sensible of
 the presence of external objects and obstructions that  are neither
 seen,  smelt, heard, touched,  or tasted : for it will cautiously avoid
 them  when all the senses are purposely closed up.  And hence many
 naturalists  have ascribed a sixth sense  to this animal.  It is equally
 difficult by any of the known  senses of fishes or of birds to account
 for  the accuracy with which their migratory tribes are capable
 of steering their annual course through the depths of the ocean, or
 the trackless regions of the atmosphere, so as to arrive at a given
 season on  a given coast or  a  given climate,  with the precision
 of the expertest mariner.   Whilst  with respect to mankind them-
 selves we sometimes meet with persons  who are so peculiarly
 affected by the presence of a particular object that is neither seen,
 smelt, tasted,  heard, or touched, as not only to be conscious of its
 presence,  but  to  be in great  distress till it is removed.  The pre-
 sence  of a cat not unfrequently produces such an effect: and the au-
 thor has himself been a witness of the most decisive proofs of this
 in several instances.  It is possible that the peculiar sense may, in
 such cases, result from a preternatural modification in some of the
 branches of  the olfactory nerve, which may render them capable of
 being stimulated in a new and peculiar manner; but the individuals
 thus affected are no more conscious  of an excitement in this organ
 of sense than  in any other:  and, from the anomaly and rare  oc-
 currence of the sensation itself, find no terms by which to express it.
   In Germany it has of late been attempted to be shown that every
 man is possessed of a sixth sense, though of a  very different kind
 from those just referred to; for it is a sense not only common to every
 one, but to the system at large ; and consists in that peculiar kind of
 internal but corporeal feeling respecting the general state of one's
 health  that induces us to exult in being as light as a feather, as elas-
 tic as a spring; or to sink  under a sense of lassitude, fatigue, and
 weariness,  which cannot be accounted for, and is unconnected with
 muscular labour or disease.  To this sensation M. Hubner has given
 the name of caenesthesis, and  several of his compatriots that of sel-
 bstgefiihI,andgemeingefiihl,"sel/"-feelingorgeneral-feeling;" and its
 organ is supposed  to exist in the extremities of all the nerves of the
 body, except those that supply the five external senses.* I scarcely
 know why these last should have been excepted : for the sensation
 itself is nothing more than a result of that general sympathy which
appears  to take place between  different organs and parts of the
  * Comment, de Cxnesthesi. Dissert. Aug. Med. Auct. Chr. Fred. Hubner, 1794
  Nature and Origin of Mental Derangement, by A. Crichton, M. I). 2 Vols
Svo. 1798.
VOL. III.—3 
18
PHYSIOLOGICAL PROEM.
[CL. IV.
 body, expressive of a pleasurable or disquieting feeling according
 as the frame at large is in a state of general or uninterrupted health
 or affected by some cause of  disquiet.
   II. As the nerves thus generally communicate with each other,
 and with the brain, where this organ exists, it has been a question
 in all ages by what means they maintain this communication,  and
 what is the  nature of the communicated influence? or, in other
 words, what is the fabric of the nerves,  and the quality of the ner-
 vous power ?
  Upon  these points two very different opinions have been enter-
 tained from an early period of the world, which under different mo-
 difications have descended to our own times : for by many physio-
 logists, both ancient and modern, the nerves have been regarded as
 solid capillaments, or tense and elastic strings, operating by tremors
 or oscillations, like the chords of a musical instrument; and by
 others as minute and  hollow  cylinders  conveying a  peculiar fluid.
 The word nerve, which among the ancients was applied to tense
 chords of every kind, and especially to bow-strings and musical
 strings, affords a clear proof how  generally the former of these
 hypotheses prevailed among the Greeks. It was not, however, the
 hypothesis either of Hippocrates or Galen ; for by them, while the
 nerves were regarded  as the instruments of sensation and motion,
 the medium by which they acted was supposed to be a fine ethereal
 fluid, elaborated in the organ of the brain;  to which they gave the
 name of animal spirit, to distinguish it from the proper fluid of the
 arteries which was denominated vital spirit.  " Not,"  says  Galen,
** that this animal spirit is of the substance of the soul, but its prime
agent while inhabiting the brain."*  But with respect to the man-
ner in which the animal spirit operates upon the nerves they spoke
with great modesty; for though they thought they  had been able
to trace a tubular  form in some of the nerves,  and  particularly
those of vision, they had not  been able to succeed in others. " And
hence," says Galen, " it is impossible for us to pronounce absolutely
and without proof, whether a certain power may not be transmitted
from the brain through the  nerves to the different members; or
whether the material of the animal spirit may not itself reach  the
sentient and moving parts ; or, in some way or other, so enter into
the nerves as  to induce in them a change which  is  afterwards ex-
tended to the organs of motion.t
  In a state not much less unsettled, remains the subject at the pre-
 sent moment.  Dr. Hartley,  in  the beginning of the seventeenth
 century, revived  the hypothesis that the nerves are bundles of solid
capillaments conveying motion, sensation, and even perception, by
a vibratory power,  and supported his opinion with great ingenuity
  * De Hippocratis et Platonis Decretis, Lib. VII.  A. Tom. I. p. 967.  Ed
Basil. 1542.
  f Id. Sect. C. p. 969 
CL. IV.]
PHYSIOLOGICAL PROEM.
19
 and learning ;* but the opposite  hypothesis that they are minute
 tubes filled with the animal spirit of the Greek physiologists, had ac-
 quired so extensive a hold ever since the discovery of the circula-
 tion of the blood, which presupposes the existence of tubular vessels
 too subtle to be traced by the senses, that it never obtained more
 than a partial and temporary assent; and  hence, from the times of
 Sydenham and Boerhaave almost down to our own day, the last has
 been the popular doctrine ;  is to  be traced in the general tenor of
 medical writings; and has been especially maintained by Sabatier
 and Boyer.
   In effect no fibres of  the animal frame can be less adapted to a
 communication of motion by a series of vibrations than those of the
 nerves, since none exhibit a smaller degree of elasticity; and though
 we have little reason to confide in their tubular structure, or to be-
 lieve that any kind of fluid is transmitted in this way, the close affini-
 ty which the nervous power is now known to hold with  several of
 the gases that chemistry has of late years unfolded to us; and the
 wonderful influence which some of them possess over the moving
 fibres of the animal frame, seem to leave no question  that the ner-
 vous power itself is  a fluid,  though not, perhaps, of their precise
 nature, yet resembling the most active of them in its subtilty, levity,
 and rapidity of movement. Nor is there upon this supposition any
 difficulty in conceiving  of its transmission by solid fibres or capilla-
 ments of a particular kind, whilst we behold the etherial fluids, now
 referred to, transmitted in the same way by substances still  more
 solid and unporous.
   But there is  another question, closely connected with the present
 subject, that has also greatly interested physiologists both in ancient
 and modern times, and is not yet settled in a manner altogether  sa-
 tisfactory.
   It has appeared that the nerves are  instruments both of sensation
 and motion.  Are these two effects produced by the same nervous
 fibres or by different ? or by  the same  fluids or by different ?   That
 there must be  two distinct kinds of fibres, or of fluids, is  clear, be-
 cause, as we shall have more particularly to observe when we come
 to treat of paralysis, the muscles of a  limb are sometimes deprived
 of both sensation and motivity at the same period, sometimes of sen-
 sation alone  while motivity continues, and sometimes of motivity
 alone while sensation continues.  And hence Hippocrates and Ga-
 len, the last of whom has treated of the subject with great minute-
 ness in many of his  writings, while they speak of only one kind of
 animal spirit, speak of two kinds of nerves, those of sense and of
 motion ; equally issuing from the brain, and mostly accompanying
 each other, and farming parts of the same organs.
  This distinction is supported by the concurrent observations and
 experiments  of modern physiologists, with  the  exception  that a
 separate and specific power has, for the  most part, been ascribed
to each division of fibres; and, that many writers have  supposed
  * Observations on Man, his frame, &c. his dutv, and his expectations, 2 vols,
8vo. 1749. 
2U
PHYSIOLOGICAL PROEM.
[CL. IV.
the motive power to be inherent in the moving fibres themselves in-
stead of being derived from the brain.  Glisson appears entitled to
whatever may be the credit of this last hypothesis ; and Girtanner,
who trod  in  the same footsteps, with a clear and comprehensive
mind, considerably enlarged upon it, and gave to the moving energy
the name of vis insita, as, by way of distinction, he applied that of
vis nervea to the energy or power of feeling.   And as he believed
that other organs besides muscles, and indeed plants as well as ani-
mals, are possessed of fibres endowed with the same power, and that
a brain is by no  means essential for their production, he,  in  like
manner, changed the name of muscular to that of irritable fibre;
and contended that a principle of irritability is common to fluids as
well as to solids, and co-extensive with organized nature.*
   Oxygene was at this time the popular aura of the philosophers,
as caloric had been a short time before.  Lavoisier had just proved
its close connexion  with several of the vital functions, and hence
the chemical divinity of Girtanner was oxygene. He paid unbound-
ed homage to its influence, attempted to show  that irritability, and
even life itself, are dependent upon it; and that in the animal sys-
tem  it is distributed  to every  part  by means  of the circulating
blood.
   But the still more striking properties of the galvanic fluid, began
now to be discovered and to  captivate the general attention; and
the  time drew nigh in which oxygene was doomed to fall as pros-
trate before the shrine of galvanic aura as caloric had fallen before
that of oxygene.  And it is curious to remark, how nearly this dis-
covery was not only made but completed in all its bearings, and by
the very same means, about fifty years before the  attention  of Gal-
vani was directed to the subject; for as we are told in the Philoso-
phical  Transactions  for  1732,t  that the Queen's physician, Dr.
Alexander Stuart, being engaged in  a course of experiments upon
the frog, observed, upon thrusting the blunt end of a probe into the
spinal marrow, after decapitation, that the muscles of the animal's
body were thrown  into convulsive contractions ; and  that the same
happened to the muscles of the head when the probe was thrust
into the brain.  And by additional experiments he advanced so far
as to infer, that what the nerves contribute  in muscular motion,
cannot be produced by oscillations or elasticity, but must be owing
to a fluid contained in them ; but which fluid he was unfortunate
enough to conceive was a pure  and  perfectly defecated elementary
water; using the word water, however, in a general sense, as mere-
ly opposed to sal volatile or fermented spirits, which he  thought
the  term animal spirits was calculated to import.
   Whatever be  the nature of the active and etherial fluid which
was thus  traced by Stuart, and has since been fully established by
  * Memoires sur l'lrritabilitl, consideree comme principe de vie dans la na-
ture organised. Journ. de Phys. 1790.
  | Vol. XXXVII. p. 324. 
CL. IV.]
PHYSIOLOGICAL PROEM.
21
Galvani, there can be no question of its having a powerful influence
upon many branches or divisions of the nervous system, though not
upon all.  Its effects upon the muscles of an animal for some hours
after death are too well known to be particularized : and  Dr. Philip
seems to  have shown, by various trains of  experiments,* that it is
equally  capable of maintaining respiration, and the operation of
several of the animal  secretions, especially  those that induce diges-
tion, for as long a period.   But in drawing  from such facts the co-
rollary that the " identity of galvanic electricity and nervous influ-
ence is  established by these experiments;" he seems to  proceed
farther than he is warranted : for we have no right to say  more, than
that galvanic electricity is a stimulus exciting the nervous influence
into a state of continued secretion, or continued action; which may
possibly be done by various other stimuli, as well as by that of gal-
vanism.
  Upon the whole  the nervous system seems to present itself, in
the different classes of animals, under various scales of elaboration;
but in every scale to be  a secernent organ through its entire range;
operating by means of  two or more different sets of fibres, which
may be secretories or conductors of as many different fluids or mo-
difications of the same fluid.
  In the higher and more complicated classes of animals it consists
of a cylindrical  chord or spinal marrow, a central or  ganglionic
compages and a brain, all communicating and acting in harmony.
In some of the  inferior classes we find the cylindrical  chord alone,
and in others the  ganglionic compages: while in the lowest of all
we  trace a variety of  distinct and granular  molecules, which seem
to act the part of nervous ganglions,  though we cannot discover
their connexion.
  The brain  has so much of the general structure and character of
a gland, as to be admitted to be an organ of this kind almost without
a dissentient  voice in  the present day.  This is a  point conceded
even by Dr. Cullen, notwithstanding that by supposing the energy
of the brain to  be a mere  quality rather than a specific essence,
and to be  incapable of undergoing any change of  recruit  and ex-
haustion,  he finds no  adequate use for its glandular conformation.
As  we are justified, however, by all the force of analogy in regard-
ing it as a gland, though unquestionably a gland of a peculiar kind,
and as we are equally justified on the same ground of  analogy in
regarding the nervous  power or energy by which it maintains  a
communication with  every part of the system, as a fluid of a  pecu-
liar kind,  we are almost driven to the  necessity of contemplating it
as the source from which this fluid issues and by which it is supplied
as it becomes exhausted.
  It is probable that  the nervous fluid on  its first secretion, and
simplest state, is as homogeneous as that of the blood; but that, like
the blood, it  becomes changed by particular actions, either of the
particular parts of the  brain, or  of particular nerves themselves,
• Phil. Trans. 1815. p. 5—90. 
22
PHYSIOLOGICAL PROEM.
[CL. IV
 into fluids possessing different powers, and capable of producing
 very different effects.  And as we have reason to believe with Ga-
 len, that the nerves are  a continuation of the matter of the brain,*
 it is not  improbable that many or all of them are endowed with
 something of its secernent power, and are capable of assisting in
 the secretion of the same fluid in its simplest state, or in  some of
 its simpler modifications.  And  we  may hence see the reason of
 that complicated mechanism which distinguishes the higher classes
 of animals, and how it is possible for  a  nervous system to exist,
 though with  inferior powers, under a less-composite fabrication.
   This, however, is not mere conjecture: for in different ramifica-
 tions of the nerves, we can trace such different effects actually pro-
 duced ; and as it has sufficiently appeared  that the operative power
 is a quick and subtle fluid, we are directly led to conclude that such
 difference of effects must depend  on a diversity of fluids  or on va-
 rious modifications of a common fluid in different ramifications : the
 last of which explanations is by far the simplest and easiest.  And
 hence, in  certain parts of the system, the nervous influence becomes
 capable of producing  the  effect of sensation ;  in others of  motion.
 And hence, again, the sensific influence is rendered capable of excit-
 ing in  one set of organs a sense of sight, in others of hearing, smell,
 or taste, while that of touch is diffused over the surface generally.
   This last by its extensive diffusion is, by Mr. Hunter, called com-
 mon sensation ;  and his view of the subject is  in perfect consonance
 with the  present.  " It is more than  probable," says he, " that
 what may be called organs of  sense (local organs) have particular
 nerves whose mode  of action is different  from that of nerves pro*
 ducing common sensation ; and also different from one another; and
 that the nerves on which  the  peculiar functions of each of the or-
 gans of sense depend  are  not  supplied from different parts of the
 brain.   The  organ of sight has its peculiar nerve :  so  has  that of
 hearing ;  and probably that of smelling likewise :  and on the same
 principle  we may suppose the organ of  taste to have a peculiar
 nerve,  although these organs of sense may likewise have nerves
 from different parts of the brain ; yet it is most probable such nerves
are only for the common sensations of the part, and other purposes
answered by ncrves."t
  We  see farther that for the purpose of elaborating the  exqui-
 sitely fine and active fluid that, differently  modified,, excites the lo-
cal organs of sense, and excites them in perfection, it is necessary
that the nervous system should exist in its  highest scale of fabrica-
tion, and be crowned with the apparatus of a  brain,  though this is
not the  only use to which  the brain is subservient: and hence it
was long ago pointed out by Galen, that it is from the  brain alone
the nerves appropriated to the local senses take their rise.J  For,
* De Hippocr.et Plat. Decret.Lib. III. Tom. I.p. 921.
\ On the Animal Economy, p. 261.
t De Instruments Odoratius, Edit. Basil. Tom. I. p. 381. 
CL. IV.]
PHYSIOLOGICAL PROEM.
23
though we have instances of the existence of a few of these senses
where the nervous system is found in a less finished form, they are
never complete in number, nor apparently in acuteness.
   The sense of touch, on the contrary, which, as  we have already
observed, is regarded by Cuvier as produced by thesensific fluid in
its simplest and least compounded state, or as Galen has it* "is
the dullest and rudest of all  the sensient powers,"  flows for the
most part, as the latter has also remarked, from the spinal marrow
alone, since it is from this column that the nerves of touch almost
exclusively arise.  And hence we have little difficulty in conceiv-
ing how a  sense of this kind may exist in moluscae, shell-fishes, and
the larves of insects, which have no other nervous  system than  a
medullary  column, with a slight increment at the  upper  extremity,
or no increment whatever; and have no other sense, or none but
in a very imperfect degree.
   The nervous power producing motion, and which has been  pro-
perly denominated irritative, appears  to be of a still lower descrip-
tion than that of touch.   It is hence common to the great mass of
muscular fibres, and is probably capable of being secreted by these
fibres generally ; so that every fibre  supplies itself, where  it re-
ceives no supply from any other source.   Yet the proper source or
reservoir  of  this modification of nervous fluid seems  to  be  a
ganglionic system : that which, in the higher classes of animals we
have already noticed as  formed by the curious structure and rami-
fications of the  intercostal nerve, and that which  appears to  be  a
copy of it in worms and zoophytes, who have no other nervous or-
ganization  whatever.   From the copiousness with which this cen-
tral system furnishes a recruit to the involuntary organs with which
it is peculiarly connected in mammals, we may  see  why these or-
gans are able to persevere in  one uninterrupted train  of action,
without exhaustion or  weariness, from the beginning to the end of
life; and why  several of them, as the heart,  the lungs, and the sto-
mach, should be able  to exhibit  proofs of irritative power for  a
considerable period of time after the death of the system, and espe-
cially when  roused  by  particular stimulants.  Fishes in general
have few pretensions to this structure,  and hence  they die sooner
than most other animals, and exhibit little muscular irritability af-
terwards.  Yet it is remarkable that in those genera, which  make
the nearest approach to a ganglionic system, as  the cod  and carp,
we have examples of a like power. The fish-mongers of  the me-
tropolis have taken advantage of this endowment  in the cod-kind,
and  introduced the fashion of crimping or corrugating the flesh, by
the stimulus of transverse incisions, and in some curious experiments
on the carp, lately instituted by Mr. Clift, he found its heart leap-
ing,  when out of water, four hours after a separation from  the body.t
If the apparently isolated molecules  found in the make of the
polype  and  various  worms  are ganglions  of nervous irritation,
• Loco citat.
f Phil. Trans. 1815, p. 90. 
24
PHYSIOLOGICAL PROEM.
[CL. IV.
 extending their  vital  influence  through  certain ranges or peri-
 pheries, we are also hence enabled to account for  the peculiar te-
 nacity with which the principle of life adheres to them, and  the
 wonderful power of reproduction which belongs  to  detached seg-
 ments.
   The curious and  striking experiments  which  have lately been
 made upon animals by Dr. Philip and M. Le Gallois, confirm the ge-
 neral view now offered so far as  they  bear upon  it.  These have
 consisted in an examination into  the different effects produced on
 the heart and lungs by suddenly destroying or cutting off the com-
 munication of the whole brain ; by slowly destroying it; by destroy-
 ing it m the posterior part alone; and  in the anterior part alone ;
 and by destroying, in like manner, the spinal marrow at the  neck,
 or where it unites with the brain; in its middle or dorsal, and in
 its lumbar region.  The animals operated upon were chiefly rabbits.
  According to the experiments of M. Le  Gallois,* after the de-
 struction of the brain, the action of the heart still  continues  for a
 considerable period of time  unimpared; while on  the destruction
 of the  spinal marrow at its  upper or cervical extremity, this ac-
 tion becomes instantly so debilitated  as to be no longer capable of
 supporting the circulation.   Whence he infers that it is from the
 chord of the spinal marrow, and not from the gland of the brain that
 the heart derives the principle of its life and motions.
  The experiments of Dr.  Philipt are at variance with  the above
 of M.  Le Gallois,  and his  conclusions  are, therefore,  somewhat
 different.   They  seem to show that both the brain  and spinal  mar-
 row  may be destroyed, and yet the heart continue to act forcibly
 and steadily, provided the lungs be excited by the  artificial breath
 of a pair of bellows.
  The brain and spinal marrow were destroyed by a hot wire, the
 animal being first stupefied by a blow on the  occiput.  Frogs and
 a few other animals were here employed as well as rabbits.   It is
 not exactly stated how long, under this process, the heart continued
 to beat.  Yet, contrary to what Dr. Philip seems to have expected,
 but in perfect concurrence with the hints I have just thrown out,
 he found that  certain stimuli applied to the brain,  whether in the
 anterior or posterior part of the head, increased very sensibly the
 action  of the heart, the animal being still prepared as just stated.
 The same effect ensued when the same stimuli were applied to the
 cervical and even the dorsal  part  of the spinal marrow :  but not
when applied to the lumbar.
  Dr. Philip hence concludes that there are three kinds of vital
 power: muscular, possessed by the lowest kinds of animals that
 arc destitute of both the others ; nervous, or that which is here de-
nominated the medium of touch or simple feeling, chiefly  derived
 from, or dependent upon the  spinal marrow, and possessed by ani-
* Experienses sur la principe de la Vie, &c.
t Phil. Trans. 1815. p. 15 and 414. 
CL. IV.]
PHYSIOLOGICAL PROEM.
25
mals somewhat more advanced in the scale of life ; and  sensorial,
constituting what we have just regarded as the medium of the local
senses, and appertaining to the higher classes.  He adds, that each
of these may exist alone, and consequently  independently of the
rest;  but admits  that where  the  nervous principle co-exists with
the muscular, it exerts an influence over it, so that the latter may
even be overborne or destroyed by such influence: and  when the
sensorial co-exists with both,  it exercises over both an equal degree
of control.
   III.  But the nervous organ in its most elaborate and perfect state,
as in man, is not only the seat of sensation and motion, but of intel-
ligence : it is the instrument of communication between the mind
and the body, as well as between the body and the objects by which
the body is surrounded.  And as a failure or irregular performance
of its function in various ways, lays a foundation for an extensive
division of corporeal  diseases, so a like failure  or irregularity of
performance in other ways lays a foundation for as numerous a train
of mental maladies.
   Of the nature of the mind or soul  itself, we know little beyond
what revelation has informed us; we  have no  chemical test that
can reach its essence;  no glasses that can trace its mode of union
with the brain; no  analogies  that can illustrate the rapidity of its
movements.   And hence the darkness that, in this respect, hung
over the speculations of the Indian gymnosophists and  the philoso-
phers of Greece continues  without abatement, and has equally re-
sisted the labours of modern metaphysicians and physiologists. That
the mind is an intelligent principle we know from nature; and that
it  is a principle endowed with immortality, and capable of existing
after death in a state separate from the body, to which, however, it
is  hereafter to be re-united at a period when that which  is now mor-
tal shall put on immortality, and death itself be swallowed up of vic-
tory—we learn from the God of nature.  And with such  information
we may well rest satisfied : and, with sutiable modesty, direct our
investigations to  those lower branches of this mysterious  subject
that lie within the grasp of our reason.
   I cannot, however, drop the subject altogether without observing
that the discussion concerning the particular entity of the mind,
seems to have been conducted with an undue degree  of heat and
confidence on all sides, considering our present  ignorance of what-
ever substance has been appealed to as constituting its specific frame.
   Is the essence of the mind,  soul, or spirit, material or immaterial ?
The question, at first sight, appears to be of the utmost importance
and gravity; and to involve nothing less than a  belief  or disbelief,
not indeed, in its divine origin, but in its divine similitude and im-
mortality.   Yet I may venture to affirm, that there is  no question
which has been productive of so little satisfaction, or has laid a foun-
dation for wider or wilder errors  within  the whole range of meta-
physics.   And for this plain and  obvious reason, that  we have no
distinct ideas of the terms, and no settled premises to  build upon,
   vol. in.—4 
*}b
PHYSIOLOGICAL PROEM.
LCL.  IV
Corruptibility and incorruptibility, intelligent and unintelligent, or-
ganized and inorganic, are terms that convey distinct meanings to
the mind, and impart modes of being that are within the scope of our
comprehension.  But materiality and immateriality are equally be-
yond our reach.  Of the essence of  matter we  know nothing, and
altogether as little of many of its more  active qualities: insomuch
that, amidst all the discoveries of the day, it  still remains a contro-
vertible position, whether light, heat, magnetism and electricity are
material substances, material properties, or  things superadded to
matter and of a higher nature.
   If they be matter, gravity and ponderability are not essential  pro-
perties of matter, though commonly so regarded.  And if they be
things superadded  to  matter, they are necessarily immaterial, and
we cannot open our eyes without beholding  innumerable prools of
material and immaterial  bodies co-existing and  acting in  har-
monious union through the entire frame of nature.  But if we know
nothing of  the essence, and  but little of the qualities of matter, of
that common substrate which is diffused around us in every  direc-
tion, and constitutes the whole of the visible world, what can we
know of what is immaterial? of the full meaning of a term that in
its strictest sense comprehends all the rest of the immense fabric of
actual and possible being; and  includes, in its vast circumference,
every essence and mode of essence  of every other being, as  well
below as above  the order of matter, and even  that  of the  Deity
himself?
   Shall we  take the quality of extension as the line of separation
between what is material and what is immaterial ?   This, indeed,
is the general and favourite distinction brought  forward in the  pre-
sent  day; but it is  a distinction founded on mere conjecture, and
which will  by no means stand the test of inquiry. Is space extend-
ed ? every one admits it to be so.  But is space material ?  is it body
of any kind ?  Des Cartes, indeed, contended that it  is body, and a
material body ; for he denied a  vacuum, and asserted space to  be a
part  of matter itself: but it  is probable that there is not a single es-
pouser of this opinion in the present day. If then extension belong
equally to matter and to space, it cannot be contemplated  as the pe-
culiar and exclusive property of the  former; and if we allow  it to
immaterial space, there is no reason  why we should not allow  it to
immaterial spirit.   If extension appertain not to the mind or think-
ing principle, the latter can have no place of existence; it can exist
no where : for where or place is an idea that cannot be separated
from the idea of extension.   And hence, the metaphysical immate-
rialists of modern time freely admit  that the mind has no place of
existence;  that it does exist no where ; while, at the same time,
they are compelled  to allow that the immaterial Creator, or univer-
sal Spirit, exists every where, substantially as  well as virtually.
   Nor let it be supposed that the difficulty is removed by adding to
matter the  quality of solidity in conjunction  with that of extension,
and hence distinguishing it as possessed of solid extent ; for the qua-
lity of solidity is less characteristic of it than any we have thus far 
CL. IV.]
PHYSIOLOGICAL PROEM.
27
taken notice of; and is perpetually fleeing from us as we pursue it.
That matter is infinitely divisible we  dare  not  say, because we
should hereby reduce it to mathematical points, and because, also,
there would, in such case, be no certain or permanent basis to build
upon, and to ensure a punctuality of material  cause and effect: and
hence, Sir Isaac Newton was obliged to suppose that it is possessed
of ultimate atoms which are solid and  unchangeable.   But of these
the senses can trace nothing, and  our admission is  nothing more
than conjectural.
  Let not the author, however, be misunderstood upon this abstruse
and difficult subject. That the mind has a distinct nature and is a
distinct reality from the body; that  it is gifted with immortality,
endowed with reasoning faculties, and  capacified for a state of sepa-
rate existence after the death of the corporeal frame to which it is
attached, are, in his opinion, propositions most clearly deducible
from  revelation, and, in one or two points, adumbrated  by a few
shadowy glimpses of nature. And that it may  be a substance strictly
immaterial and essentially different from matter is both possi-
ble and probable;  and will hereafter, perhaps, when faith is  turned
into vision, and conjecture  into fact, be found to be  the true and
genuine doctrine upon the subject. But till this glorious era arrives ;
or till, antecedently to it, it  be  proved, which  it does not hitherto
seem to have been, that matter, itself of divine origin, gifted even
at present, under certain modifications, with instinct and sensation,
and destined to become immortal hereafter, is physically incapable,
under some still more refined, exalted, and spiritualized  modifica-
tion, of exhibiting the attributes of the soul, of being, under such
a constitution, endowed with immortality from the first, and capaci-
fied for existing separately from the external  and grosser frame of
the body ; and  that  it is beyond the power of its own Creator to
render it intelligent, or to give it even  brutal  perception, the argu-
ment must be loose and inconclusive : it may plunge us,  as  it has
plunged thousands before, into  errors, but  can never conduct us to
demonstration.  It may lead us, on the one hand, to the proud Brah-
minical and Platonic belief that the  essence of the soul is the very
essence of the Deity, and consequently a part  of the Deity himself:
or, on the other, to the gloomy regions of modern materialism, and
to the cheerless doctrine that it dies and dissolves in one common
grave with the body.
  It is no fair objection, however, against the immaterialist, that by
contemplating the mind as a distinct essence from that of the body,
man is hereby rendered a compound  being, possessing at one and the
same time two  distinct lives mysteriously united in an individual
frame, and running in parallel lines  till the hour of death.  For
whilst the known and obvious laws  and  faculties  of the mind and
body are so widely different, as they are acknowledged to be on all
hands, some such composite union has been and must be allowed
under every hypothesis whatever.   And least df all have the scep-
tical  physiologists of  the present day any riglR to triumph upon 
28                 PHYSIOLOGICAL PROEM.             [eL.  IV

such an objection ; who, drawing no light from nature, and reject-
ing that of sacred writ, contemplate the mind as formed of the same
gross modification of matter as the body, and doomed to fall with it
into one common and eternal dissolution.  For even these acute ma-
terialists, with all the aid of physiological, anatomical and chemical
research, instead of simplifying the human fabric, have made it more
clumsily complex, and represented it sometimes, indeed, as a duad,
but of late more generally as a triad, of unities, a combination of a
corruptible life within a corruptible life  two or three deep, each
possessing its own separate faculties or manifestations, but covered
with a common outside
  This remark more especially applies to the philosophers of the
French school: and particularly to the system of Dumas, as modifi-
ed by Bichat ;* under which more finished form, man is declared to
consist of a pair of  lives, each distinct and  co-existent under the
names of an organic and an animal life ; with two distinct assort-
ments of sensibilities, an unconscious and a conscious. Each of these
lives is limited to a  separate set of organs, runs its race in parallel
steps with the other; commencing coetaneously and perishing at the
same moment.f  This  work appeared at the close of the past cen-
tury ; was read  and admired by  most physiologists;  credited  by
many ; and became the popular production of the day. Within ten or
twelve years,  however, it ran its course, and was generally either
rejected or forgotten even in France ;  and Mr. Richerand first, and
M. Magendie afterwards, thought themselves called upon to modify
Bichat, in order to render him more palatable, as Bichat had already
modified Dumas.   Under the last series of remodelling, which is
that of M. Magendie, we  have certainly an improvement, though
the machinery is quite  as complex. Instead of two distinct lives, M.
Magendie presents  us with two distinct sets or systems of action or
relation, each of which has  its separate and  peculiar functions, a
system of nutritive  action or relation, and a system of vital.   To
which is added, by way of appendix, another system, comprising the
functions of generation-!   Here, however, the brain is not only the
seat but the organized  substance of the mental powers: so that, we
are expressly told, a man must be as he  is made in his brain, and
that education, and  even logic itself, is of no use to him.   " There
are,"  says M. Magendie, " justly celebrated  persons who  have
thought differently ; but they have hereby fallen into grave errors."
A Deity however   is allowed to  exist, because, adds the writer,
it is comfortable to  think that he  exists, and on this account the
physiologist cannot doubt of his being. " L'intelligence de l'homme,"
says he, " se compose de phenomenes tellement differens de tout ce
que presente d'ailleurs la nature, qu'on les rapporte a  un etre par-
* Principes de Physiologic 4 Tom. 8vo. Par. 1800-3.
f Recherches sur la Vie et la Mort, &c.
± Precis Elementairdfee Physiologic 2 Tom. 8vo. Paris, 1816, 1817. 
CL. IV.]
PHYSIOLOGICAL PROEM.
29
ticuliere qu'on regarde commune emanation de la Divinite.  II est
trop consolent decroired cet etre, pour que le physiologiste mette en
doute son existence; mais  la severite de language ou de logique
que comporte maintenant la physiologie, exige que l'on  traite  de
l'intelligence humaine comme si elle etait la resultat de Faction d'un
organe.   En s'ecartant de cette marche, des hommes justement ce-
lebres sont tombes  dans des graves  erreurs ;  en  la suivant, on a,
d'ailleurs, le grand avantage de conserver la meme methode d'etude,
et de rendre  tres-faciles, des  choses  qui  sont envisagees generale-
ment comme presque au-dessus de  l'esprit humain."—" II existe
une science  dont le  but est d'apprendre a* raisonner justement, c'est
la logique, mais le jugement errone ou l'esprit faux (for judgment,
genius,  and  imagination, and therefore false reasoning, all depend
on  organization) tiennent a l'organization.  II est impossible  de
ce  changer  a" cet egard; nous restons  tels que  la nature nous s
faits."*
  Dr. Spurzheim has generally been considered,  from the concur-
rent tenour of his doctrines, as belonging to the class of material-
ists: but this is to mistake his own positive assertion upon the sub-
ject, or  to conclude in opposition to  it.   He speaks,  indeed, upon
this topic with a singular hesitation and reserve, more so, perhaps,
than upon any other point whatever; but as far as he chooses to ex-
press himself on so abstruse a subject, he regards the soul as a dis-
tinct being from the body, and at least intimates that it may be near-
er akin  to the Deity.  Man  is with him also possessed of two lives,
an  automatic, and  an animal: the first  produced by organization
alone, and destitute  of consciousness; the second possessed of con-
sciousness dependent on the soul, and merely manifesting itself by-
organization.  "We do not,"  says  he,  "attempt to explain how
the body and soul are joined together and exercise a mutual influ-
ence.  We do not examine  what the soul can do without the body.
Souls, so far as we know, may be united to the bodies at the moment of
conception or afterwards; they may be different in all individuals,
or of the same kind in  every one;  they may be  emanations  from
God, or something  essentially different."!  The mind of this  cele-
brated craniologist seems to be wonderfully sceptical and bewildered
upon the subject, and studiously avoids  the important question of
capacity of the soul for  an independent,  and future existence: but
with the above declarations he cannot well be arranged in the class
of materialists.
  The  hypothesis  which has lately been started by Mr. Lawrence
is altogether of a different kind, and though undoubtedly much sim-
plerf than  any of the preceding, does  not seem to  be built  on a
more stable foundation.   According to his  view of the subject, or-
ganized differs from inorganized  matter merely by the addition of
* Precis Elementaire, &c. et supra, passim.
f Physiognomical System, &c, p. 250. 8vo. Lond. 1815.
\ Introduction to Comparative Anatomy and Physiology, &c, 8vo. 1816 
 30                 PHYSIOLOGICAL PROEM.            [CL. IV.

 certain properties which are called vital, as sensibility and irrita-
 bility.  Masses of matter endowed with these new properties be-
 come organs and systems of organs, constitute an animal frame, and
 execute distinct sets of purposes or functions, for functions and pur-
 poses carried into execution are here synonymous.  " Life is the
 assemblage of all the functions (or purposes) and  the general re-
 sult of their exercise."*
   Life, therefore, upon this hypothesis, instead of being a two-fold
 or three-fold reality, running in a combined  stream, or in parallel
 lines, has no reality whatever.   It has no esse or independent exist-
 ence.  It is a mere assemblage of purposes, and accidental or tem-
 porary properties: a series of phaenomena,t as Mr. Lawrence has
 himself correctly  expressed it;—a name without a thing.  "We
 know not," says he, " the nature of the  link that unites these phae-
 nomena, though we are sensible that a connexion must exist;  and
 this conviction is sufficient to induce us to give it a name, which the
 vulgar regard as the sign of a particular principle ; though in fact
 that name can only indicate the assemblage of the  phenomena
 which have occasioned its formation."!
   The human frame is, hence, a barrel-organ, possessing a system-
 atic arrangement of parts, played upon by peculiar powers, and ex-
 ecuting particular  pieces or purposes;  and  life is  the  music pro-
 duced by the general   assemblage or result of  the  harmonious
 action.  So long as either the vital or the mechanical instrument is
 duly  wound  up by a regular  supply  of food or of the wince, so
 long the music will continue: but both  are worn out by their own
 action; and when the machine will no longer work, the life has the
 same close as the music; and in the language of Cornelius Gallus,
 as quoted  and appropriated by Leo X.,

           —redit in nihilum, quod fuit ante nihil.

   There is, however, nothing new either in  this hypothesis or the
 present explanation of it.   It was first started in the days of Aris-
 totle  by Aristoxenus, a pupil of his, who was admirably skilled in
 music, and by profession a physician.   It was propounded  to  the
 world under the name of the system of  harmony, either from  the
 author's fondness for music, or from his comparing the human frame
 to a musical instrument, and his regarding life as the result of all its
 parts acting in accordance, and producing a general and harmoni-
ous effect.
   How far Mr. Lawrence's revised edition of this hypothesis may
 prove satisfactory to other classes of materialists I cannot tell;  but
if he should succeed, he will be more  fortunate  than Aristoxenus,
who pleased neither the other materialists nor the immaterialists of
  *  Introduction to Comparative Anatomy and Physiology, &c. 8vo. p. 120
1816.
  t  Id. p. 122.
  *  Id. p. 122. 
CL. IV.j
PHYSIOLOGICAL PROEM.
3i
his day. From the latter, indeed, he could expect no countenance :
but even the Epicureans, though they held that the mind was cor-
ruptible, as formed of matter, which they had no reason to believe
was then or ever would  be otherwise than corruptible under  any
modification whatever, held,  at the same time, that it had a sub-
stantive existence, distinct from that of the  grosser frame of the
body, and  possessed of other and far higher properties: being form-
ed of the  finest, lightest, smoothest, and most moveable material
elements,  and hence exquisitely etherialized and volatile :

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

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

 is the eye alone that beholds the tree,  while  the mind only per-
 ceives a notice of its presence  by some  means or other, from the
 visual organ.  So, in touching this table it is my hand alone that
 comes in contact with it,  and communicates to my mind a know-
 ledge of its hardness and other qualities.  What then is the medium
 by which such communication is  maintained ?  which enables the
 mind to  have a perception of the form, size, colour, smell, and even
 distance of objects, correspondent with that of the senses which are
 seated on the surface of the body ?  and which at the same time that
 it conveys this information, produces such an additional effect, that
 the mind is able, at its own option, to call up an exact notion or idea
 of those  qualities at a distant period, or when the objects themselves
 are no longer present ?  Is there, or is there not,  any resemblance
 between the  external  or sensible object, and the internal or mental
 idea or notion ?  If there be a resemblance, in what does  that resem-
 blance consist ? and how is it produced  and supported ?  Does the
 external object throw off representative likenesses of itself in films
 or under any other modification, so fine as to be able, like the elec-
 tric or magnetic aura, to pass without injury from the object to the
 sentient  organ, and from the sentient organ to the sensory, or men-
 tal presence-chamber? or has the mind itself a faculty of producing,
 like a mirror, accurate countersigns, intellectual pictures or  images
 correspondent with the sensible images communicated from  the ex-
 ternal object  to the sentient organ ? If, on the contrary, there be no
 resemblance, are the mental perceptions mere notions,  or intellec-
 tual symbols  excited in the mind by the action of the external sense;
 which, while they bear no similitude to the qualities  of the object
 discerned, answer the purpose of those qualities, as letters answer
 the purpose  of sounds  ?  or  are we  sure  there  is  any external
 world whatever;  any  thing beyond the intellectual principle that
 perceives and the sensations and notions that are perceived; or even
 any thing beyond those sensations  and notions,  those impressions
 and ideas themselves ?
  Several of  these questions  may perhaps appear in no small de-
 gree whimsical and brain-sick, and more worthy of St. Luke's than
 of a work of  physiological study.   But all of them, and at least  as
 many more, of  a temperament  as  wild as the wildest, have been
 asked and insisted upon, and supported again and again in different
 ages and countries, from the zenith of Grecian science down to our
 own day, by philosophers of the clearest intellects in other respects,
 and who  had  no idea of  labouring under any such mental infirmity,
 nor ever  dreamed of  the  necessity of being  blistered and  taking
 physic.
  The nature of the questions themselves, therefore, when  put by
 the characters referred to, sufficiently manifest the obscurity of the
 subject to which they  relate :  and to  enter into  the discussions  to
 which they have given rise, would  lead us to an irrecoverable dis-
 tance from the path before us.  Those who are desirous of follow-
ing them up and of witnessing an exposure of their absurdity, can-
not do better than apply themselves to the metaphysical writings of 
CL. IV.]
PHYSIOLOGICAL PROEM.
33
Dr.  Reid, Dr. Beattie,  Dr. Campbell and Professor Stewart; who
if, on the overthrow of so many Babel-buildings, they have not been
able to raise an edifice  much more substantial in their stead, have
only failed from the insuperable difficulty of the attempt.
   No  man  was more sensible of this difficulty than Mr. Locke, nor
has taken more pains both  to avoid what is unintelligible and un-
profitable,  and to  elucidate what may be turned to a good account
and  brought home to an ordinary comprehension.  It was his im-
perishable Essay on Human Understanding that gave the first check
to the wild and visionary conceits in which the most celebrated lu-
minaries of the age were  at that time engaged; recalled mankind
from the chasing of shadows  to the study of realities, from a pur-
suit of useless and inexplicable subtleties to that of important and
cognoscible subjects ; or rather to the only mode in which the great
inquiry before him could be followed up with any reasonable hope
of success or advantage.
  To this elaborate and wonderful  work, which has conferred an
ever-during fame, not only on  its matchless author, but on the na-
tion  to which he belonged,  and even the age in which he  lived, the
physiologist cannot pay  too close an attention.  It is, indeed, of the
highest importance to every science, as teaching us the elements of
all science, and the only  mode by which science can be rendered
really  useful, and carried  forward to ultimate perfection ; but it is
of immediate importance  to every branch of physical knowledge,
and particularly to that which is employed in unfolding  the struc-
ture of the mind, and its connexion with the visible fabric that in-
closes it.  It may, perhaps, be somewhat too long ;  it may occasion-
ally  embrace subjects which  are not necessarily connected with it;
its terms may not always be precise, nor its opinions  in  every in-
stance correct; but it discovers intrinsic and  most convincing evi-
dence that the man who wrote it must have had a head peculiarly
clear, and a heart peculiarly sound: it is strictly original in its matter,
highly important in its subject, luminous and forcible in its argument,
perspicuous in its style, and comprehensive in its scope.   It steers
equally clear of all former systems: we have nothing of the mystical
archetypes  of  Plato, the incorporeal phantasms of Aristotle, or the
material species of Epicurus; we are equally without the intelligible
world of the Greek schools, and the innate ideas of Des Cartes. Pass-
ing by all which, from actual experience and  observation it deline-
ates the features, and describes theoperationsofthe human mind with
a degree of precision and minuteness which has never been exhibited
either before or since; and stands, and probably ever will stand, like
a rock before the puny waves of opposition by which  it  has  since
been assailed from various  quarters.   The author may  speak  of it
with warmth, but he speaks from a digested knowledge of its merits:
for he has studied  it thoroughly and repeatedly, and there is, per-
haps, no  book to which he is so much indebted for whatever small
degree of discrimination, or habit of reasoning he may possibly be
allowed to lay claim to.
  vol. hi.—5 
34
PHYSIOLOGICAL PROEM.
LCL. IV.
   Upon one point he is perfectly clear* and that is, that the chief
 Objections at any time urged against this celebrated production have
 proceeded from an utter mistake of its meaning, of which he could
 give numerous instances, if such a digression were  allowable, from
 the writings of many who have the credit of having studied it pro-
 foundly.  The remark applies to  several of the most popular psy-
 chologists of both North and South Britain, but especially to those
 of the continent, and more particularly still to M. Condorcet, from
 whom  the French  in general  have  received an erroneous  idea of
 several of its leading doctrines.  It is to this book the medical stu-
 dent ought to turn himself for a knowledge of the laws that regulate
 the development and growth of the mind,  as he should do to the
 labours of Haller or Hunter for a knowledge of those that regulate
 the development and growth  of the body, and I shall hence draw
 largely upon it through the remainder of this introduction.
  The whole then of the metaphysical rubbish of the ancient schools
 being  cleared  away by the purging and  purifying energy of the
 Essay  on Human Understanding, mankind have since been enabled
 to contemplate the body and mind as equally, at birth, a tabula rasa,
 or unwritten  sheet of paper;  as  consisting equally of a blank or
 vacuity of impressions ; but as equally capable of acquiring impres-
 sions by the operation of external  objects, and equally and most
 skilfully endowed with distinct powers or faculties for this purpose;
 those of the body being the external senses of sight, hearing, smell,
 taste, and touch; and those of the mind the internal senses of per-
 ception, reason, judgment, imagination, and memory.
  It is possible that a few  slight  impressions may be produced a
 short time antecedently to birth ; and it is certain that one or two
instinctive  tendencies  which,  however, have no  connexion  with
the mind, are more perfect, because more needful,  at the period of
birth than ever afterwards; and we have also frequent proofs of an
hereditary or accidental predisposition towards particular subjects.
But the fundamental doctrine  before us is by no means affected by
 such collateral circumstances.
  External objects first impress or operate upon the outward senses ;
and these senses by means hitherto unexplained, and, perhaps, al-
together inexplicable, immediately impress or operate upon the
mind, or excite in it perceptions or  ideas of the presence  and quali-
ties of  such objects; the word idea  being here employed, not in any
of the  significations of the schools, but  in its broad, popular mean-
ing, as importing " whatever a man observes, and  is conscious to
himself he has in his mind;"* whatever was formerly intended  by
the terms archetype, phantasm, species, thought, notion, or concep-
tion, or whatever else it may  be which we can be employed about
in thinking.f  And to these effects Mr. Locke  gave the name of
ideas of sensation, in allusion to  the source from which they are
derived.
• Locke, on Human Understanding, B. I. ch. i. § 3.
t Locke, B. I. ch. i. § 8. 
CL. IV.]
PHYSIOLOGICAL PROEM.
35
    But the mind, as we have already observed, has various senses or
 faculties as well as the body; and they are quite as active and lively
 in their respective functions:  in consequence of which the ideas of
 external objects are not only perceived, but retained, thought of,
 compared, compounded, abstracted, doubted, believed, desired ; and
 hence another fountain, and of a very capacious flow, from  which
 we also derive ideas :  viz. a reflex act or perception of the mind's
 own  operations; whence the ideas derived from  this fountain are
 denominated ideas of reflexion.
   The ideas, then, derived from these  two sources, and which have
 sometimes been called objective and subjective, constitute all our
 experience, and consequently, all our knowledge.   Whatever stock
 of information a man may be possessed of,  however richly he may
 be stored with taste, learning, or science, if he turn  his attention
 inwards, and diligently examine his own thoughts, he  will find that
 he has not a single idea in  his  mind,  but what has been derived
 from the one or the other of these two channels   But let not this
 important observation be forgotten by any one ;  that  the ideas the
 mind possesses will be fewer or more numerous, simpler or more
 diversified, clear or confused according to the number of the ob-
 jects  presented to it, and the extent of its reflexion and  examination.
 Thus a clock or a landscape may be for ever  before our  eyes, but
 unless we direct our  attention  to them, and  study their different
 parts, although we cannot be deceived in their being  a clock or a
 landscape, we can have but  a very inadequate  idea of their charac-
 ter and composition.
   The ideas presented to the mind, from  which soever of these
 two sources derived, are of two kinds—simple and complex.
   Simple ideas consist of such as are limited to a single notion  or
 perception ; as  those of unity, darkness, light, sound, simple pain or
 uneasiness.  And  in the reception of these the mind is passive ; for
 it can neither make them to itself, nor can it,  in any instance, have
 any idea which does not wholly consist of them ; or, in other words,
 it cannot contemplate any one of them otherwise than in its totality.
   Complex  ideas are formed out of various simple ideas associated
 together or  contemplated derivatively.  And  to this  class  belong
 the ideas of an army,  a battle, a triangle,  gratitude, veneration,
 gold,  silver, an  orange, an apple: in the formation of  all  which it
 must  be obvious that the mind is active : for it is the activity of the
 mind  alone that produces the complexity out of such ideas as are
 simple.  And that the ideas I have now referred  to are complex,
 must  be plain to every one; for every one must  be sensible that
the mind cannot form to itself the idea of an orange, without uniting
into one aggregate the simple ideas of roundness, yellowness, juici-
ness, and sweetness; and so of the rest.
  Complex ideas are formed out of simple ideas by many operations
of the mind; the principal of which, however, are some combina-
tion of them, some abstraction or some comparison.  Let us take a
view of each of these. 
36
PHYSIOLOGICAL PROEM.
[CL. IV.
  And first of complex ideas of combination.  Unity, as I have al-
ready observed, is a simple idea ; and it is one of the most common
simple ideas that can be presented to the mind; for every  object
without, and every notion within,  tend equally  to  excite it : and
being a simple idea, the mind, as I have also remarked, is  passive
on its presentation : it can neither form such an idea to itself, nor
contemplate it otherwise than in its totality : but it can combine the
ideas of as many units as it pleases, and hence produce the romplex
idea of a hundred, a thousand, or a hundred thousand.  So, beauty is
a complex idea; for the mind, in forming it, combines a variety of
separate ideas into one common aggregate.   Thus  Dryden, in de-
lineating the beautiful Victoria in  his Love Triumphant,

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

  In like manner the mind can produce complex ideas by an oppo-
site process; and that is by abstraction or separation.  Thus chalk,
snow, and milk, though agreeing, perhaps, in no other respect, coin-
cide in the same colour; and the mind, contemplating this agree-
ment, may  abstract, or separate the colour from the other properties
of these three objects, and form the idea which is indicated  by  the
term whiteness ; and having thus acquired a new idea by the process
of abstraction, it may afterwards apply it as a character to a  variety
of other objects ; and hence particular ideas  become general or uni-
versal.
  Other complex ideas are produced by comparison.  Thus if the
mind take one idea, as that of a foot, as a determinate measure, and
place it by  the side of another idea, as the idea of a table, the re-
sult will be a formation of the complex idea of length, breadth, and
thickness.  Or, if we vary the primary idea, we may obtain, as a
result, the  secondary ideas of coarseness and fineness.
  And hence, complex ideas must be almost infinitely more numer-
ous than simple ideas which  are  their elements or materials;  as
words must be always far more numerous than letters.   I have in-
stanced only a few of their principal kinds, and have applied them
only to a few of the  great variety of subjects to which  they are re-
ferable, and by which they are elucidated, in the great work  on
Human Understanding.
   It must,  however, from this imperfect sketch, appear obvious that
many of our ideas have a natural correspondence, congruity, and
connexion with each other; and as many, pet haps, on the contrary,
a natural repugnancy, incongruity, and disconnexion.   Thus, if I
were to speak of a cold fire, I  should put together ideas that are
naturally disconnected and incongruous ;  and should consequently
make an absurd proposition, or  to adopt common language, talk
nonsense.  I should be guilty of the same blunder if I were to talk of
a square billiard-ball, or a soft, reposing rock ; but  a warm fire,  on 
CL. IV.]
PHYSIOLOGICAL PROEM.
37
 the contrary, a white or even a.black billiard-ball, and a hard, rug-
 ged rock,  are  congruous ideas,  and consequently consistent with
 good sense.  Now it is the direct office of that discursive faculty of
 the mind which we call reason, to trace out  these  natural coinci-
 dences or disjunctions, and  to connect or separate them by proper
 relations : for it is a just perception of the natural connexion and con-
 gruity  or  of the natural repugnancy and incongruity of our ideas
 that shows a sound mind and constitutes real  knowledge.  The wise
 man is he  who has industriously  laid  in and  carefully assorted an
 extensive stock of ideas;  as the stupid or ignorant  man is he who,
 trom natural hebetude, or having had  but few opportunities, has
 collected and  arranged but a  small number.  The man who dis-
 covers the natural relations of his ideas  quickly, is a man of sagaci-
 ty ; and in popular language, is said, and correctly  so, to possess a
 quick, sharp intellect; the man, on  the contrary, who  discovers
 these relations  slowly,  we call  dull or heavy.  If he rapidly discover
 and put together relations that lie remote, and, perhaps touch only
 in a lew points, but those  points striking and  pleasant,  he is a man
 of  wit, genius, or brilliant fancy, of  agreeable allusion and meta-
 phor ; if he intermix ideas of fancy with ideas of reality, those of
 reflexion with those of sensation,  and mistake the  one for the other,
 however numerous  his ideas may be, and whatever their order of
 succession, he  is a madman ; he reasons from false  principles, and,
 as we say in popular language, and with perfect correctness, is out
 of his judgment.
   Finally, our ideas  are very  apt to associate  or run together in
 trains; and upon this peculiar and happy disposition of the mind we
 lay our chief dependence in sowing the seeds  of education. It often
 happens, however, that some of our ideas  have been associated
 erroneously, and even in a state of early life, before education has
 commenced ; and hence, from the difficulty of  separating them,
 most of the sympathies and antipathies,  the whims and prejudices
 that occasionally haunt us to the latest period of old age.
   Such, then, is the manner,  in which the mind, at first a sheet of
 white  paper, without  characters of any kind,  becomes  furnished
 with that vast store of ideas, the materials of wisdom and knowledge,
 which the busy and  boundless fancy of man paints upon it with an
 almost endless variety. The whole is derived  from experience, the
 experience of sensation or of reflexion ;  from the observations
 of the mind employed  either about external sensible objects, or the
 internal operations of itself, perceived  and reflected upon by its own
 faculties.
  These faculties  are to the mind what organs are to the body:
 they are its ministers in the production, combination, and resolution
 of different trains of ideas, and in  supplying it with the results of its
 own activity.  We sometimes, however, are  apt to  speak of them
 as distinct and separate existences from the mind, or as possessing
 a sort of independent entity, and as controlling one another by their
individual authorities, and occasionally,  indeed, as  controlling the 
38
PHYSIOLOGICAL PROEM.
[CL. IV.
 mind itself: for we accustom ourselves to describe the will as being
 overpowered by the judgment;  or the judgment as being over-
 powered by the imagination ; or the  mind itself as  being carried
 headlong by the violence of its own passions.   By all which, how-
 ever, we only mean, or should only mean, that the mind does not,
 on such occasions, exert is own faculties in a fitting or sober man-
 ner, or that from some diseased affection, it is incapable of doing so.
 For the faculties of the mind are  so many  powers ; and, as powers,
 are mere attributes of a being or substance, and not the being or
 substance itself.  These, therefore, being all different powers in the
 mind or in the man, to do several actions, he exerts them as he thinks
 fit: but the power to do one  action is not operated upon by the
 power to do another action :  for the power of thinking operates not
 on the power of choosing, nor the power of choosing on the  power
 of thinking :  any more than the power of dancing operates on the
 power of singing, or the power of singing on the power of dancing,*
 as any one who  reflects on  these things will easily perceive.
  The body  has its feelings, and the mind has its feelings also;
 and it is the  feelings  of the latter which we call passions, a mere
 Latin term for  the feelings or sufferings  of colloquial language.
 The feelings of the body are numerous and diversified, as those of
 simple ache or ease,  hunger, thirst, heat, cold, and a multitude of
others.  Those  of the mind are still more numerous and more
diversified,  for they complete  the multifarious train of grief, joy,
love,  hatred, avarice, ambition,  conceit, and  perhaps hundreds
more : all which whether of body or mind, Mr. Locke has endea-
voured to resolve into different modifications of pleasure or pain,
 according as they are productive of good or evil.
  But the analogy we are thus conducting between the mind and the
 body holds  much farther : for as the latter is subject to diseases of
various kinds, so also is the former.   The body may be enfeebled
in all its powers, in only a few of them, or in only  a single one.
 So also may the mind: " The powers of perception  and imagina-
 tion," observes  M. Pinel,  " are  frequently disturbed without any
excitement  of the passions.  The functions of the understanding, on
the  other hand, are often perfectly sound, while the man is driven
by his passions to acts of turbulence and outrage."  And  these
infirmities,  whether of body or mind, may be  constitutional and
permanent, periodical or recurrent, or merely incidental and tem-
porary.   The body may be  of a sanguineous temperament, of a
plaionic temperament, of  a nervous  or  irritable temperament;
and the mind may, in like  manner, possess an overweening confi-
 dence and courage ;  be  characteristically dull  and inactive;  or be
even goaded on  by  restlessness and eager desire;  it may be  quick
in apprehension and taste, but weak in memory ; strong in judgment,
but  slow in  imagination; or feeble in judgment, but rapid in imagi-
nation: its feelings or passions may  be sluggish, or all alive;  or
•Locke, p. 120. 
CL. IV.]             PHYSIOLOGICAL PROEM.                 39

some passion may be peculiarly energetic, while the rest remain at
the temperate point.
   When the corporeal deviations from the standard of high health
are but slight, they are scarcely entitled to the name of diseases,—
but when severe or  extreme,  they  become subjects of  serious
attention.  It is the same with  the different  states of the mind with
which I have just contrasted them.   While  several, or even all the
mental faculties are slightly weak or sluggish or inaccordant with
the action of the rest, they are scarcely subjects of medical treat-
ment—for otherwise  half the world would be daily consigned to a
strait waistcoat: but  when the  same changes become striking and
strongly marked, they are real diseases of the intellect; and, in
the ensuing order, the genera will be found taken from the peculiar
faculties of  the mind that chance to be thus affected.
   The mind and  the body bear also, in many cases a reciprocal
influence on each other; which is sometimes  general, and some-
times limited to particular faculties or functions.  It is hence that
fever or cephalitis produces delirium; and vapours or low  spirits
dyspepsy.
   The mind, therefore, like the body, becomes an  interesting field
of study to the pathologist, and  opens to his view an additional and
melancholy train of diseases. It is these which will constitute the
subject of the first order of  the class we  have now entered upon,
and which are entitled to a deep and collected attention. 
 
CLASS  IV
NEUROTIC A.
                          ORDER  I.

                      PHREMCA.

              Mntzmb affettttifl tfie Kntriiect

ERROR, PERVERSION, OR DEBILITY OF ONE OR MORE OF THE MENTAL
                          FACULTIES.

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

       I. ecphronia.             insanity.
      II. EMPATHEMA.            UNGOVERNABLE PASSION.
     III. ALUSIA.                 ILLUSION.
     IV. APHELXIA.              REVERV.
      V. PARONIRIA.             SLEEP-DISTURBANCE.
     VI. MORIA.                 FATUITY.

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


                         GENUS I.

                      ECPHROMA.

                   Knsanttg.   (Kvaiintm.

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

The generic term ecphronia, in the Greek writers extyanv or extyoo-wti,
is derived from t*.$%m " extra mentem"—literally  " out of one's
mind,"  as ep<p%m is " mentis  compos"  or " in one's mind."  It is
here used as among the Greeks, generically alone, in  the ordinary
sense of insanity; and is designed  to  include the  two following
species:

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

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

                       Ira furor brevis est,

or else that the insanity was  caused  not by the cataract,  but by the
frequent fits of violent passion.  Thousands of persons have had
cataracts in  every form, and  other external senses than the eye dis-
eased in every form, and  have been born defective in  several of
these senses without the least mark of insanity; while  other per-
sons, apparently in the most perfect  possession of all the five senses,
have been stark mad.   And hence the doctrine of M. Dufour boasts
of few advocates  in the present day.
  In insanity or delirium without fever, it  is far more obvious that
there is a morbid  condition of the judgment or of the perception or
of both.  Mr. Locke, and after him M.  Condillac, refers it to the
former alone, and characterizes madness in the general sense of the
term, by false judgment;  by a disposition  to associate ideas  incor-
rectly and to mistake them for truths; and hence, says Mr. Locke,
"madmen err as men do that argue  right from wrong principles."*
Dr.  Battie on the contrary, refers madness  to  the latter  faculty
alone, and characterises it by false fiercefition ; but the perceptions
in madness seem, for any thing we know to the contrary, to be fre-
quently as correct as in health, the judgment or reasoning being alone
diseased or defective.
  It is difficult to say which of these two  explanations of madness
is most imperfect. It is sufficient to observe that neither of them,
taken alone, describes a condition of the faculties strictly morbid,
and consequently  neither of them defines madness.  For we are dai-
ly meeting with thousands of mankind who are under the influence
of false judgments, who unite incongruous or discrepant ideas, and
draw from false associations  right conclusions, yet whom we never
• B. II. Ch. xi. § 13. 
GE. I.]
NERVOUS FUNCTION.
45
think of regarding as out of their senses.  While on the contrary, if
false perceptions be  sufficient to constitute madness, every man is
insane who mistakes at a distance a square for a round tower, the
bending azure  sky that terminates an extensive landscape for the
sea, or the distant rumbling of a heavy waggon over the streets for
a  peal of thunder:  and  we should none of us be safe from such a
charge for a single day of our lives.
   Dr. Cullen seems to  have embraced Mr. Locke's view of the sub-
ject ;  for his definition of insanity (vesaniae) in the later editions of
his synopsis is " injured functions of the mind in judging (mentis ju-
dicantis) without pyrexy  or coma."   Dr. Crichton, on the contrary
seems rather to adhere to Dr. Battie's view, though  he enlarges
and improves  upon  it: and  hence his definition is " General de-
rangement of the mental faculties, in which diseased  perceptions
are mistaken for  realities ; with  incoherent  language and unruly
conduct."
   Diseased  is certainly a better term than false, which is that of
Dr. Battie ;  but " unruly conduct" does not essentially belong  to
madness even under  this  excellent writer's own explanation :  for of
the three species which he comprehends under this disease as a ge-
nus, viz. mania furibunda, mania mitis, and melancholia, while the
last, as he afterwards illustrates it,* evinces these symptoms only
occasionally, he expressly tells us of the second, that the diseased
are " all happy, gay, and cheerful;" that "  good humour character-
ises this insanity, and hence the patients are in general very trac-
table."!
   But the chief objection to Sir A. Crichton's definition of insanity,
is  his limiting it in respect to the mental faculties, to the power of
perception while the judgment  remains totally unaffected. " In re-
gard to lunatics, says he, in another  place, and men who are of a
sound mind, the faculty of judging is the same in both, but they have
different perceptions, and their judgments therefore must be differ-
ent."!
   Now if the faculties of perception,  attention and memory be lia-
ble to derangement,  as the same writer admits, and there be  " a
general derangement of mental faculties in  insanity, there seems no
sufficient ground for exempting the faculty of judgment.  And a lit-
tle attention to the history of an insane patient will, I think,  suffi-
ciently support the opinion of Mr. Locke and Dr. Cullen upon this
point, and show that this, if not the faculty chiefly diseased, labours
under at least as much disease  as that of perception.
   We have already observed in the proem  to the present class, that
all the powers of the mind are as liable to be affected with diseases,
and diseases of various kinds, as those of the body ; and that either
the body or the mind  may be enfeebled at the same  time in  the
* Of Mental Derangement, Book HI. Ch. III. Vol. II.
f Id. Book I. Ch. V. p. 181, 182. Vol. I.
* Id. Vol. I. p. 401. 
46
NEUROTICA.
[CL. IV.—OR. I-
whole of its powers,  in a few of its powers, or in a single power.
A sound mind supposes an existence of all the mind's feelings and
intellectual powers in  a state of vigour, and under the subordination
of the judgment, which is designed by nature to be the governing
or controlling principle.  And thus constituted, the mind is said to
be in  a state  of order or arrangement.  It often happens  that this
order or arrangement is slightly broken in upon by natural  constitu-
tion, or some corporeal affection:  but so  long  as the  irregularity
does not essentially interfere with the mental health, it is no  more
attended to than slight irregularities or  disquietudes of the  body.
Yet whenever it becomes serious  and complicated it amounts to a
disease, and the mind  is said, and most correctly so, to  be deranged
or disordered.
  This derangement may  proceed from  a morbid state of any of
the intellectual or any of the empassioned faculties of the mind, for
the perception may not correctly convey the ideas we receive by
the external senses, or the judgment may lose its power of discrimi-
nating them; or the memory may not retain them, or the  imagina-
tion or the  passions may  be in a  state of unruly excitement: all
which will lay a foundation for different kinds or genera of diseases,
and in fact form the foundation of those appertaining to the present
order.
  Now an attentive examination into the habits of an insane person
will show first, that the judgment and the perception are both injured
during the  existence  of insanity;  and next that, though from a
violent or complicated state of the disease, the morbid condition often
extends to some other, or even to all the other mental faculties, yet
it does not necessarily or essentislly extend to them ;  for a madman
may  be furious or passionate, yet every madman  is  not so ; his
memory may fail or his attention be incapable of fixing  itself, or his
imagination be wild and extravagant, but these do not always occur.
The  faculties, however, of the judgment and  the perception are
affected in every case, though they are not always equally affected
at one and  the same time: for the morbid power seems, for the
most part, unaccountably to shift in succession from the one to the
other, so as alternately to  leave the judgment  and  alternately the
perception free or nearly free from all estrangement whatever, the
disease, being, however, always accompanied with irregular remis-
sions ; and often with such a diminution of sensibility that the patient
is uninfluenced by the  effects of cold, and hunger, and very generally
unsusceptible of febrile miasm.
  Thus a madman will often mistake one person who is introduced
to him for  another, and under the influence of this mistake will
reason correctly concerning him,  and although  he may have been
for years his next neighbour, will ask him  when  he came  from
China or  the East Indies, by what ship  he returned  home, and
whether his voyage had been successful.  In all which  the  error
may be that of the perception alone.  But if, as is frequently the
case, the patient address his visitor by his proper name, he gives a 
GE. L]
NERVOUS FUNCTION.
47
ground for believing that he perceives him aright, and that the error
is that of  the judgment,  which  thus unites  incongruous ideas
applying a visionary history to a real and  indentified person.  At
another time, he may, from  the first perfectly recognize the indi-
vidual so presented to him ; and to prove his recollection and  the
correctness of his perception, may  rapidly run over a long list of
his relations, and a long string of anecdotes respecting  his former
life : after which he may suddently start, and looking at the visitor's
walking-stick, tell him that that drawn  sword will  never save him
from destruction,  nor all the men that slept with him in the same
bed the night before—that his rival is now pushing forward with all
speed on a black horse with a large army behind him, and that to-
morrow he will fight and lose his crown.
  In such a case, and it is by no means  an extreme one, the percep-
tion and the judgment travel  soundly and in harmony at the outset
of the interview ;  but  they soon separate and abandon  each other
as far as  east  and west.  It is not always easy to say whether the
fresh  paroxysm of insanity  that thus suddenly displays itself is
limited to the one faculty or to the other,  or is common  to both.
For if the perception suddenly wander, the judgment has a new train
of ideas presented to it, and must necessarily take a new direction.
Yet it is difficult to conceive how the judgment can be thus abruptly
led astray if it continue sound: and hence  it is more probable that
the judgment itself is at fault and admits a train  of ideas which,
however congruous to themselves, are incongruous to those furnish-
ed by the faculty of perception ; or both may equally wander, and
accompany each other in the visionary  scene, as  they at first asso-
ciated in the real. It  is obvious, however, if I mistake not, that
both faculties are affected in the derangement of insanity jointly or
in irregular succession.
  How far a morbid state of the mental faculties may in any case
depend upon the  mind itself, as distinct from  the sensorium  or
instrument by which it is connected with the body, it is impossible
for us to know till we become acquainted  with  the nature of this
connexion, and perhaps also with the essence of the mind,  which,
in our present stale of information, seems to be a hopeless subject of
inquiry.  But we may possibly obtain some  insight into the manner
in which correct  ideas of perception are  changed in their nature
and rendered incorrect or incongruous by  a diseased judgment, by
attending  to  a process of variation  that is  frequently occurring in
perfect sanity and acuteness of mind.  " The ideas  we receive by
sensation," says Mr. Locke, " in adverting to this process, are often
in grown people altered by  the judgment without our taking notice
of it." And he explains this position by observing that when a ball
of any uniform colour, as of gold, alabaster, or jet, is placed before
the eye, the idea thereby imprinted in  the  mind is that only of a
flat circle variously shadowed, with different degrees of light and
brightness  coming to the organ of sight. " But having by use been
accustomed to perceive what kind of appearance convex bodies are 
48
NEUROTICA.
[CL. IV.—OR. f.
 wont to make in us : what alterations are made in the reflexions of
 light by the difference of the  sensible figures of bodies, the judg-
 ment presently, by an habitual custom, alters the appearances into
 their causes:  so that from that which truly is variety of shadow or
 colour, collecting the figure, it makes it pass for a mark of figure,
 and frames to itself the fiercefition of a convex figure and an uniform
 colour."* And the same change occurs still  more conspicuously in
 looking at an engraving or a picture, in  which the only idea pre-
 sented by the  eye  to the perception is that of  a plane variously
 shaded or coloured; but which the judgment immediately changes
 and  multiplies into other ideas  of  life and  motion,  and running
 streams, and fathomless woods, and  cloud-capt mountains.   And if
 in a sane state we find  the judgment capable of thus varying  the
 ideas of preception presented to it, we can  have no great difficulty,
 I think, in conceiving  by what means such a variation may  be
 produced and may ramify into  incongruities of great extravagance
 in a judgment deranged by disease.
   Nor is there much  difficulty in conceiving how the paroxysm
 should be subject to remissions or even intermissions more or less
 regular; or the derangement  be  limited, as  we frequently  find it,
 and  especially  in melancholy, to particular subjects  or trains of
 ideas.  For first, all diseases have a tendency to remissions or inter-
missions ; but those connected with the brain or  nerves more than
any others, as  is evident  in hemicrania, epilepsy, hysteria, and
palpitation of the heart. And next, there is no man in a slate of the
most perfect sanity whose judgment is equally strong and exact upon
 all subjects: and few whose judgments are not manifestly influenced
 and led astray by partialities,  or  peculiar incidents of a thousand
 kinds; insomuch that we dare not, on various occasions, entrust to a
man of the  strictest honesty and the  clearest head  a particular
 subject for his decision, whom we should fly to as  our counsellor
upon every other occurrence.   And it is not therefore very extra-
ordinary that in a mordid state of the mind, and particularly of that
faculty which constitutes the judgment, there should be an aberra-
tion in some directions or upon some subjects which does not exist
upon others.
  Concerning the remote or even the proximate cause of the dis-
 ease, we have  yet much to learn.  From the view we have taken
in the proem  of the close connexion between the mind and the
brain,  it  seems reasonable to conceive  that the remote  cause is
ordinarily dependent upon some misconstruction or misaffection of
 the cerebral organs: and hence every part of them has been  scruti-
nized for proofs of so  plausible  an hypothesis, but hitherto to no
purpose whatever.  The form of the cranium,  its thickness and
other qualities; the meninges,  the substance  of the brain, the
ventricles, the pineal gland, the commissures, the cerebellum, have
all been analyzed in turn, by the most dextrous and prying anatomists
* Hum. Underst. Book U. Ch. ix. § 8. 
CE. I.]
NERVOUS FUNCTION.
49
of England, France, Germany, and  Italy, but with no satisfactory
result.  The shape or thickness of the  scull has been started, indeed,
as a cause, by many anatomists of high and established reputation ;
but  the conjecture  has  been completely disproved by others, who
have found  the  very structures  supposed to be most certain of
producing madness, exist in numerousinstances with perfect sound-
ness of intellect.   A particular shape of the scull seems, indeed, to
be often connected with idiotism from birth or soon after birth, but
with no other species of mental  derangement whatever.
  Morgagni engaged in an extensive course of dissections upon this
subject, and pursued it with peculiar ardour:  and his results are
given in  his eighth epistle, from the second  to  the  eighteenth
article.   In  some cases the brain was  harder, in some softer, than in
a healthy state ; occasionally the dura mater was thicker,  and was
studded with soft, whitish bodies on the sides of the longitudinal
sinus.   This sinus itself sometimes evinced polypous concretions;
and the pineal gland, or several of  the glands in the plexus choroides
were in a diseased state.   Dr. Greding,* with a like spirit of inves-
tigation,  has arrived at a like  diversity of facts.   Meckel tells us
that he found the brain denser and harder than usual ;f  Dr. Smithf
descried a bony concretion, and Plenciz and various others represent
the brain  as bony or calculous in various parts; while Jones, in the
Medical Commentaries, found it softer than usual with a thickening
of the membranes and a turgescence of the ventricles.  From all
which,  nothing precise or pathognomic can be collected,  since all
such morbid appearances have been traced under other diseases as
well as  under insanity.
  M. Pinel  is firmly decided  upon  this  point; and after a very
extensive course of investigations he asserts, with respect to the
cranium, that there are no facts  yet clearly established which prove
the faculties of the mind (except in  the case  of idiotism)  to be, in
any  degree, influenced by  its size, figure, or density: while with
respect to the contents of the  cranium.   " I can affirm,"  says he,
" that  I have  never met  with  any  other  appearances within the
cavity of the scull, than are observable on opening the bodies of
persons who have died of apoplexy, epilepsy, nervous fevers, and
convulsions."
  The  observations  of  Haslam  are nearly  to  the  same effect:
for they  concur in  showing that, except in so considerable a mis-
formation of the scull or its contents, as to induce idiotism  from an
early period of life, as in the case of cretinism, nothing decisive can
be obtained in reference to  insanity from any variations of  appear-
ance that have hitherto been detected.
  The  dissections of Greding  extended to  not  fewer than two
hundred and sixteen maniacal patients, the whole of whom,  how-
* Vermischte medicinische und chirurgische Schriften.  Altenb. 1781.
 \ Hist, de l'Acad. Royale des Sciences, &c. Ann. 1760. Berol. 4to. 1761.
 t Med. Observ. and Inquir. Vol. VI.
 VOL. III.—7 
 •50                       NEUROTICA.            [CL. IV.—OR. I

 ever,  died  of disorders  unconnected with their mental ailments :
 three  of the heads were exceedingly large, two exceedingly small;
 some  of the scull-bones extremely thick, others peculiarly thin :
 in some, the frontal bones were small and contracted, in others, the
 temporal bones compressed and narrow.*
   In a table containing  an aggregate of the patiens received into
 the  lunatic  asylum at Bicetre during a  considerable part of  the
 French  revolution, from  1784 to 1792, by far the greatest number
 admitted were  between  the ages of thirty and forty:  next,  those
 between forty and fifty; next to these, patients between twenty and
 thirty  ; then those from  sixty to  seventy; and  lastly, those from
 fifteen to twenty; below which we have no account of any admis-
 sion whatever.  Hence different stadia of life seem to exercise some
 control,  and  the period most exposed to the disease is that in which
 the influence of  the passions may be  conceived to be naturally
 strongest and  most operative.  " Among the lunatics confined at
 Bicetre," says M. Pinel,  "during the third  year of the republic,
 and whose cases I particularly examined, I observed that the exciting
 causes of their  maladies, in a great majority  of instances, were
 extremely vivid  affections of the mind ; as ungovernable or disap-
 pointed ambition, religious fanatacism, profound chagrin, and unfor-
 tunate love.  Out of one hundred and thirteen madmen, with whose
 histories I took pains to make myself acquainted,  thirty-four were
 reduced  to  this  state by domestic misfortunes: twenty-four by
 obstacles to matrimonial unions which they had ardently desired to
 form;  thirty by political events connected  with the  revolution;
 and  twenty-five  by  religious fanaticism."   Those were chiefly
 affected  who  belonged  to professions  in which  the imagination is
 unceasingly  or ardently  engaged, and not controlled in its excite-
 ment by the  exercise of the tamer functions of the understanding,
 which  are more susceptible of satiety  and  fatigue.  Hence the
 Bicetre registers were chiefly filled from the professions of priests,
 artists, painters,  sculptors, poets, and musicians:  while they con-
 tained  no instances of persons whose line of life demands a predo-
 minant exercise of  the judging faculty :  not one naturalist, physi-
 cian, chemist, or geometrician.
   But  there  are other organs that also betray very prominent  signs
 of diseased  action in insanity as well as the brain, as those of the
 epigastrium  and  the adjoining regions:  and  hence other physiolo-
 gists have sought for a  remote or even a proximate cause of the
malady in these, rather than in the encephalon.   This was  the case
 among several, though not the majority, of the Greek physicians, as
we have seen already : and it is to this quarter that M. Pinel refers
the proximate  cause  in  almost  every  instance in our own day.
It  is  here he  supposes the disease to commence, and contends that
the affection of the brain and of the mental faculties is subsequent
to  the abdominal symptoms, and altogether dependent upon them :
* Vermische Schriften, ut supra. 
GE. I.]
NERVOUS FUNCTION.
51
 and in proof of this he ad?erts to various dissections which have
 shown a considerable derangement, not only in the function but even
 in the structure of one or more of the abdominal organs, and parti-
 cularly a displacement of the transverse colon.
   But this is to give a weight to the morbid appearances occasion-
 ally manifested in these organs, above what is allowed to like mis-
 formations in the cranium.  Yet there can be no doubt that, in most
 cases of insanity, the brain and epigastrium suffer jointly ; and that
 the disease may, and often does, commence  in some structural or
 functionary affection of the abdominal organs, is perfectly clear from
 the frequency of this complaint during pregnancy and in child-bed :
 its being connected with a peculiar state of the genital  organs, as*
 we shall presently have occasion to show, and its following upon a
 sudden suppression  of the menstrual or hemorrhoidal discharge.
  Nor is it difficult to account for this association of influence from
 the extensive  distribution of the par vagum,  and more particularly
 of  the intercostal nerve  over the abdominal viscera : on  which
 account a like sympathy is by no means uncommon in various other
 disorders.   Thus while a concussion or compression of  the brain
 produces nausea, sickness, and constipation,  worms are frequently
 found to excite convulsions or epilepsy.
  The fair result of  the whole inquiry appears to be, that  insanity,
 in every instance, to  adopt the language of Sir A. Crichton, " arises
 from a diseased state of the brain  or nerves, or both:"*  but that in
 many instances this diseased state is a primary affection, and in others
 a secondary, dependent upon a morbid condition of the epigastric
 or some other abdominal organ :  for, in whatever this morbid
 condition may consist, and whatever symptoms  it may evince, it is
 not till the sensorium  has by degrees associated in the chain of
 unhealthy  action that the signs of insanity are unequivocal.   And,
 in like manner, dyspeptic and other  abdominal  symptoms are not
 unfrequently brought on by a  previous diseased state of  the mind :
 and it is hence peculiarly  difficult, and perhaps in some cases alto-
gether impossible, to determine, where we are not acquainted with
 the incipient symptoms, whether melancholy  or hypochondrias, has
 originated  in the state of the abdominal viscera or of the cranium;
 or in other words, whether the one or the other be a primary or a
 secondary affection.
  When, however, we are made acquainted with the history of the
 incipient symptoms,we have a tolerable clue to guide us ; and, for
 the most part may safely decide that the region  primarily  affected,
 is that which first evinces morbid symptoms : And hence, while we
 shall have  little scruple in assigning the origin of most  cases of
 hypochondrism to a morbid condition of one  or more of the diges-
 tive organs, we need have as little in assigning  the greater number
 of cases of mania to a primary  misaffection of the brain or the
 nerves.
* Of Mental Derangement. Vol. 1. p. 138. 
 52                      NEUROTICA.            [CL. IV.—OR. I

   In what that misaffection consists, is a question that has never been
 settled to the present hour, and from our total inacquaintance with
 the nature of the connexion between the brain and  the mind, it never
 will be in any  very  satisfactory  manner.  The morbid  changes,
 indeed, which we have already seen are frequently to be traced in
 the structure of the brain, show very sufficiently that a considerable
 degree of diseased action has been taking place there ; but as these
 changes are also found in other disorders of the head as well as in
 mania, and more  especially as we  cannot tell whether they have
 preceded or  been produced by  such action, they  give us little
 information as to the nature of the diseased action itself.
   Dr. Cullen  has offered a series of ingenious arguments to  prove
 that mania consists in some inequality in the excitement of the
 brain,* or of the nervous power,t  and in most  cases in an increased
 excitement.   Dr. Cullen's idea of the nervous power, as  we have
 already had occasion to observe, is very  far  from being explicit:
 for he defines  it  " a subtile very moveable fluid, included or inherent
 in  a  manner  ive do not clearly  understand in  every  part of the
 medullary substance of the brain and nerves."  While in other parts
 of his writings he represents it as never either recruited or exhaust-
 ed, and thus conceives it to possess qualities  beyond the ordinary
 endowments of living matter.  Yet his general principle appears to
 be well founded, and Sir  Alexander Crichton has availed himself of
 it in giving a fuller explanation of this highly probable hypothesis :
 and, after appealing to the doctrine which has already been advanced
 and supported in the preceding pages of the present work, that  the
 nervous  power is a peculiar fluid secreted in the medullary sub-
 stance of the brain or the nerves,  he endeavours to show  that  the
 cause of insanities is a specific morbid action of the vessels which
 secrete the nervous fluid  in the brain ;\ and which may  hereby be
 altered not only in quantity but in  quality.§
  From the quickness of the external senses,  the irascibility, heat
of the skin,  flushed  countenance,  and uncommon energy  which
 maniacs evince, we have  reason to believe this morbid action to  be,
 for the most part, a  preternaturally increased action; and we  are
 hence able to account for the various exacerbations and  remissions
which  it evinces, sometimes periodically, and sometimes irregularly.
 Yet as the health of the faculties of  the mind must depend  upon a
healthy energy of the vessels, too scanty a secretion of nervous
fluid must be as effectual a  cause of mental  derangement as too
copious a  flow:  and hence torpor of the vessels of the  brain may
prove as certain a cause of a wandering mind as entony, and, conse-
quently, typhus fever may become a  source of delirium  as well as
inflammatory.  And as the various secretions can only be elabo-
* Pract. Phys. Vol. IV. Aph. MDLXU.
t Id. MDXLIV.
* Of Mental Derangement, Vol. I. p. 174,
§ Id. Vol. I. p. 169. 
GE. I.]
NERVOUS FUNCTION.
53
rated from the blood, and are often affected by its condition, we may
see also how madness may be a result of acrid narcotics and other
poisons introduced into the blood  by absorption, or a transfusion of
blood from animals of a different nature, of which Dionis has given
some very striking examples.
  That there  is a tendency not only to an  increased secretion of
sensorial  power in the head in most cases of insanity, but to an
accumulation of it from all parts of the body, and especially from
the surface, is clear from the  patient's diminished  sensibility to
external impressions, and his  being able to endure  the  severest
winter's cold, and a fasting of many days without inconvenience or
indeed consciousness. But that there is, in some cases, a diminish-
ed secretion of this fluid producing a general debility of the living
fibre, is also clear from  the  great  tendency manifested by some
maniacs to a gangrene in their  extremities, and, where they are
uncleanly, about the  buttocks.  The insensibility from this cause is
sometimes so considerable as to affect, not only the diffuse organ of
feeling, but some of the local senses as well.   And hence some
patients lose their hearing, and  others are  capable of staring at the
meridian sun without pain, or any change in the diameter of the iris.*
Sometimes,  however, the increased secretion of sensorial power is
so considerable as not only to affect the head, but to augment the
corporeal senibility generally.  And  hence  Hoffman  makes accu-
mulated sensation  an ordinary symptom of this disease,! mistaking
the exception for the general rule: and Riedlin gives us an instance
of a maniac, who, instead of calling for and being able to endure
large quantities of snuff, sneezed and was convulsed on smelling the
mildest aromatics.^
  It is  a melancholy reflection  that insanity is often  the result of
an hereditary predisposition.   This, indeed, has been denied by a
few writers; but their opinion has unhappily been lost in the con-
current voice of those who have thought differently, and the irresis-
tible evidence of daily facts.  Mysterious as the subject is we have
perpetual proofs that a peculiarity of mental characters is just as
propagable as a peculiarity of corporeal;  and hence wit, madness,
and  idiotism are as distinctly  an heir-loom of some families as
scrophula, consumption and cancer of others. In most of the latter
we have already observed that something  of a constitutional make
or physiognomy is often discernible; and the same is contended for
by many authorities in the disease before  us.  Yet, if we examine
the marks accurately, we shall  find  that they merge, for the most
part, into  the common symptoms of a sanguineous, or a melancholic
temperament:  either of which constitutions exercise such a con-
trol  over the disease as to give it a peculiar modification whatever
be the  nature of  the exciting  cause; which is  in truth of little
• Blumenb. Bibl. I. p. 736.
f Opp. Suppl. II. 2.
* Lin. Med. 1696. p. 29 
54                        NEUROTICA.           [CL.IV.—OR. I.

importance to the constitutional turn the malady may take, though
well worth attending to in the moral treatment.  " The violence of
the maniacal paroxysm," observes M. Pinel, " appears to be indepen-
dent of the nature of the exciting cause; or at least to be far more
influenced by the constitution of the individual, and the peculiar de-
gree of  his physical and moral sensibility.  Men of a robust consti-
tution, of mature years, with black hair, and susceptible of strong and
violent passions, appear to retain the same character when visited by
this most distressing of human misfortunes. Their ordinary energy
is augmented  to outrageous fury.  Violence, on the other hand, is
seldom characteristic of the paroxysms of individuals of more mode-
rate passions, with brown or auburn hair.  Nothing is more common
than to  see men with light-coloured  hair, sink into soothing  and
pleasurable reveries ; while  it seldom  or never happens that they
become furious or unmanageable. Their pleasing dreams, however,
are at length overtaken by, and lost amidst the gloom of  an incura-
ble fatuity. Those of the greatest mental excitement, of the warm-
est  passions, the most active imagination,  the most acute sensibi-
lity, are chiefly predisposed to insanity. A melancholy reflection !—
but such as is calculated to call forth our best and tenderest sympa-
thies."
  It has long been a current opinion that insanity is a disease more
common to our own country than to any other : and this opinion has
of late been rendered more seriously alarming by the following as-
sertion of Dr. Powell, secretary to the commissioners for licensing
lunatic establishments, and which is given as the result of his official
tables of returns from  1775 to 1809 inclusive, divided into  lustra
or  periods of five years  each.  " Insanity appears  to  have been
considerably upon the increase: for if we compare the sums of two
distant lustra, the one beginning with 1775, and the other ending with
1809, the proportion of patients returned as having  been received
into lunatic houses during the latter period, is to that of the former
nearly as 129 to 100."  "The facts also," says he, " which present
themselves to  the observation of the traveller, whatever direction
he  may take through this country, and  all  the local information
which we receive from the subject, supply us, as I am  led to think,
with sufficient proof that the increase must actually have been very
considerable, though we cannot ascertain what has been its exact
proportion."*
  The first part of this opinion, or that which regards insanity as a
disease peculiarly prevalent in England, does not seem to rest on
any established basis: for, calculating with Dr. Powell,  that the
number of lunatic paupers and those received into public hospitals,
which, under the act of parliament are not cognizable by the com-
missioners, together with those neglected to be returned, compared
with the returns entered  into the commissioners' book, bear the
  * Med. Trans. Vol. lV. p. l.ii. Art. Observations on the Comparative Pre-
valence of Insanity at different periods. 
GE. I.]
NERVOUS FUNCTION.
55
proportion of three to  two, which is probably far above the, mark,
still the aggregate number of insane persons for the year 1800, con-
trasted with the  general census for the same year, will only hold a
ratio of about  1  to 7300:  while if we take, with Dr. Burrows, the
proportion of suicides committed in foreign capitals as a test of the
extent to  which  insanity is prevalent in the same towns, which is,
nevertheless a loose mode of reckoning, though it is not easy to ob-
tain a better, we have reason to conclude that insanity is, compara-
tively far  less frequent among ourselves than in  most parts of the
continent: the suicides of Paris, Berlin and Copenhagen, as drawn
from  tables collected by Dr. Burrows  for this purpose, being in
proportion to the relative population of London  as 5 to 2 for the
first, 5 to  3 for the second, and  3 to 1 for the third.*
  Nor does the idea that insanity is an increasing disease in our own
country appear to rest on  a stabler foundation.   Taking Dr. Pow-
ell's result as drawn from  full and incontrovertible  data, and com-
paring the supposed march of  the disease with the acknowledged
march of  the population, although the former may possibly be  said
to have overstepped  the  latter by a few paces the difference  will
hardly justify the assertion,  that " insanity is considerably upon the
increase."  And if we take into view the intensity of interest with
which this subject has for the last twenty years been contemplated
by  the public,  the operation of those feelings of humanity  which
have dragged the wretched victims of disease from the miserable
abodes of prisons and neglected workhouses, and placed them under
the professional care of the superintendants of licensed establish-
ments, and above all, the augmented number of such establishments
in consequence  hereof, and the great respectability of many  who
have the management of them, thus giving the commissioners re-
turns which by  the power of their Act of  26 Geo.  III. they could
otherwise have been in possession of,  we may, I  think, fairly con-
clude that this apparent overstep, be it what it may, in the march
of insanity beyond that of the population of the  country, is a  real
retrogression.
  At this conclusion we might, I think, fairly arrive, even if the
data selected by Dr. Powell were full and incontrovertible; but he
himself has candidly admitted,  that* instead of being full and incon-
trovertible they  " are subject to numerous inaccuracies, and  that
any deductions which may be made from them must be imperfect."
It is still more consolatory to learn that the direct deductions from
the parochial and district establishments are not only not in accord-
ance with  Dr. Powell's, but such as seem to show that a retrogression,
instead of an advance, has actually taken place.   Dr. Bu.icws has
industriously collected many of these, and, as far as they go, they,
lead to such an  inference  almost without exception.!  Yet it  is pro-
bable that even  this inference does not give us the precise fact, and
* Inquiry into certain causes relative to insanity, &c. p. 93. 8vo. 1820.
| Inquiry, &c. ut supr. p. 66 et alibi. 
5b*                      NEUROTICA.           [CL. IV.—OR. I.
that it is as chargeable with an error on the favourable side, as the
opposite account is on the unfavourable; since the increase of licens-
ed houses, whose returns seem to have swelled the list of the com-
missioners beyond its proper aggregate, has been considerably sup-
ported by a transfer from the establishments which have thus fallen
off.  And hence, allowing the  error on the one side to compensate
that on the other, we are brought to the conclusion which, after all,
appears more natural, that the career of insanity is only varied in
its uniformity by temporary contingencies, but that it is by no means
a prevalent disease in our own  country.
                        SPECIES  I.

           ECPHRONIA MELANCHOLIA.

                       JHelanchoIg.

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

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

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

  The same variety of symptoms, as  chiefly modified by the pre-
vailing temperament, are noticed by Fracastorio.  " The phlegma-
tic," says he, " are heavy;  the  sanguine, lively, cheerful, merry,
but not witty; the choleric are in rapid and perpetual motion. 
E. I.—SP. I.J
NERVOUS FUNCTION.
57
 impatient of dwelling  upon any subject.  An acuteness of wit be-
 longs to  most of the varieties, but not  to all."*  And hence Dio-
 des in opposing Galen for holding after Hippocrates, that gloom  and
 terror are pathognomic signs of melancholy, observes, " Upon seri-
 ous consideration I find some patients that have nothing of these qua-
 lities: and others that exhibit every diversity of feeling:  for some
 are sad without being fearful; and others fearful without being sad;
 some neither, and some both."
   Besides these  modifications there is another of a very peculiar
 kind noticed by Dr. Spurzheim, in order to show that the faculties
 of the mind are double, and that each hemisphere of the brain con-
 tains a distinct set.  As I have never met with an instance of this
 variety I  must describe it in his own words.  " Tiedman," says he,
 " relates  the example  of one  Moser, who was insane on one side,
 and who observed his  insanity with the other.   Gall attended a mi-
 nister who, having a similar disease for three years, heard constantly
 on his left side reproaches and injuries,  and turned his head to that
 side in order to look at the persons.  With his right side he com-
 monly judged of the madness of his left side : but sometimes in a fit
 of fever  he could not rectify his peculiar state.  Long after being
 cured, if he happened to be angry, or if  he had drank more than he
 was accustomed to do, he observed, in  his left side, a tendency to
 his former alienation."!
   It may appear strange to those who have not studied the subject
 with much attention that persons who are possessed of a diseased or
 even a defective judgment should at any time be of quick and lively
 apprehension, and thus be witty without being wise. But the fa-
 culty of wit is dependent not so much on the judgment as on the
 imagination and particularly on the memory, on the possession of a
 large stock of ideas stored up for ready use, and brought forth with
 rapidity.  " And hence,"  says Mr. Locke,  " some  reason may per-
 haps  be   given of that common  observation that men who have a
 great deal of wit and prompt memories have not always the clearest
judgment or deepest reason.  For wit lying most in the assemblage
of ideas,  and  putting  those together with quickness and variety^
wherein can be  found  any resemblance or congruity, thereby to
make up pleasant pictures and agreeable visions in the fancy, judg-
ment, on the contrary,  lies quite on the other  side, in separating
carefully,  one from the other, ideas wherein can be found the least
difference, thereby to avoid being misled by similitude, and by affi-
nity to take one thing for another."J  And hence, we may easily
account for that gaiety and those ebullitions of a vivid fancy which
so often assume the character of wit in persons whose minds are
deranged, and especially in the sober faculty of the judgment.
  Mirth and wit, however, though sometimes found in the present
       * De Intellectione, Lib. II.
       f Physiognomonical System, &c. p. 144. 8vo. 1816.
       t On Human Understanding-, Book 11. Ch. XI. § 2.
vol. Hi.—8 
55                      NEUROTICA.             LCL. 1V.-OR. t;

species of insanity, are by no means its  common characters, but on
the contrary as we have already observed, a love of solitude, gloom,
and taciturnity, and an indulgence in the distressing emotions of the
mind.  And hence, whenever hypochondrism merges into actual in-
sanity, it almost always takes this form ; as melancholy, from a  sort
of natural connexion between the two, often  assumes many of the
symptoms that essentially appertain to  the hypochondriac disease;
the morbid state of the brain influencing the abdominal organs in the
latter case, as the morbid state of the abdominal organs influences
the brain in the former.
  The disease shows itself sometimes suddenly, but more generally
by slow and imperceptible degrees.  Among the earliest symptoms
may be mentioned head-aches, frequent attacks of giddiness, sudden
confusion of ideas, a great disposition  to anger, violent agitations
when irritated, and an uncommon sensibility of nerves, whereby the
patient is apt to be carried to as  great excesses from causes of joy
as from those of grief.  There is a desire of doing well,  but the
will is wayward and unsteady, and  produces an inability of firmly
pursuing any laudable exertion or even  purpose, on account of some
painful internal sensation, or the  perversement of the judgment led
astray by false or erroneous ideas which command a firm conviction
in the mind.*  And if the disease occur in a person possessing that
temperament which has been conceived to predispose to it, and  was
by the Greeks denominated melancholic, the external signs become
peculiarly marked and prominent, " the patient," says Hippocrates,
in his book on insanity, " is emaciated,  withered, and hollow-eyed:
and is at the same time troubled with flatulency and acid eructations,
with vertigo and singing  in the ears: gets little sleep, and when he
closes his eyes is distracted with  fearful and interrupted dreams."
  The first variety  most commonly commences with this charac-
ter, and creeps on so gradually that it is for some time mistaken for
a mere attack of hypochondrism or lowness of spirits, till the men-
tal alienation  is at  length decided by the wildness of the  patient's
eyes,  the hurry of his step whenever he walks, his extraordinary
gestures, and the frequent incongruity of his observations and re-
marks.  The first stage of the disease is thus admirably expressed
by Hamlet: " I have of late, but wherefore I know not, lost all my
mirth, foregone all custom of exercise;  and,  indeed, it  goes so
heavily with my disposition, that  this  goodly  frame,  the earth,
seems to me a sterile promontory;  this most excellent canopy, the
air, look you, this brave o'erhanging firmament, this majestical roof
fretted with golden fire, why it appearss no other thing to me than
a foul and pestilent congregation of vapours."
  But while the external world is thus in general falsely recognized
by the perception or  falsely discriminated by the judgment, the
mind is so completely possessed by some particular trains of imagi-
nary ideas that the attention is perpetually turned to them, and the
* Crichton, of Mental Derangement, passim, 
GE. I.—SP. I.]        NERVOUS FUNCTION.                   59

judgment mistakes them for substances;  and,so far as it is sensible
of surrounding objects or scenery, is perpetually blending the vision
with the reality.  It is not that the patient's ideas are incongruous
with themselves  but  with  the world around him;  for the remarks
of the  melancholy  man, when his attention is once correctly fixed,
are for the most part peculiarly shrewd and pointed.   But in the
gloom  that hangs over him, under the variety  we are now contem-
plating, he can rarely be brought into  conversation, seeks for soli-
tude, sits moping in one continued posture from morning to night;
or if he walk at all, seeks for orchards, back-lanes, and the gloomiest
places he can find.  " One of the chief reasons," says Hippocrates
in his  epistle to Philopoemenes, " that induced the citizens of Ab-
dera to  suspect  Democritus of craziness, was that he forsook the
city, and lived in groves and hollow trees, upon a  green bank by a
brook  side, or by a confluence of waters all day and night."
  Sauvages under the variety of melancholia attonita, gives an ex-
treme  case of the present modification, though not from personal
knowledge.  " The patient," says he, " never moves from place to
place nor changes his posture ; if he be seated he never stands up;
if standing he never sits; if lying he never rises.  He never moves
his feet unless they are  pushed aside by a bystander:  but he does
not shun the presence of man, if asked a question he dues  not an-
swer,  and yet  appears  to understand what is said.   He does not
yield to admonition nor pay  any attention  to  objects  of sight or
touch : he seems immersed in profound thought, and totally occupi-
ed by foreign matters.  Yet at times he is more awake: if  food be
put to his mouth  he eats, and if  liquor be presented he drinks."
M  de  Sauvages then adds, that this rare modification of the disease
occurred once to Dr.  James,  physician to the elector of Saxony, in
a man  about thirty years old, who was terrified with  the thought
that the Deity had condemned hitn.  It continued for four  months
during the autumn and winter; but  the patient was  at length restor-
ed to his right understanding.*
  Grief, and particularly for the loss of friends, discontent, severe
disappointment, the dread of some  real or imaginary evil, a violent
and long continued exertion of any of the passions, and deep unin-
terrupted study, have frequently proved accidental causes or acces-
sories  of  this variety of melancholy, where the peculiarity of the
constitution has formed a predisposition, and have  sometimes pro-
duced it even where no such  predisposition can be traced.   In like
manner it has proceeded from immoderate exercise; insolation,or
long exposure to the direct rays of the sun ;  sudden  transitions from
heat to cold ; powerful stimuli applied  to the stomach.
  In the case related by Sauvages the disease appears to have pro-
ceeded from a heated imagination exercised upon false views ot
religion:  and perhaps there is  no cause more common or more
operative,  especially  in timid minds; and more particularly  still
* Nosol. Med. Class VIII, Ord. III. 
b'O
NEUROTICA.
[CL. IV.—OK. i;
 where the conscience is alarmed by a reviewof a long catalogue of
 real delinquencies, and a dread of eternal reprobation.
   The same causes operate in the production of roving or restless
 melancholy, forming the second variety, and exhibiting a modifica-
 tion which often depends obviously upon a difference of idiosyncra-
 sy, though the cause  is not always to be explained, and under the
 operation of which  the patient has a constant desire to change his
 pursuit or his residence.  And hence, while Albert Durer is entitled
 to the approbation he has so long received for his admirable- picture
 of melancholy  under the guise of a pensive female leaning on  her
 arm with fixed looks and neglected dress, Shakspeare has equally
 copied from nature  in his description of the beautiful and interest-
 ing  Ophelia, who, instead of shutting herself up from the world,
 and  seeking silence and solitude, is represented as peculiarly busy
 and  talkative, and unwittingly divulging the fond secret of her dis-
 traction to every one she meets, as well in verse as in prose.  Sad-
 ness is the prevailing colour of the mind ; but it is often as Jaques
 expresses it, "  a most  humorous sadness," blended with sallies of
 pleasantry and  wit, that it is impossible to listen to without smiling,
 notwithstanding the gravity of the occasion.  " Humorous they are,"
 says Burton, (and unhappily for himself no one  knew how  to  de-
 scribe the disease better) " beyond all measure ;  sometimes profuse-
 ly laughing, extraordinarily merry, and then again weeping without
 a cause;  groaning, sighing, pensive and  almost distracted.   Multa
 absurda fingunt et a ratione  aliena ;* they feign many absurdities,
 void off all reason ;  one supposeth himself to be a dog, cock, bear,
 horse, glass, butter.  He is a giant, a dwarf, as strong as an hundred
 men, a lord, duke, prince.  Many of them are immovable and fixed
 in their conceits; others vary upon every object heard or seen.   If
 they see a stage-play, they run upon that  a week after; if they hear
music or see dancing, they have nought but bag-pipes in their brain ;
 if they see a combat they are all for arms; if  abused, the abuse
 troubles them  long  after.  Restless in their thoughts and actions,
 continually meditating,

                      velut aegri somnia, vans
             Pmguntur species:

 more like dreamers ihan men awake, they feign a company of entire
fantastical conceits; they have most frivolous  thoughts impossible to
 be effected; and sometimes think verily that they hear and see pre-
 sent  before their eyes such phantasms or  goblins they fear, suspect
or conceive:  they still talk with and follow them.  " They wake,"
 says Avicenna,  " as others dream.   Though they do talk with you,
 and  seem  to be very intent and busy,  they  are only thinking of a
toy;  and still that toy runs in their mind whatever it be ;  that fear,
 that suspicion, that abuse, that jealousy, that agony, that vexation,
that cross,  that  castle in the air, that crotchet, that whimsie, that
* Frambes. Consult. Lib. 1.17. 
GE. I.—SP. I.]
NERVOUS FUNCTION.
bi
 fiction, that pleasant waking dream.   If it be offensive, especially,
 they cannot forget it; they may not rest or bleep for  it; but still
 tormenting themselves Sisyphi saxum volvunt sibi suis."
   How melancholy a reflexion that  the writer of this  spirited de-
 scription, should have drawn many of its features from himself: and
 that the work from which it is copied, engaged in for the purpose
 of diverting his  thoughts, and replete with genius, learning, and the
 finest humour, should only have exasperated  the disease and urged
 the pitiable patient, as there is  too much reason  to fear, to an un-
 timely end.  " He composed his book," says Mr. Granger, " with
 a view  of  relieving his own melancholy, but  increased it to such a
 degree that nothing could make him laugh but going to the bridge-
 foot, and hearing the ribaldry of the  bargemen, which rarely failed
 to throw him into a violent fit of laughter.  Before he was  over-
 come with this horrid disorder he, in the intervals of his vapours,
 was esteemed one of the most facetious companions in the  univer-
 sity."
   The third variety, in which the alienation assumes a morose or
 mischievous character, is perhaps the most  common  form under
 which the disease  makes its appearance.  Sometimes the patient is
 extrqpiely passionate, and will quarrel furiously with every one alike
 in whatever tone or manner he is addressed, and expresses  himself
 with great violence of language, occasionally with gross unqualified
 abuse, but occasionally also in a style of repartee that was never
 evinced in  a sane state.   More generally,  however, he selects his
 objects of resentment : which are, for the most part, unaccountably
 taken from his nearest relations and kindest friends.  Against these
 he harbours the blackest  suspicion and jealousy, believing that they
 are haunting him to take away his  money or his life, or to put him
 to torture.   He  loads them with every term of the deadliest hatred,
 or scowls at them  with contempt, and denounces them as fools and
 idiots.  Under the distressing influence of this horrid form of the
 disease, the mother abominates her infant family, and the wife her
 husband : the most chaste become lascivious: and lips which have
 hitherto uttered  nothing but the precepts and  the language of piety
 become grossly  profane, and are the vehicles of oaths and impu-
 dence.  The unhappy individuals  are at the same time not only
 sensible of what  they say or do, but occasionally sensible of its being
 wrong, will express their sorrow for it immediately afterwards, and
 say they will not do so again.   But  the waywardness of the will,
and its want of control by the  judgment, urges them forward in
 spite of their desire, and they relapse into the same state almost as
 soon as  they have expressed  their regret.  Mr.  Locke has, with
 great ability pointed out the proper distinction between these two
 faculties of the desire and the will, and has exemplified  it by the
 chastisement with  which an indulgent father frequently finds  him-
 self called upon to visit an offending  child, and which he wills to
perform though  his desire is in the utmost degree reluctant.  The
disease before us is pregnant with examples of the same kind, and 
b'2
NEUROTICA.
[CL. IV.—OR. I.
 strikingly'shows the correctness with which this great master of his
 subject analyzed ihe human mind.
   We have already observed that the peculiar turn or modification
 of the malady depends in general far less upon the immediate  and
 exciting cause, than upon the constitutional temperament, or some
 operative principle which we  cannot always  develop.   And  in
 proof of this it may be observed, that I have drawn the principal
 lineaments of the description just laid down from the case of a lady
 of about sixty years of age, respecting whom I was lately consulted,
 and whose exciting  cause has been, manifestly, suppressed grief
 for the death  of an only  son, and separation from a daughter who
 was the remaining solace of her advancing years, in consequence of
 her  having married a gentleman whose station is in a remote part
 of the globe.  Possessed  by  nature of a  high and commanding
 spirit, and of a  peculiar degree of energy and activity, she  ef-
 fectually succeeded, by  a  violent  internal  struggle, in  subduing
 the pangs that at  first suffocated her; and has for several years
 talked of her daughter and her  daughter's children, for the latter
 has since become a mother, without  emotion.   But with the loss of
 fine  feeling for her daughter, she has lost, at the same time, all fine
 feeling upon other subjects ; and her  judgment has sunk amidst the
 general wreck.  The  love  of her nearest  relations has turned to
 contempt or hatred : the ardour and  animation of her mind, which
 restrain her from taciturnity and retirement, have rendered her for-
 ward and invective ;  rational expostulation has  yielded to  sudden
 and  unmeaning fits of violence and blows, and the voice of piety to
 exclamations that would formerly have shocked her beyond endur-
 ance.  She too is often sensible of  her doing wrong, and in letters
 of great sobriety and excellence, often complains of her own con-
 duct, and the burden she  is become to her friends, but the intervals
 of sanity are only of a few hours' duration, and  with all  her  calm-
 ness she is sure to relapse   For many months she was  entrusted
 in her own house to the control of a  professional female  attendant
 who, with great dexterity, at length succeeded in obtaining a due de-
 gree of authority over her without personal restraint; and under the
regimen of perfect quiet and seclusion from  the world, she seemed
 to be in a fair  way of recovery;  but the mischievous fondness of her
 nearest relations has since removed  this faithful watchwoman, and
 her senses have again been  bartered for her liberty.
   The symptoms most afflictive to the relations of the patient  in
 this  variety of insanity is the tendency to behold them with indiffe-
 rence or  even violent aversion, and  to utter exclamations and em-
 ploy language of the most offensive kind to a serious and a delicate
 ear ; and it is the symptom apparently most  unaccountable to  those
who  have not studied the  disease with much attention.  I have al-
 ready remarked that in insanity the corporeal sensibility is greatly
diminished, but it is not more so than the moral  sensibility; and  as
the moral sensibility disappears, all moral restraint disappears also:
and for the very reason that  the insane man has little feeling  of
cold  or hunger, he has also little feeling of decency or religion.  In 
GE. I.—SP. I.]
NERVOUS FUNCTION.
63
the present variety the worst passions are in a state of excitement,
and the language most freely employed is the language of the pas-
sion that predominates, and  there being no  longer any moral re-
straint, it is employed in its utmost vehemence and coarseness. And
as the fond affections  have given way to the irascible, it should
seem to follow of course that the greater the love or  friendship
formerly the greater the hatred at present.
  There is one consolation, however, though a small one,  that we
may reap from  this distressing  contemplation, and to  which the
friends of the sufferer should  not be indifferent. It is that, with this
blunted sensibility of mind, the patient has no pain from a conscious-
ness of his degraded condition.  And  it  is singular to observe, what
may also  contribute to alleviate  the distress of the sympathising
heart, how completely his unconsciousness prevails even after a pa-
tient's restoration to health, so that few look  back upon  what they
have undergone with the horror  that  would be  expected; while
many, even in the apprehension of a relapse, contemplate it, and
turn their eye to the abode of misery  where they were lately in-
mates without dread.
  The fourth variety or self-complacent melancholy is  perhaps
less frequent than any of the rest; but it occurs occasionally, and is
often accompanied with a high-coloured and ruddy complexion, and
other marks of a sanguineous habit; " Such persons," says Butler,
" are much inclined to laughter, are  witty and merry, conceited in
discourse, pleasant, if they be not far gone, and much given to mu-
sic, dancing, and to be in women's company."  Aristotle gives the
case of an inhabitant of Abydos, who, labouring under this variety
of the disease, would sit for a whole day as if he had been upon a
stage, listening to visionary actors; sometimes acting himself, and
occasionally clapping his hands and laughing as overjoyed with the
performance.*  Such persons have not  unfrequently thought them-
selves called upon to undertake some desperate adventure, and are
exquisitely elated with  the new and  lofty character they are about
to embrace.
  These stimulant feelings are not unfrequently connected  with er-
roneous ideas of religion, and excite in  the mind of the patient  a
belief that he is supernaturally  endowed with a power of working
miracles, or undergoing the severest mortifications  without injury.
The German  Psychological  Magazine is full of examples of this
kind; and among others relates the case of a gens d'arme of Berlin,
whose name was Gragert, of  a harmless and  quiet disposition, but
rather of a superstitious turn  of mind.   From poverty, family mis-
fortunes, and severe military  discipline, he brought on a series of
sleepless nights, and a mental disquietude that, according to his own
report, nothing could  dissipate  but a perusal of pious books.  In
reading the Bible he was struck with the book of Daniel, and  so
much  pleased with it  that it became  his favourite study: and
*Lib. deReb.mir, 
l>4
NEUROTICA.
[CL. IV.—OR. 1.
from this time the idea of miracles so strongly possessed his imagi-
nation that he began to believe he could perform some himself. He
was persuaded more especially that if he were to plant an apple-
tree with a view of its becoming a cherry-tree, such was his power
that it would bear cherries. He was discharged from the king's ser-
vice and sent to the workhouse where he conducted himself calmly,
orderly and industriously for two years, never doing any thing that
betrayed insanity.   At which time Dr. Pike examined him, that he
might be discharged and sent to  his family.   He answered every
question correctly, except when  the subject concerned miracles : in
regard to which he retained his old notions; adding however,at the
same time, that, if  he found  upon trial  after he was at home that
the event did not correspond with his expectation, he would readily
relinquish the thought and believe he had been mistaken; and con-
fessed thai he had already removed one error  in  his mind in this
way; for there was an old woman whom he had at one time con-
sidered as a witch, but  whom he afterwards discovered upon trial
to be no such thing.
  Upon the medical treatment of diseases of this kind we  shall not
have to say much ; but as the plan chiefly advisable for the pre-
sent species is equally advisable for the ensuing, it will  be most
expedient to reserve the discussion of it till  the latter  has  beew
described in its order.
                       SPECIES II


                 ECPHRONIA MANIA



THE DISCREPANCY  BETWEEN THE PERCEPTION AND THE JUDGMENT
  GENERAL; GREAT EXCITEMENT OF THE MENTAL, SOMETIMES OI
  THE CORPOREAL POWERS.

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

    a, Ferox.              Furious and violent madness.
    0 Exultans.           Gay and elevated madness.
    y Despondens.        Gloomy, despondent madness.
    ^ Demens.           Chaotic madness.

  The exciting causes, like the predisposing, are chiefly those al-
ready enumerated under melancholy ecphronia, as sudden and vio- 
GE. I.—SP. II.]
NERVOUS FUNCTION.
65
lent mental emotion; bad passions indulged habitually; false views
of religion, especially the dread of reprobation and eternal punish-
ment; sudden  reverses of fortune, whether  from bad to good,  or
from  good to bad; preying anxiety,  or  lurking discontent; deep
protracted study, unrelieved from week to week by an interchange
of exercise or society, and breaking in upon the hours of sleep; un-
kindly child-bed; a suppression of various periodical evacuations;
and sometimes even a virtuous restraint of sexual orgasm in a vigo-
rous constitution,  without  taking purgative  or other means to  re-
duce the irritative entony.
  Of these one of the most frequent causes is that of child-bed, and
recovery from  child-bed, though  it is not always easy to  develop
the immediate  mode by which this change in the constitution acts
upon the brain : for it has occurred not only  where there has been
some organic affection from puerperal fever, a sudden cessation of
the lochia, or a sudden relinquishment of nursing, but where the re-
covery has been unattended with a single unfavourable symptom,
and the  mother has already persevered  in  the  office of a nurse.
It shows us,  however, very sufficiently, how strong is the chain of
sympathy between the brain and many remote organs of the body,
and especially those subservient to the function of generation.
  M. Esquirol, not long ago, communicated  a paper to the Societe
de Medicine  upon this important subject, enriched with the results
of the Hospital de Salpetriere, for the years 1811, 12, 13, and  14.
During these four years, eleven hundred and nineteen women were
admitted labouring under mental derangement:  of whom ninety-
two (nearly an  eleventh part of the whole) had become deranged
after delivery, during or immediately subsequent to the period of
suckling.  In the higher ranks of society the proportion of puerpe-
ral maniacs he calculates to be not less than a seventh of the whole.
Of the above  92 cases,  16 occurred from the first to the fourth day
after delivery: 21 from the fifth to the fifteenth:  17 from  the six-
teenth to the sixtieth day;  19  from the sixtieth to  the the twelfth
month of suckling; and in 19  cases it appeared after voluntary  or
forced  weaning.
  Of the above 92 cases 8 were idiotic, 35 melancholic, and, 49 ma-
niacal.  The respective  ages  were as follows; 22 from 20 to 25
years: 41 from 25 to 30 years  ; and  12 above 30.  Fifty-six out of
the ninety-two were entirely cured, and thirty-eight of these within
the first six months.  Fright was the most frequent cause.*
  I have said that a virtuously  restrained orgasm in a full habit, and
where  no steps have been taken to reduce the entonic vigour, has
occasionally   induced mania.   There  is a curious instance of the
powerful effect of such a state  related by Kemnesius in his History
of the Council of Trent, which though it did  not terminate in mad-
ness proved quite as fatal.   In  the year 1419, Rossa, nephew to the
King of Portugal, and Archbishop elect, of Lisbon, was taken seri-
      • Quarterly Journal of Foreign Medicine, No. I. p. 98.
vol. in.—9 
66                       NEUROTICA.           [CL.IY.—OR. i

ously ill at Florence.  His physicians told him that his disease pro-
ceeded from an excessive irritation of the  genital organs, and that
he would certainly die unless he committed fornication or married.
With a courage worthy of a happier issue, he  resolved on death,
and met it without breaking his vow of celibacy.*
  The following instance, however, will prove that mania itself is
sometimes a consequence of the same firmness of mind.  A clergy-
man of exemplary character, and one of the  most distinguished
preachers I have the pleasure of being acquainted with, was many
years ago very unexpectedly attacked with a paroxysm of mania,
the cause of which it seemed impossible to unfold.  He recovered
in about six months, and returned to a regular and punctilious dis-
charge of clerical duty.  He is a man of exquisite taste, warm ima-
gination, exalted and highly cultivated mind.  With these qualifica-
tions, in less than a  year after his recovery, he married his maid
servant, and  the world imagined he was gone or  going out of his
senses a second time. A confidential statement of his situation soon
proved  to myself that nothing could be more  prudent or  praise-
worthy than the step he had thus taken, and which had excited so
much astonishment among his friends.  He was  fully convinced, he
said though he had  never  communicated  it to  any one, that  the
cause of bis unfortunate malady was a genital irritation, exciting to
a constant desire of matrimony, which he was not in a situation to
comply with, and which compelled him to exercise from day to  day
a severe restraint upon his feelings.  On being  fully restored to
health,  he found the same morbid propensity beginning to  return.
I felt, said  he, it would  again drive me mad if I did not relieve it,
and my principles forbade me to think for a moment of relieving it
immorally.  To what respectable family could I now offer myself,
having so lately been discharged from private confinement ?  The
servant who  lived with me was a  very excellent young woman 2
her disposition was amiable, her mind  well capable of cultivation,
and her form and manners by no means unpleasing: and hence, after
jnature deliberation, I determined upon marrying  her if she herself
would venture upon so perilous a risk.  He married her accordingly;
—has  ever since, for upwards of twenty years, enjoyed an almost
uninterrupted share of  health,  and has been more than ordinarily
happy in his family.  Other examples of a like kind are to be found
in Paullini,t  Martini,^ and Vogel;§ but it  is unnecessary to copy
them.   And hence castration has been often advised, and submitted
to, and occasionally with success.
  It is from a like sympathy of action between the brain and other
parts of the body,  that we meet  with instances of the one or  the
other species of disease  before us, produced occasionally, and, per-
* Kemnis. Concil. Trident. Part III.  De Ccelibatu sacerdotum.
f Cent. III. Obs. 14.
X Observazioni, ch. II. 10.
$ Beobachtungen, p. 9. 
GE. I.—SP. II.]       NERVOUS FUNCTION.
67
 haps, in habits of great sensibility, by suppressed irritations of much
 smaller moment, as  those of herpes, scabies, tinea;* a suppressed
 hemorrhoidal flux;t suppressed perspiration; suppressed plica^ or
 an ulcer of long standing suddenly dried up.§
   Furious mania, constituting the first variety, sometimes makes its
 attack very abruptly, and commences with the patient's being sen-
 sible of some indescribable movement in his head, which excites
 him to loud and sudden shrieks, at the same  time that he runs up
 and  down the room,  and  mutters something to himself that is alto-
 gether unintelligible: though the symptoms even in this abrupt and
 violent attack admit  of much diversity.
   More commonly,  however, the disease is the work of time, and
 its growth is thus  admirably described by Dr. Monro in his reply to
 Dr.  Battie.  " High spirits, as they are generally termed, are the
 first symptoms of  this kind of disorder.  These excite a man to
 take a larger quantity of wine than usual,  and the person thus
 afflicted, from being abstemious, reserved, and modest, shall become
 quite the contrary, drink freely,  talk boldly, obscenely, swear, sit
 up till midnight; sleep little, rise suddenly from bed, go out a hunt-
 ing, return again immediately, set all  his servants  to work, and
 employ five times the number that is necessary.  In short, every
 thing he says or does, betrays the most violent agitation of mind,
 which it is not in his own power to correct.  And yet, in the midst
 of all this hurry, he will not misplace one word or give the least
 reason for any one to think he imagines things to exist that really
 do not, or that they appear to him different  from what they do to
other people.  They who see him but seldom admire his vivacity,
are pleased with his  sallies of wit and the sagacity of his remarks ;
nay, his own family are  with difficulty persuaded to take proper
 care of him, till it becomes absolutely necessary from the apparent
ruin of his health and fortune."
  This picture is drawn  from a rank of life something above that
of mediocrity, but its general features of ebullient spirits, and hurry
and  bustle, and  " much  ado about nothing," will apply to every
rank.  Such a person,  says  Sir A. Crichton, in allusion to the pre-
sent description, cannot be said as yet to be delirious, but that event
soon follows, and he has then the symptoms common to the disease,
symptoms which only differ from a difference in the train of thoughts
which are  represented in his mind.  He  begins to  rave and talk
wildly, and incoherently: swears as if in the most violent rage, and
» Art. Nat. Cur. Vol. VIII. Obs. 28.
  Descottes, Journ. de Med. T. LXVI.
  Petit, Traite Oeuvre posthume. T. III.
f Sanctacrux, De Melancholia, p. 29.
  Lentilius, Miscell. I. p. 36.
t Hoffman, Beschreibung der Weichselzopfes, &e
  Eph. Nat. Cur. Cent. I. II. Obs. 35.
§ Forestus, Lib. X. Obs. 24. 
b'S
NEUROTICA.
[CL. IV.—OR. I.
then immediately afterwards bursts into fits of laughter, talks ob-
scenely, directs offensive and  contemptuous language against his
relations and those around him ; spits at them ; destroys every thing
that comes in his way; emits loud and discordant screams, and con-
tinues  this conduct till  he is quite exhausted.  The state of rest
which follows is generally short and sleepless; the patient is obsti-
nate; he will not speak a word ; and clenches his teeth if any tl'ing
be offered  him to swallow; or else cunningly pretends to drink a
little, but immediately squirts  it out on the person who offers it.
Instantly he again breaks out into all the wild and extravagant lan-
guage and actions he committed before.  If kept in strict coercion
he has often so much command over himself as to behave mildly
and modestly; and were it not for the  general expression of his
countenance, and  the peculiar glistening appearance and  rapid
movement of his eyes, he might impose on many of the by-stand-
ers,  and make  them imagine that the  phrenzy was  over.   The
length  of the paroxysm and of the  interval varies greatly in differ-
ent individuals.   But, generally speaking,  the more violent the fit
the sooner it ceases from  exhaustion ; and hence sometimes it ceases
in a day or two, and sometimes runs on to a month or  even more:
returning at the distance of a  few weeks  or at certain periods  of
the year.
  In the second variety, or elevated madness, the passions, and
especially the irascible ones, are  less busy, and the imagination is
chiefly predominant,  and at work  without ceasing.  It is here we
most frequently trace something of the ruling pursuit of their former
lives, so that the covetous man is still conversant about purchasing
lands and tenements, and amuses himself with perpetually augment-
ing his possessions :  while the devotional character is  for ever en-
gaged in a routine  of prayers, fastings and ceremonies, visions and
revelations, and fancies himself to-be inspired and lifted into heaven.
The phantoms are all of a pleasurable kind, and mostly such as afford
the deluded sufferer a vast opinion of his own rank or talents. Dona-
tus gives the case of a lady at Mantua, who conceited she was mar-
ried to a king, and would kneel  down and affect to converse with
him as if he were present with his  attendants; and if she found by
chance a piece of glass in the  street she would hug it as a jewel
sent her from her royal lord and husband.* He relates another case
from Seneca of Senecio, a madman of  considerable wealth,  who
thought himself and  every thing about him  great; that  he had a
great wife and great horses, and could not endure little things of
any kind ; so that he would be served with great pots to drink out
of; great hosen, and great shoes bigger than his feet: " Like  her,"
says Burton, " in Trallian,  that supposed she could shake all the
world with her finger, and was afraid  to clench her hand lest she
should crush the world to pieces like an apple."t
* De Hist. Med. Mirab. Lib. II. Cap. I.
f Anat. of Melancholy. Part I. Sect. 3. 
GE. I.—SP. II.]       NERVOUS FUNCTION.
69
  Yet even here the train of thoughts or ideas which occupies the
mind of the maniac in many instances throw no light whatever on
the nature or origin of the complaint;  and we can still less  avail
ourselves of them than in various cases of melancholy.
  This is particularly observable in the third variety or despondent
madness;  for though this modification of the disease may occasion-
ally be produced by suspicion, terror, or a guilty conscience, it is
far more frequently the result of a melancholic idiosyncrasy, or a
debilitated state of the constitution at the time of the attack, in con-
sequence of which the sensorial fluid is secreted perhaps even less
freely instead of more so than in a condition of health: so that the
patient sinks by degrees into a state of insensibility; unless he should
be roused with false courage and find means to  put  an end to his
existence before this period arrives.
  In dementia  or chaotic madness this state of sensorial exhaustion
and consequent insensibility is still more obvious, though there is,
perhaps, less constitutional tendency to the depressing passions. The
judgment is here more  diseased and weakened than in any  other
form, and none of the kindred faculties assuming a paramount pow-
er,  there is a general anarchy and  confusion  in the ideas that flit
over the sensory  without connexion or association of any kind. And
hence Pinel has admirably  characterised it, as consisting in a " ra-
pid succession  or uninterrupted alternation of insulated ideas and
evanescent and unconnected emotions ; continually repeated acts of
extravagance;  complete forgetfulness of every previous state; di-
minished sensibility to external impressions; abolition of the facul-
ty of judgment; perpetual  activity without object or design, or any
internal sense of its taking  place."*
  These maniacs are often ungovernable except by means of coer-
cion, but they  are  more easily restrained than those who are in  a
state of phrenzy.   They are intractible, and neither listen  to in-
treaty or to menaces.  Fear  or corporal  punishment, however,
makes them obey.   They  willingly avoid the light, burying them-
selves under the bed-clothes, or under the  straw of their  cells.
They  are totally regardless of decency and  cleanliness, and from
some strange motive  are often found smearing themselves over with
their excrement.  For the most part they have little  appetite, and
refuse the food offered them ;  yet a sense of hunger seems some-
times to return with great  keenness when they will greedily devour
their feces.  Of  the nature of the ideas that take place in the sen-
sory, and are  expressed by an  unintelligible muttering, we  know
nothing further  than  that, from the screams and howlings  with
which their jargon is accompanied, there can be no doubt that they
are often excited by painful sensations of body or mind.
   It is happy for those who suffer under this as  well as under the
preceding form, that they rarely sustain a long conflict; the exhaus-
tion of sensorial  power  by repeated paroxysms soon leading to  a
* De 1'Alienation Mentale, Chap. III. iii. § 176 
70
NEUROTICA.
[CL. IV.—OR. i
 total  torpitude, and consequently a death of the sensorial organ;
 though there are instances in which  a  paroxysm of more violence
 than usual has  produced a favourable change, and suddenly restored
 the patient to his senses.
   In gloomy madness, in which there is often a chronic affection of
 some of the abdominal organs co-operating with a diseased condition
 of the brain, we find least  to justify hope; the  patients  generally
 become weakened by fresh  paroxysms,  and often sink into a state of
 idiotism.
   The first variety, on the contrary, if  the constitution have not
 been  seriously broken down by  intemperance, or the patient be not
 suddenly carried off by the  violence of" the attack on its commence-
 ment, will often work its  own cure by its  own ardour; and will
 gradually soften  into a soberer state from  mere mental fatigue.
 While in the milder and more pleasurable modification of the second
 variety, in which the  secretion of  sensorial  power is  upon the
 whole perhaps less than in  a condition of sanity (since, though the
 stimulus of the disease may tend to increase it a little, the total pri-
 vation which the patient enjoys of all the vexations, and anxieties,
 and wearing vicissitudes of real life, reduce it to a moderated and
 even tenour it could not otherwise possess,) nothing is more com-
 mon than for maniacs to continue to a very advanced age.  I am at
 this moment interested  in the case of a  clergyman who has reached
 his ninety-sixth year, and has been in a state of quiet insanity for
 more than half a century.
  For the  most part those are most easily as well as  most rapidly
 cured, whose insanity,  of whatever kind  it  be, has been produced
 by accidental causes, as intoxication, sudden transition from cold to
 heat,  retention  of habitual  discharges,  or a revulsion by a transfer
 of morbid action from  other organs.   And  hence the  comparative
 facility with which a cure is effected in insanity after child-birth.
 Whilst, on the contrary, those are least likely to obtain a permanent
 recovery who possess an hereditary taint: the  disease may indeed
 leave  them for a time, but the predisposition remaining, they com-
monly fall victims to fresh  attacks  after intervals of a year or two,
 or even a few months.
  " Mania and melancholy," says Dr.  Greding, writing while he was
 physician to the workhouse at Waldheim, " have continued half a
 year with some, and remained forty years and upwards with others,
 among whom one patient only in this workhouse attained the age
 of eighty-five."*
  The chance  of recovery is considerably  greater upon the first
 than upon any subsequent attack, and especially if the disease have
 not exceeded three months' duration when the patient is first put
 under medical treatment.   If it  have, at this time, lasted a twelve-
 month, the prospect of success is diminished by half:  if two years,
 not above a fourth  part as many recover;  and  if more  than two
* Vermicide Schriften ut supra, &c. 
GE. I.—SP. II.]
NERVOUS FUNCTION.
71
years the expectation is small, though where the second year is not
much exceeded, a cure is by no means to be despaired of.
  The treatment of ecphronia has generally been} discussed under
the two heads of medical and moral.  Both have undergone a very
great improvement within the last twenty or thirty years; the first
by  being  considerably simplified, the second by being more tho-
roughly studied and raised to a higher degree of importance.
  Nothing can be more injudicious than the ordinary routine of
medical treatment, which, till within a few years, was equally em-
ployed in almost all the larger  lunatic establishments in our own
country and  on the continent, especially at Bethlem, the Hospice
d'Humanite, and the Hotel Dieu ; and which consisted in a course
of venesections, emetics and purgatives administered in every case
indiscriminately, and often, indeed, without even the  personal in-
spection of the consulting physician or other superintending medi-
cal  officer; and if to these means of cure we add the occasional use
of bathing in  various forms and various temperatures, we shall very
nearly  have exhausted the merely medical process that till of late
was ordinarily  had  recourse to.  It is  satisfactory, however, to
know,  that a more judicious and discriminative practice has in all
these asylums been  introduced since  the above period, and that it
has been followed by an abundant success.
  Admitting  the proximate cause of insanity to be in most cases an
increased action of the vessels secreting the nervous  fluid, venesec-
tion and cathartics and a general reducent regimen seem indicated
as an ordinary mean of relief; and is unquestionably called for when
the pulse is full and strong, and the temperament is sanguineous :
and the success which has so frequently accompanied this practice
stamps it  with  the highest sanction  it can receive.   But there is
great reason  to  believe that even were the demand for  blood-let-
ting is unequivocal, it has been carried to a mischievous extent, and
ruined its own benefit.   Thus Plater made a point of  repeating it
once a week, and tells us that he has sometimes had recourse to it
for  seventy weeks running.*
  Much caution, however,  is necessary even in the first trial:  for
as a sound  intellect depends apparently upon a certain degree of
excitement in the sensorial  vessels, and a certain quantity of the
fluid secreted, derangement may take place also, as  we have alrea-
dy observed,  from diminished instead of from increased action, and
diminished instead of increased secretion.  And such we have rea-
son to believe is the course of delirium whenever it  occurs in pro-
fuse hemorrhage,  and in typhous fevers; and it is obvious that in
all such instances a reducent plan must necessarily tend to augment
instead of to carry off the disease.  And hence the patient's general
habit and temperament, the nature of the exciting cause, the proba-
bility of visceral congestion, the violence or mildness of the mania-
cal  symptoms, the progress they have made, and the length of time
• Observ. Lib. I. p. 86. 
 72                       NEUROTICA.           [CL. IV.—OR. I.

 he has laboured under them, are all to be taken into  consideration
 before we can determine upon the expediency of bleeding even at
 first.  And if, when we  have decided upon its propriety, no benefit
 be produced from a second or a third  repetition, we  have no en-
 couragement to proceed further, and should  withhold the lancet
 altogether.
   To a series  of purgative medicines there is less objection, pro-
 vided they are not rendered too violent.   The abdominal viscera,
 it has already appeared, form in many instances an important link in
 the morbid chain of action, and are sometimes the primary cause of the
 disease:  and it hence is of great moment that they should be effectu-
 ally cleared of viscid or acrimonious matter that may irritate or clog
 them up.  But, beyond this, by keeping up such an increased ac-
 tion in the abdominal  region as the organs may bear  without debi-
 lity,  we may diminish or change the morbid action in the head by
 remote sympathy, or entirely withdraw it  by a revulsion.   A spon-
 taneous diarrhoea has  been known in various cases  to carry off the
 disease as by a charm : and the use of this class of medicines is the
 more necessary, as the bowels of maniacal patients are apt to be ex-
 tremely costive.  If the black  hellebore of the ancients, which ap-
 pears to have been a different plant from that of the modern dispen-
 satories, were ever entitled to half the  antimaniacal virtues ascribed
 to it, it was most probably upon the obvious ground of its being a
 purgative attenuant and  deobstruent.
  Dr. Dubuisson  has lately revived  the use of the modern black
 hellebore in various species of mental  alienation, as chronic mania,
melancholy  and hypochondrism : in  all  which  he speaks  of  its
 effects, after an extensive trial,  as highly successful.  He has given
 it also in every form, as that of powder,  decoction, watery extract
 and  tincture;  but prefers  the extract as least  irritating.*  His
 opinion, however, is not supported by  the  result  of general prac-
tice, and  appears to  be by far too sweeping and indiscriminate.
 Spleissius, nevertheless, affirms that in   his hands, when  given
 freely, it proved sedative and produced sleep.f
  Upon no other description of medicines  can we place any rational
 dependence.  Emetics, narcotics, and other sedatives, and antispas-
 modics have been tried for ages in every form  and  in every pro-
 portion;  sometimes  alone,  and sometimes in  conjunction  with
 blisters and the warm or co:d bath.  There are instances in which
 they have all appeared to produce some benefit, but the far greater
 number in which they  have  failed prevents us from placing any
 reliance upon them.
  Of the  narcotics the  chief  that have  been had recourse to are
 opium, aconite, bella donna, and the stramonium.  Far more mis-
 chief than good seems to have  followed from the use of all of them,
 with the exception of the  first, which would probably be found a
* Des Vesanies on Maladies Mentales.  Paris. 1816.
\ Annotat in Zapat. Mirabil. p. 136, 
GE. I.—SP. n.]         NERVOUS FUNCTION.
73
remedy of high value if  we could duly discriminate the proper
states or modifications of the disease  for its use.   Dr. Cullen's
experience of it in mania he admits to be small, but he has correctly
estimated its general effects in telling us, that in some cases he found
it  useful in moderating the violence of the disease, but that in
others he found it manifestly hurtful.  A monographist upon this
malady could not, perhaps, be engaged  more usefully than in turn-
ing his attention to the peculiarities which produce this difference.
On the continent it has also been given sometimes alone, but  more
usually in conjuncture with nitre or camphor or  both ;  but in all
these forms also with variable success.*
  Upon what ground St. John's wort was ever advanced to the rank
of a powerful sedative I know not; but, in this class, it at one time
took the lead and held it for ages.  Its  antispasmodic powers were
regarded of so high a character as equally to put to flight hysterics,
hypochondrism  and  madness of  every kind, and especially that
which was  formerly described under the name  of daemonomania,t
whence, indeed, its technical name of hyfiericum orfuga daemonum
under which  it was also celebrated.   It occupied  a place in a  late
edition of the pharmacopoeia of the London College, and was atone
time noticed  as an antispasmodic even  by Dr. Cullen, who rejected
it  however, most deservedly, in his maturer courses of lectures.
Its only sensible qualities  are those of  a slight resinous bitter, not
worth the trouble of extracting.
   Camphor is a  sedative far better entitled to attention, and appears
to have been tried with  more extensive  success than  any  other
medicine of the same tribe.  It has been given alone and in  union
with  other sedatives, chiefly with opium, nitre  and the mineral
acids, none of which  however seem to have improved its powers.
Berger, Fischer, and Herz, speak favourably of its effects abroad ;
and in our own country  it has  had  equal  commendations from
physicians of distinguished talents. Dr. Mead thought highly of it:
Sir Clifton Wintringham  tells  us that he found it, given to the
amount of half a drachm in the evening, diminish the phrenzy,
procure sleep, and produce perspiration.   Unfortunately, however,
here, as in the case of opium, we have so many proofs of its utter
inefficacy, as to  render us  at present incapable  of placing any de-
pendence upon it in any quantity or with any auxiliary. Dr. Cullen
had a patient who began with five grains for the night's dose,  and
advanced it gradually to thirty without any benefit, though without
any increase  of  the pulse.  At this time it was  carried by accident
to forty grains, which  produced syncope  and nearly proved fatal.
The patient, however, recovered from the accidental symptoms, but
unhapily no impression was made on the constitutional disease.]
   * Friborg. Coll. Soc. Med. Hafn. II. p. 176.
   f Abrah. Mayer, Archiv. der Practischen Arsneykunde
   * Mat. Med. Vol. II. p. 294.
VOL. ill.—10 
74
NEUROTICA.
[CL. IV.—OR. 1
  The warm and cold bath have also had their votaries, but no cer-
tain benefit appears to have been derived from either. The last may
be useful as a tonic in a state of convalescence, but has rarely pro-
duced real  benefit during the progress of the disease. Weber, how-
ever, thought it useful, and published several cases to this effect *
  From an idea that the disease consists in an undue determination
to the head, or an  undue  excitement of the vessels secreting the
nervous fluid,  Wendtf surrounded the head  with cataplasms of
pounded ice in the form of a night-cap;  and Daniel, with a still
more ingenious spirit of adventure, applied cataplasms of the same
kind to the same organ, while the body, with a view of encouraging
a revulsion more effectually, was plunged into a warm-bath.   The
process will be found described in his Beytragc zur medicinischen
Gelehrsamkeit, published in quarto at Halle in  1749.   And  I men-
tion the fact  as an act of justice  to the author, since the same
process has of late years been revived in our own country as a new
discovery.   Daniel  thought it  highly beneficial; and by its recent
revivers it  was at  one time  held up as a specific : but whatever
success may in a few rare instances have attended it, the practice
has not been able to work itself into public  favour: and a sober
attention to its effects does not seem to justify its further continuance.
  After all we  have chiefly to depend on moral treatment.  Firm-
ness on the part of the attendant  with conciliatory manners, has
done wonders ; but  a sense of authority must be maintained, though
occasional severity should be necessary for this purpose :  yet it will
rarely be needful to exceed  the coercion  of the  strait  waistcoat.
It is needless to add that the diet should be of the simplest kind, that
every thing which  can tend to produce excitement should be pro-
hibited, and that in public institutions, the patients should be divided
into proper classes.  Amusements  of every kind that may engage
the attention and encourage exercise in the open air, without rousing
the passions or producing fatigue, should  be promoted by  every
contrivance that can be thought of.  And if the turn or previous
occupation of the patient point to any particular pursuit, and espe-
cially to handicraft  trades and those that employ the mind without
exhausting it, as that of sawing, gardening, book-binding, or watch-
making, he should be enabled to  pursue it according to his own
desire. The desire  itself is a favourable symptom, and has often led
to the most beneficial results.
  Judicious conversation  and cheering  advice  are also of  great
importance; and regular daily attendance on religious services in
the bosom of a private  family, or  with a few patients of a like
standard in a public institution, may be allowed, where the disease
has assumed a convalescent  form, and the  service is performed
  * Observ. Med. Fascic. I. p. 26.  See also Act.  Med. Berol. Dec. I. Vol.
VII. p. 61.
  f Nachricht, Von dem Klinischen institut. zu Enlangen. 1783. 8vo. 
  CJE. I.—SP. II.]         NERVOUS FUNCTION.                  ?5

  sobedy and dispassionately.  This will at first, perhaps, be only of
  use as promoting * habit ot moral order and  quietism; but every
  $TZ™ W1   \  JSl lhC h°pe  lhat lt m^ Awards introduce
  Y« ,h, T     h,ShCr blebSlnSof sPiri'^ Peace and consolation.
  naiien, h»   P' """i "^ ^ bCgUn t0° S°°n' and in no Case lil1 the
  K-anou iht?  W^  H°l °nly a SPiHt  °f ^ordination but of
  auemn  Ivn,'    rC lh" pen°d nolhiu« Can be  so abs»rd «» to
  can on.v   IhT   in"rUCUon °f any klnd : *"« the subject of religion
  of whiih rf  ad<lreSSed to the reason °r «o the passions : the former
  of  »h■ k  ?S.n0t CX1St ln a State lo  be ^fenced, and the latter
  ol  which, ,t they  could be influenced at all, would only add to the
  !L7 ^T'    lncrease ^* disease.  The clear duty of the priest
  ana ne physician is  in this case one and the same: it istobrimrthe
  mind home to the world around it: to draw it down and fix it upon
  imngs 01 time and sense, instead of rousing it to things invisible and
  eternal: to enable it  to behold God in the materialities of his works
  instead ot urging  lt to a contemplation of him  in  the spiritualities
  01 nis word,   lo instigate a madman to an abstract and  elevated
  communion  with his Creator, who is incapable of holding an inter-
  course upon ordinary topics with his  fellow-creature, is to cure  a
 irozen limb by pouring boiling  water upon it, or to teach the optics
 ot Mewton in a  nursery.
   In many cases the cure mainly depends  upon withdrawing the
 patient s mind as  much as possible from  every former scene and
 every former companion,  in setting before him a new  world, and
 giving an  entire  change  to  the  current of his  recollections and
 ideas.  1 here are particular cases, however, and perhaps particular
 periods of the disease, if we could  accurately hit upon them,  in
 which the  sudden admission of a well known friend or relation, and
 a sudden recall of the mind to its former images and habits, tend  to
 produce a most salutary  excitement, and disperse the maniacal
 cloud like a dream.   Dr. Gooch has given an interesting illustration
 of this remark, in  the case of a  lady, twenty-eight years of  age,  of
 good  constitution but susceptible mind,  who  fell  into a  state  of
 melancholy, in the ordinary sense of ihe term, a few months after a
 second child-birth, and at length became furious.  " She was now,"
 says he, "put under  the  care of  an experienced attendant, sepa-
 rated entirely from her  husband, children, and friends ;  placed in a
 neat cottage surrounded by  agreeable country (it was the finest
 season of the year) and visitid  regularly  by her physician.  For
 several weeks she  manifested no improvement;  sometimes she was
 occupied with one notion, sometimes with another; but they were
 always of the most gloomy description : at length it became her firm
 belief that she was  to  be executed for her crimes in the most  public
and disgraceful way;  every noise she heard was that of the  work-
men erecting the  scaffold; every  carriage, the officers of justice
assembling at  the  execution; but what affected her most  deeply
was that her infamy had occasioned the disgrace and death  of her
children and husband  and that his spirit haunted her.  As soon as 
76
NEUROTICA.
[CL. IV.—OH. I.
the evening closed, she would station herself at a window at the
back of the cottage, and fix her eyes on a white post that could be
seen through the dusk ; this was the ghost of her husband ; day and
night he  was whistling in her ears.  Several weeks passed in  this
way;  the daily  reports varied,  but  announced nothing happy;
at  length  her  husband became impatient and  begged  to  have
an  interview  with her,  thinking that the best way  to convince
her he was not dead was to show himself.   This was objected to;
he was told the general fact that patients are more likely tov recover
when  completely separated from their friends;  that if she saw him
she would say it was not himself but his ghost.   But the husband
was obstinate and an interview was consented to.  When he arrived
at the cottage he was told that she had had a tolerable night, was
rather more  tranquil,  but that  there  was  no  abatement of her
gloomy notions.  " As soon as I entered the drawing-room, where
she usually spent the day, (I copy his own statement which I  have
now before me and which he wrote  down at the time of the occur-
rence) she ran into a corner, hid her face  in a  handkerchief,  then
turned round, looked me in the face, one moment appearing delight-
ed at the thought that  I was alive, but immediately  afterwards
assuming a hideous expression of countenance, and screaming out
that I was  dead and come to  haunt her.   This was exactly  what
Dr.---- had anticipated, and for some minutes I thought all  was
lost.   Finding that persuasions and  argument  only irritated and
confirmed her in her belief, I desisted, and tried to draw off her
attention  to other subjects ; it was some time since she  had either
seen me  or her children; I  put her  arm under mine, took her
into the garden, and began to  relate what had occurred to me and
them  since we parted; this excited her attention, she soon became
interested,  and I entered with the utmost minuteness and  circum-
stantiality into the affairs of the nursery, her home, and her friends.
I now felt that I was gaining ground, and  when I thought I  had
complete possession of her mind, I ventured to ask her in a joking
manner,  whether I was not  very  communicative for  a  ghost;
she laughed;  I immediately drew her from the  subject,  and again
engaged  her  attention with  her children and  friends.  The plan
succeeded beyond my  hope;  I dined, spent the evening with  her,
and left her at night perfectly herself again."   He went the next
morning in a  state of intense anxiety to know whether his success
had been permanent;  but her appearance at the window with a
cheerful countenance soon relieved  his apprehensions.  While he
was there Dr.----• came in;  he  went up stairs without knowing
the effect of  the interview, and came down, saying, " it looks  like
magic 1"  With a view of confirming her recovery, she was ordered
to the sea-side to bathe.  As soon as the clay of her departure was
fixed, she began to droop again, the evening before it she was  very
low, and on  the morning of her sitting  off was as bad  as  ever.
This  state continued  for several  weeks,  in spite of sea air  and
bathing, and ceased as  suddenly as it had done before, apparently in 
GE. I.—SP. II]
NERVOUS FUNCTION.
n
consequence of interviews with friends, calculated  to remove the
apprehensions by which her mind was haunted. She  has since then
continued perfectly well,  and has  had another child without the
slightest threatening of her former malady."*
  This was a bold venture, and the physician must be of a temper
more than ordinarily sanguine who would predict  a like  success
upon every similar attempt.  Yet we have already had occasion  to
observe, that puerperal insanity is more easily recovered from than
most other forms of the disease.
                        GENUS II.


                    EMPATHEMA.

                  SXngofocruatolc Haatfoti.

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

 The term empathema is derived from the Greek -xahyM, " passio,"
 "affectio," whence tfvxafa, "cui insunt affectus seu perturbationes;
 affectu percitus vel commotus."
  We have already had occasion to  observe that the various facul-
 ties of the mind are just as liable to  be separately diseased as those
 of the body : for as  the faculty of digestion may be impaired while
 that of respiration or secretion  remains in perfect health, so  may
the perception or the judgment be  injured while the memory or
the imagination continues in  its former activity.   It is the same
with the pathetic faculties.   These I have stated are to the mental
part of the human frame what feelings properly so called are to the
corporeal; and hence both may be excited pleasurably or painfully ;
they may be in morbid  excess or in  morbid  diminution : and their
influence may equally vary according to the peculiarity of the pas-
sion or the sense affected.   Each will therefore furnish a distinct
division of diseases  : the first constitutes the genus before us; the
second will be found in the ensuing  order.
  The present genus, however, has  never hitherto been properly
arranged or digested.  Pinel is constantly describing the species
that belong to it in his  general  remarks and illustrative cases, but
allots no place to it in his nosological arrangement, with the excep-
tion of the third species, which, as I have already observed, he has
irregularly ranked as a subdivision  of mania, under the name of
* Med. Trans. Vol. VI. 
78
NEUROTICA.
[CL.  IV.—OR. 1.
manie sans delire, although he admits that the judgment and per-
ception, and, indeed, all the reasoning faculties of the mind  are in
most cases undisturbed.   In like manner Sauvages has incorrectly
merged the  whole family into a single  species under the genus
mania, to  the utter confusion of both.
  It is not a little singular that Dr. Crichton, who  has written so ex-
cellently on the diseases of the passions, and has illustrated his  ob-
servations with such a variety of examples, should both in his " In-
quiry into the Nature of Mental Derangement," and in his " Sy-
noptical Table," either have assigned no place to  these diseases, or
have transferred  them, like Sauvages, to insanity,—under his no-
menclature, derilium ; although, as I have just remarked, the per-
ception and the judgment (a diseased condition of which are usually
appealed to  as constituting pathognomic symptoms of  insanity)
are, for the most part, strikingly clear in empathema,  and often
peculiarly acute.   This last faculty, indeed, is frequently fireverted
by the prevailing emotion or passion of the hour; as where a man,
under the  influence of despair, reasons himself into the lawfulness
and  expediency of suicide;  but the argument, though  deflected,
runs still in a right line ; or, in other words, consists of correct rea-
soning built on a perception of false ideas as its premises, of which
we  have had  various examples in the philosophical suicides of Ger-
many. In the greater number of cases,  however, the judgment,
instead of being perverted, is merely overpowered by the empas-
sioned emotion ;  there is neither false judgment nor false percep-
tion.
  Ungovernable passion or empathema, nevertheless, though not
strictly insanity, is as much a mental derangement as insanity itself.

                Ira furor brevis est

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

1.  empathema entonicum.           empassioned excitement.
2. —--------atonicum.             empassioned depression
3,  ---    '   inane.                hair-brained passion. 
 GE. U._SP. I.]        NERVOUS FUNCTION.                  ;9


                         SPECIES I.

             EMPATHEMA  ENTONICUM.

                 EmjiaMonea TEvtiUmtnt.

 THE PREDOMINANT PASSION ACCOMPANIED WITH INCREASED EXCITE-
   MENT, ARDOUR, AND ACTIVITY; EYE QUICK AND DARING; COUNTE-
   NANCE FLUSHED AND TUMID.

 The varieties are innumerable: the chief are as follow :

       * Letitiae.                 Ungovernable Joy.
       b Philautiae.               Self-love.  Self-conceit.
       y Superbiae.               Pride.
       <5* Gloriae famis.            Ambition.
       e Iracundiae.               Anger.
       C Zelotypiae.               Jealousy.

   All  these, and indeed, all other passions whatever are as  much
 direct and indirect stimulants to the mind as provocative foods or
 drinks are to the body.  Employed occasionally and in moderation
 both may be of use to us, and are given to us by nature for this pur-
 pose: but when urged to excess they throw the system off its healthy
 balance, rouse it by excitement or depress  it by exhaustion,  and
 weaken the sensorial vessels by the wear and tare they prodnce,
   As those we are now contemplating are attended with  increased
 action they have some few symptoms in common, how widely soever
 they may differ in others; of which  the chief are an  augmented
 temperature and an accelerated  pulse.  If carried to such a degree
 that the judgment loses its power, or in other words the man  has
 no longer any command over himself, they betray themselves by
 their effect on particular features and particular organs, according
 as the emotion is of  a painful or a pleasurable character,  or as the
 pain or the pleasure  predominates in  those which partake of both.
   There are some organs, however, that seem to be equally affect-
 ed under a vehement excitement of whatever may be the prevail-
 ing passion, as the brain, the heart, and the lungs; for head-ache
 and apoplexy, palpitation and anhelation are alike common to sud-
 den fits of extreme joy, terror, and rage.   The thoracic effects are
 indeed the most striking; and hence  it is that the prjecordia have
 been more generally supposed  in all ages and countries to be  the
 seat of mental emotion than  the encephalon; and the state of the
 heart, as light and jumping for  joy, oppressed  and breaking with
 grief, or black and bilious with  hatred, has  been more commonly
appealed to than  that of the animal spirits; though the latter is the
cause, and the former the mere effect.
  It maybe thought, perhaps, that the vulgar charactar of the  heart 
80
NEUROTICA.
[CL. IV.—OR. 1.
as indicative of hatred or revenge, is merely figurative and has no
foundation in nature.  But this is not the case : for anger when long
indulged is well known to affect the functions of the liver, and has
often laid a foundation for jaundice, and consequently for a deeper
colour of the blood that circulates through the heart: a fact so well
known, that the seat of anger has, in the poetical language of most
countries, been transferred to this  organ, and  bilious  or  choleric
and irascible are convertible terms in the popular language of our
own day.
  We have endeavoured to account for the difference of effect pro-
duced by the sensorial fluid in the different organs of local sensation,
by supposing some degree of change to take  place in the nature of
this fluid by the action of the respective sentient  nerves at  their
origin or extremity. It is possible that other changes may take  place
in the sensorium from  the influence of peculiar mental impressions,
and that certain classes or ramifications of nerves may  be more af-
fected by particular impressions than others.   And we may hence
account not only for the  sympathy of the liver with the sensorium
when urged by anger,  but for that of other organs under other em-
passioned excitements, and  this not merely whether pleasurable or
painful, but according to the peculiarity of the pleasure or the pain
which forms the source of incitation.  Thus while anger stimulates
the liver, fear  has a tendency to produce a diarrhoea and inconti-
nence of urine; grief disorders the stomach, and effects the lachry-
mal glands;  sudden fright divests the muscles of  locomotion, and
produces palsy; while mirth throws them into involuntary action,
and compels a man to  leap, laugh and sing.
  This, however, is to digress; for our present business is to con-
template the mental rather than the corporeal effects of the passions
when urged to excess, or intemperately protracted.
  The instances of derangement produced by  a sudden fit or immo-
derate flow of joy are numerous, and not difficult to  account for.
As this empassioned emotion, when indulged with a rampant domi-
nation over the judgment, is a direct stimulus of a very powerful
kind, acting not only on the nerves but on  every part of  the  body,
it cannot take place without producing great  sensorial  exhaustion,
and consequently cannot  be persevered in without remissions of lan-
guor and lassitude, like the effects of intoxication from strong wine
or spirits.  The misfortune is, that when the elevating faculties of
the mind, and especially  the imagination, are  once let loose by the
operation of this  passion, and  both run wild together, the mental
excitement will sometimes continue after the strength of the  body
is completely prostrated.  And when the strength is sufficiently re-
cruited for the external senses to convey once more to  the precep-
tion true and lively impressions of the objects that surround them,
the perception which  has been also morbidly affected  by the vio-
lence of empassioned paroxysms will not receive or convey them in
a true state, and a  permanent derangement is the consequence. Car- 
GE. II.—SP. I.]
NERVOUS FUNCTION.
81
dan* gives the case of an artisan of Milan, who having had the good
luck to  find an instrument that formerly belonged to Archimedes
ran mad with the fit of transport into which he was hereby thrown:
and Plutarch, in his life of Artaxerxes, has a like story of a soldier
who, having had the high honour of wounding Cyrus in battle, be-
came so overjoyed that he  lost his wits  from the moment.  Boer-
haavef and Van SwietenJ relate cases of epilepsy that have follow-
ed from the same cause.
  Occasionally the exhaustion of sensorial power hereby produced is
so sudden and total, that the whole nervous system seems instantane-
ously to become discharged of its contents, like a Leyden phial load-
ed with electricity  when touched with a  brass rod, and death takes
place at the moment. There are various instances on record in which
a like fate  has followed upon the  injudicious production of a par-
don to a culprit just on the point of his being turned off at the gal-
lows.  Valerius Maximus relates two anecdotes of matrons who, in
like manner, died of joy  on seeing their sons return safe  from the
battle at the lake Thrasis : the  one died while embracing her son,
the other had been misinformed and was at that  moment lamenting
his death.  The power of surprise was added therefore in this case
to that of joy, and  she fell even before  her arms could clasp him.§
Marcellus Donatus, Pechlin, and other collectors of medical curiosi-
ties  are full of incidents of this kind:  and a case not very unlike
occurred  a few years since to the present author, in the person of
an  intimate friend and  most  exemplary clergyman.   This gentle-
man who had consented to be nominated one of the executors in the
will of an  elderly person of considerable property with  whom  he
was acquainted, received a few years afterwards, and at a time when
his own income was but limited, the unexpected news that the tes-
tator was dead, and had left him  sole executor, together with  the
whole of his property, amounting to three thousand pounds a year
in landed estates.  He arrived in  London in great agitation, and on
entering his own door dropt down in a fit of apoplexy, from which
he never entirely recovered; for  though he regained his mental,
and most of his corporeal faculties, his mind was shaken and render-
ed timid, and an hemiplegia had so weakened his right side that he
was incapable of walking farther than a  few steps.
  Could this passion be employed as a  medicine, and administered
with a due regard to time  and measure, from its powerful influence
on the whole system there can be no doubt that it might be made
productive of the  most beneficial effects.  And there is hence no
reason  for hesitation in  admitting  many of the  wonderful cures
which are reported to have been  occasionally operated by its sud-
den incursion.  Corineus  gives the case of a tertian ague thus  re-
              * De Sapientia, lib. ii.
              | De Morb. Nerv. lib. ix. cap. 12.
              $ Comment. Tom. III. p. 144.
              § Lib. IX. Cap. 12
VOL. III.—11 
S3
NEUROTICA.
[CL. IV.—OR. I.
 moved ; Lory that of a stricture of the pylorus with incessant vomit-
 ing ;* and Trellian, what we should  less have expected, a radical
 cure of melancholy.f
   In  the second variety we have noticed the predominace of self-
 conceit.  The ordinary feeling is still of a pleasurable kind, but
 never amounting  to the paroxysms of the preceding : its effects
 therefore on the  soundness of the mind are more gradual, but in
 many  instances quite as marked.  It is a vain and preposterous es-
 timation of one's personal powers or endowments, accompanied with
 so immoderate a love of one's own self on this very account, as to
 make  the possessor blind to every instance of superiority in another
 person, and hence to save  him in a  considerable degree from the
 pain he would otherwise endure: for the self-conceited man is not
 easily  mortified or humiliated,  and hence  not easily cured of the
 malady.  " A wise maB," says Mr. Mason in his Treatise on  Self-
 knowledge,  " has his foible as well as a fool; but the difference be-
 tween them  is, that the foibles of the one are known to himself and
 concealed from the world ; the foibles of the other are known to the
 world and concealed from  himself.  The wise man sees those frail-
 ties in himself which others cannot; but the fool is blind  to those
 blemishes in  his  character which are conspicuous to  every  one
 else.'^  It was under the influence of this disease that Menecrates,
 as we learn from TEiian,became so mad, as seriously to believe him-
 self the son of Jupiter, and  to request of Philip of Macedon that he
 might be treated as a god.   But it is not always that the man thus
 deranged falls into such good hands as those of the Macedonian mo-
 narch ; for Philip humorously determining  to make the  madman's
 disease work its own cure, gave orders immediately that his request
 should be complied with and invited him to a grand  entertainment,
 at which was a separate table for the new divinity, served with the
 most costly perfumes  and  incense, but with nothing else.   Mene-
 crates was at first  highly delighted and  received  the worship that
 was paid to him with the greatest complacency, but growing hungry
 by degrees  over  the  empty viands that were offered him, while
every  other  guest was indulged  with  substantial dainties, he at
length keenly felt himself to be a man, and stole away  from the court
in his right senses.§
  The passion of pride has a close affinity to that of self-conceit:
but is less confined to self-endowments, and is a relative as the for-
mer is a personal  vanity.   The  proud man may indeed have the
 same preposterous estimation for some supposed gift of person, but
 the grasp of the passion does not terminate here; for he carries the
 same estimation to every thing that in the remotest degree apper-
* De Melancholia, Tom. I. p. 37.
f Lib. XLI. p. 17.
* Part I. Ch. VII.
§ Lib. XII. cap. 51. 
GE. II.—SP. I.]         NERVOUS FUNCTION.                 83

tains to him, and is hence as vain of his birth, or family connexions,
his wealth, his estates, his country, his office, his honour, or his re-
ligion :  and he is hence open to more numerous mortifications, and
is in fact more frequently mortified than the mere egotist.  Exam-
ples of  a deranged  mind from ungovernable pride are to be found
in every rank of life, but as those in the loftiest have the cup of in-
toxication most frequently offered to them, and drink deepest of its
contents, it is here, among kings and courtiers, and prime ministers
and commanders, that we are to look for the most striking instances
of this malady.  Many a crown  won by good fortune, and which
might have been preserved by moderation, has been lost by the de-
lirium of pride and vain-gjory; of which the history of Demetrius
of Macedonia furnishes us with one of  the most memorable exam-
ples : who, in his disgraceful  fall, was obliged to abandon, among
the other idols of his  heart, the unfinished robe which was to have
hung over his shoulders a magnificent embroidery of the sun, the
moon, and all the stars of heaven, to have represented him as the
sovereign lord of the  whole.
   There is, however, another kind of madmen, to adopt the words
of Butler,* opposite to these;  " that are insensibly mad and know
nothing of it; such as affect to contemn all praises and glory, and
think themselves most free when they are most mad: a company of
cynics,  such  as  monks, hermits, and anchorites, that contemn the
world, contemn themselves, contemn all titles, honours,offices, and
yet in that contempt are more proud than any man living.  They
are proud in  humility, proud in that they are not proud.   They go
in sheep's russet, many great men that  might maintain themselves
in cloth  of gold, and seem to be dejected ;  humble by the  outward
carriage, when as inwardly they are swollen full of pride, arrogancy,
and self-conceit.  And therefore Seneca adviseth his friend Luci-
lius in his attire  and gesture, his outward actions especially, to avoid
all such things as are most notable in themselves; as a  ragged at-
tire, hirsute head, horrid beard, contempt of money, coarse lodging,
and whatever leads to fame that opposite way."f
   When the passion  of pride is united with that of  ardent desire
after something  beyond us and above us it constitutes the next feel-
ing of ambition: and hence this also is an inflating emotion, a tym-
pany of the mind, and may be called firosfiective vanity, as pride is
relative vanity, and self-conceit fiersonal. It is the more  dangerous
to the understanding in consequence of the double force with which
it overpowers the judgment: and hence the slave of inordinate am-
bition is far more restless and in  a far higher degree of excitement
than the slave of either of the other two kinds of vanity; and, as
being dependent upon a greater number of contingencies, he is most
of all open to reverses and downfalls.
   Examples are not necessary, and would be a waste of time. When-
ever the stimulant ideas or thoughts that are connected with any
* Anat. of Melanch. Part I. Sect. ii. Vol. I. p. 182.,
f Epist. v. 
W
NEUROTICA.
[CL. IV.—OR. I.
one of this train of passions pass over the mind, the blood, as is
justly observed by Sir A. Crichton, rushes with impetuosity to the
head, the sentient principle is secreted in preternatural quantity,
and the excitement is at last so often renewed and increases to such
a degree as to occasion an impetuous and permanent delirium. But
when the expectations and  high desires, which pride or vanity na-
turally suggest, are blasted ; when these passions are assailed by po-
verty, neglect, contempt, and hatred, and are unequal to the contest,
they now and then terminate in  despondency or settled melancholy.*
  But if such be a frequent effect of the stirring passions of a plea-
surable kind ; it is not difficult  to conceive that those accompanied
with pain, as the passion of anger, and all its compounds, suspicion,
revenge, and especially jealousy, must make a much wider inroad
upon the domain of a well-ordered mind, and introduce confusion
and derangement.   Nor is  the effect confined  to the head ; for  a
stimulus thus violent affects the entire system, and, as we have al-
ready observed,  has a peculiar sympathetic influence on the liver;
producing, in many instances, a very diseased secretion of bile, and
altering it in a very short period not only  in its quantity,  but in its
quality.  At the same time, every vessel is exhausted of its irrita-
bility, and the whole strength is so prostrated  as occasionally to lead
on to obstinate faintings, convulsions, and death.  The expressions
and gestures are always violent and offensive, and are similar to
those of  maniacal rage; the eyes are red and inflamed, the counte-
nance is flushed, swollen and distorted, and the person is ungovern-
able.  Such was the case in 1392 with Charles VI. of France, who
being violently incensed against the Duke of Bretagne, and burn-
ing with  a spirit of malice  and revenge, could neither eat, drink,
nor sleep for many days together,  and  at length became furiously
mad as he was riding on horseback, drawing his sword, and strik-
ing promiscuously every one who  approached him.  The disease
fixed upon his intellect,  and accompanied him to  his death.
  In jealousy, as in ambition, thf re is a  combination of irritating
passions, and the combination  is still more complicated ; for it is a
compound of suspicion, hatred, eager desire of revenge, occasionally
intermixed with  love.   To  hot climates it appears  to be endemic,
and there is not  perhaps an eastern dynasty that does not offer nu-
merous examples of its sanguinary phrenzy, and diabolical career.
  It is not often, however,  that any of the varieties of this species
terminate in permanent  insanity,  although the case of Charles VI.
of France forms an exception to the general rule.  As moral treat-
ment appears to  be of more benefit in  the preceding genus than
medical,  it is almost the only  treatment that can be recommend-
ed in ungovernable passion: though the violence  of the excite-
ment should unquestionably be reduced by venesection and purga-
tives.  After this, time and perfect quiet must be chiefly depended
upon : yet judicious conversation, and more  especially a judicious
* Of Mental Derangement, Book HI. Ch. II. 
GE. II.—SP. I.]        NERVOUS FUNCTION.                 85

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

             EMPATHEMA ATONICUM.



THE PREDOMINANT PASSION ACCOMPANIED WITH DIMINISHED EXCITE-
  MENT, ANXIETY AND LOVE OF SOLITUDE :  EYE FIXED AND PENSIVE ',
  COUNTENANCE PALE AND FURROWED.

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

       « Desiderii.        Ungovernable Love.
       0 Auri famis.       ——----------Avarice.
       y Anxietudinis.        ■           Anxiety.
       S* Moeroris.-------------Heart-ache.
       f Desperationis.   ----——-.----Despondency.

  As increased sensorial excitement produces various symptoms in
common,  whatever be  the nature of the governing passion at the
time, there are also various symptoms common to decreased senso-
rial excitement under each of these depressing passions: as a greater
or less degree of  torpor in every irritable part, especially in the 
86
NEUROTICA.
[CL. IV.—OR. I.
 circulating and absorbent systems; whence paleness of the counte-
 nance, coldness of the extremities, a contraction and  shrinking of
 the skin, and general surface of the body : a retartadion and small-
 ness of the pulse, want of appetite, deficiency of muscular force,
 and a sense of languor which overspreads the whole frame.
   The ardent desire which is distinguished by the name of longing,
 is directed towards objects of various  kinds that  are  absent, and
 equally relate to places and persons. It is a painful and exhausting
 emotion, as compounded of hope, love and fear, and peculiarly agi-
 tates the prsecordia: and hence the striking and beautiful apoph-
 thegm of the wise man, " Hope deferred maketh the heart sick."
 It is felt  by children  at a distane from home and  who are eagar
 to return to  the embraces of their  parents;  by foreigners  who
 have a strong and inextinguishable love for their country,  and are
 anxious to return to the scenes and the companions of former times:
 and.by the youthful pair that  have vowed an eternal  attachment,
 and are sure that they cannot  live without each other, but whose
 union is opposed by bars that are felt to be insurmountable.   And
 hence the present variety includes the  three modifications of home-
 sickness, country-sickness, and love-sickness. The first is for the
 most part transitory; the second  has  sometimes, and especially
 among the Swiss, when their manners were simpler and their do-
mestic virtues and feelings much stronger than they seem to have
been of late years, produced not only a permanent melancholy but
hectic fever.  Yet it is to  the  third that our attention is chiefly
 called on the present  occasion, from the greater  frequency of its
 occurrence and the severer and more tragic  effects to whicfi it has
 led, where obstacles have arisen in its progress.
   We have, on the present occasion, nothing whatever to  do with
 the gross passion of concupiscence, which is as different from that of
pure and genuine love as light from darkness.  The man of lust
 has indeed his love, but it is a love that centres in himself and
 seeks alone his  own gratification:  while the passion we are  now
 speaking of puts self completely out of the field, and would volunta-
 rily submit to every pain and sacrifice, even the loss of life itself in
 promoting the happiness of the beloved object.  Yet, constituted as
 we are by nature for the wisest and best of purposes, a pure corpo-
 real orgasm still inweaves itself with the sentimental desire, though
 subordinate to it in virtuous minds, and the flame is fed from a dou-
ble source. " Nuptial  love," says Lord Bacon, " maketh mankind ;
friendly love perfecteth it; but wanton  love corrupteth and emba-
 seth it."*
   What it is that first lights up this flame is of no importance to the
 present subject. A peculiar cast of form or of features acknowledg-
 ed by all to be moulded according to the finest laws of symmetry,
 and productive of a high degree of external grace or beauty; or a
 figure or a manner that to the eye of the enamoured beholder gives
* Essays, No. X. 
QE. II.—SP. 11.]        NERVOUS FUNCTION.
87
 token of a mind adorned  with  all he  can wish for;  or an actual
 knowledge, from long acquaintance, of the existence of such inter-
 nal cultivation and excellence, may  be equally causes of the same
 common effect.   And hence this is of little or no account;  for the
 passion being once excited, the judgment runs a risk of being over-
 powered by  its warmth and violence; and the moment it is over-
 powered, the new train of ideas that are let loose upon the mind
 are of a romantic character ; and as soon as any obstacle starts up as
 a barrier in the vista of hope,  instead of being damped or repressed,
 they grow wilder and more vivid, till at length the sensorial system
 is worn out by the vehemence of its labour ; and though the excite-
 ment is really less than at first, because there is less vascular  vigour
 for  its  support,  it  is  still greater than ever compared with the
 weakened state of the sentinet organ.
   Yet love-sickness itself,  whatever mischief it may work in the
 corporeal frame, by sleepless nights,  a feverish pulse, and  loss of
 appetite,* and however, from the exalted state of the imagination,
 and the increased sensibility of the body, it may transpose the reali-
 ty of life into a kind of visionary existence, and so far produce men-
 tal derangement, rarely leads to direct insanity so long as there is
 the  remotest hope of the attainment of its object.   But if hope be
 suddenly cut off by an inexorable refusal, the intervention of a more
 fortunate rival, the  concealment of the  object of adoration, or any
 other cause whatever, the mind is sometimes incapable of resisting
 the shock thus produced by the concurrent yet opposite powers of
 desire and despair ; and in a moment in which the judgment is com-
 pletely overwhelmed,  the love-sick maniac calls to his aid the de-
 moniacal passion  of revenge,  and, almost at hazard, determines
 upon a plan of murder directed against his rival, his mistress, or
 himself.  The story  of Mr Hackman and Miss Rae will at once,
 perhaps, occur to the recollection of most of the author's readers in
proof of this assertion.   He himself had some acquaintance with the
former;  and  is convinced from what he knew of him that nothing
 but  a paroxysm of insanity could have urged him to so horrible an
 act.
   The operation of the passion of  avarice, when it has once ob-
 tained an ascendancy over the mind, is altogether of a different na-
ture from that of the preceding variety, though it often produces a
 wider and more  chronic alienation.  It has not a stirring property
of any kind belonging to it; but benumbs and chills every energy
of the body as well  s of 'he soul, like the stream of Lethe ;  even
the imagination is  rendered cold and  stagnant; and the only pas-
sions with which it forms a confederacy are the miserable train of
gloomy fear, suspicion  and anxiety.   The body grows  thin in the
midst of wealth, the limbs totter though surrounded by cordials, and
• Schurig. Gyneaolog. p. 94.
  Horstius, An Pulsus aliquis amatorius concedendus '
  Bilizer, De Natura Amoris. Gioss. 1611. 4to. 
 38                       NEUROTICA.           [CL. IV.—OR.  I

 the man voluntarily  starves himself in the granary  of plenty, not
 from  a want of appetite, but from a dread of giving way to it.  The
 individual  who is in such a state of mind must be estranged upon
 this point, how much soever he may be at home upon others.  Yet
 these are cases that are daily occurring,  and have been in all ages:
 though  perhaps one of the most curious is that related by Valerius
 Maximus of a miser who took advantage of a famine to sell a mouse
 for two  hundred  pence and then famished himself with the money
 in his pocket.*   And hence the madness of the covetous man has
 been  a  subject of sarcasm and ridicule  by moralists and dramatic
 writers  in  every  period, of which we have sufficient examples in
 the writings of Aristophanes, Lucian and Moliere.
   There is another mental feeling of a very afflictive, and, too often
 like the last, of a chronic kind, which is frequently found to usurp
 a  dominion over  the judgment, and to embitter life with false and
 visionary ideas, and that is a habit of anxiety or preying care ;
 which not only drives the individual who possesses it mad, but runs
 the risk of doing the same to all who are about  him, and are ha-
 rassed with his complaints and discontents.  This is sometimes the
 effect of a long succession of misfortunes or vexatious troubles; but
 seems in some persons to depend on a very high degree of nervous
 sensibility,  united with  a choleric  or melancholic  temperament.
 Their age. wealth, or situation in  life  is of  no importance, and
 though their digestive powers are good, and they are not hypochon-
 driacs, they are always apprehensive and full of alarm, and flee from
 every appearance of  joy as  they would from an apparition, or even
 sooner.   In the language of Burton, who knew too well how to de-
 scribe them, " The old are full of aches in their bones, croups and
 convulsions;  dull of hearing, weak-sighted, hoary, wrinkled, harsh,
so much so that  they cannot  know their own selves in a glass,  a
burthen  to themselves and others.  If they be sound they fear dis-
 eases  ; if sick, weary of their lives.  One complains of want, a se-
 cond of  servitude, another of a secret and incurable disease, of some
deformity of body, of some loss, danger, death of friends, shipwreck,
persecution, imprisonment, disgrace, repulse, contumely, calumny,
abuse, injury, contempt, ingratitude, unkindness, scoffs, scouts, un-
 fortunate marriage, single life, too many children, no children, false
 servants, unhappy children, barrenness,  banishment,  oppression,
frustrate hopes, ill success;

           Cxtera de genera hoc, adeo sunt multa, loquacera,
           Delassare  valent Fabium.

 In the mean time, continues the younger Democritus," thus much  I
 may say of them, that generally they crucify the soul of man, atten-
 uate our bodies, dry them, wither them, rivel them up  like old ap-
 ples, and make them  as so many anatomies."f
* Lib. Vn. Cap.
f Anat. of Melancholy. Part I. Sect. II. Subs. X. 
 GE. II.—SP. II.]       NERVOUS FUNCTION.                  §9

   Nothing can be more different than this constitutional pining, and
 the pains produced by heartache or the reality  of severe grief.
 The former is talkative and querulous ; the latter is dumb and flies
 from  company.  The sensorial exhaustion is so considerable that
 the  mind, with its  attention  upon  the  full stretch,  has scarcely
 strength enough to collect the train of ideas on which alone it  re-
 solves to dwell; and hence all  conversation is  irksome, the pres-
 ence of a friend disquieting, and the deepest solitude is anxiously
 sought for.   And not unfrequently the discharge of nervous power
 is so considerable and sudden as to produce a general torpor of  the
 brain, which, if it do not happily terminate in quiet sleep, is ihe  in-
 let of apoplexy.  Even in the former case the inirritability of  the
 nervous fibres continues to such an excess that the sufferer has  no
 natural evacuation for perhaps several days, feels no hunger, can-
 not be persuaded to take food, is incapable of sighing and sheds no
 tears.   And hence the appearance of tears and sighing are good
 omens, and are correctly regarded as such, since they show that  the
 general torpitude is giving way in the organs that most associate
 with this  painful emotion of the mind to  a slight  return of irrita-
 bility.  As soon as the flow of the sensorial principle is a little in-
 creased, the praecordia struggle with great anxiety, and the heart is
 overloaded (and feels ready to break or burst, whence  the name of
 heart-ache, so appropriately  applied to  this variety  of suffering.
 Sometimes also, hysteric flatulency oppresses the  respiration,  and
 convulsions, and, not unfrequently, death itself ensues.   Of this last
 effect Erndtl has given numerous instances.* But if recovery should
 take place it is usually long before the judgment re-assumes its pro-
 per sway  in the mind, and the temporary derangement altogether
 ceases.  At times, indeed, this never returns, and  the pitiable suf-
 ferer  only lives through  the  shock to endure  the  severer evil of
 confirmed insanity: of which Shakspeare has given us an admirable
 copy in the character of King Lear, finely  imagined to be a result of
 filial ingratitude.
   Despair makes a near  approach to heart-ache in the overwhelm-
 ing agony it produces, and its pressing desire of gloom and solitude,
but, generally speaking, the feeling is more selfish, and the mind
more  hurried, and daring.  Despair, as it commonly shows itself, is
 utter hopelessness from mortified pride, blasted expectations, or a
 sense of personal ruin; heart-ache is either hopelessness from a sense
 of some social bereavement, or relative ruin.  The gamester who
 cares for no  one but himself may rage  with  all the horror of  de-
 spair; but the heart-ache belongs  chiefly  to the man of a warmer
 and more generous bosom, stung to the quick by a wound he least
expected, or borne down, not by the loss of fortune, but of a dear
friend or relation, in whom he had concentrated all his hopes.  The
well-known picture of Beverley is drawn  by the hand of a master :
 and he is represented as  maddened by the thought of the deep dis-
         • Relatio de Morbis, anno 1720, Warsayise curatis.
VOL. in.—-12 
90
NEUROTICA.
[CL. IV.—OR. I.
 tress into which his last hazard had plunged his wife and  family:
 but if his selfish love of gaming  had not triumphed over his rela-
 tive love for those he had thus ruined he would not have been in-
 volved in any suchreverse.  While Beverley was in despair; it was
 his wife who was broken hearted.
   The sources of this most agonizing emotion are enumerable, and
 from the total shipwreck of all hope on which it  is founded  there is
 no passion of the mind that drives a man so readily to an act of sui-
 cide.  To live  is horror; the infuriated sufferer feels himself an
 outcast from God and man, and though  his judgment may  still be
 correct upon other subjects, it is completely overpowered upon that
 of his actual distress, and all he thinks of  and  aims at is to with-
 draw with as much speed as possible from  the present state  of tor-
 ture, totally regardless of the future, or falsely  satisfying himself by
 a perversion  of his judgment, that there is no  crime in  his doing
 so.
   One of the severest  causes  of  despondency is a conscience la-
 bouring under a deep sense of guilt for some
                             undivulged crime
                 Unwipt of justice.
 And so severe  has the  anguish been, in many  cases, that the  tor-
 mented wretch  thus haunted by  himself, and hating the light of
 heaven, has been compelled, as the less  evil  of the iwo,  to sur-
 render himself  to the laws of his  country, and court the disgrace
 of a public execution.   Yet the same miserable feeling has some-
 times followed from an ideal cause, especially in  a mind of  natural
 timidity, or constitutionally predisposed to  a gloomy view of  nature.
 For such, by a  mere exercise of their own meditations, but  far of-
 tener by the coarse, but  impassioned oratory  of itinerant preacherS|
 are induced to believe that the Almighty has shut them out for ever
 from the pale of mercy,  and that  the bottomless  pit is yawning to
 receive them.   And under the influence of such an impression they
 too frequently work themselves up into a slate of permanent insani-
 ty, or hurry themselves by their own hands into the horrors of a fate
 from which they feel assured that no repentance  or power of reli-
 gion can save them.
  In all these varieties of empathema the art of the physician  can
 do but little,  and in many of them nothing whatever.  Yet where
 the heart suffers acutely and  the mind is deeply dejected,  sedatives
 and antispasmodic cordials may occasionally be found useful;  and,
 as the abdominal viscera are  greatly liable  to be affected, the appe-
 tite to fail, the liver to be congested, and the bowels rendered cos-
 tive, these organs must  be watched, and such relief be afforded as
 they may stand  in need of. When aperients are required the warm
 and bitter resins will generally answer the purpose best,  alone  or
 combined with rhubarb.   Where love is the cause of disease, and
 the fair patient  is young and delicate, suppressed menstruation, or
 even chlorosis is by no means unfrequent, followed by hysteria and
other nervous affections  that  produce considerable trouble. 
GE. II.—SP. II.]
NERVOUS FUNCTION.
91
  In all cases of mental dejection, however, a kind  and judicious
friend  is by  far the best physician : medicines may do a  little,
change of scene and country, of custom and manners a little also;
but the soothing of tenderness and indulgence, and the voice of that
friendship which knows how to discriminate opportunities, and sea-
sonably to alternate  admonition  with  consolation will  accomplish
more in the way of cure than all the rest put together.  The  de-
spondency produced by the real sense of a guilty conscience or the
visionary belief of eternal reprobation, may derive important and
most salutary advantage from religious instruction when conducted
with a  judicious attention  to the exigency  of the case.   But much
circumspection and adroitness are  requisite upon this point,  for so
rooted  is the  feeling to be extirpated that no ordinary means will
suffice for its eradication, while,  if it be forcibly snapped off, it will
shoot out the wider and grow ranker than  ever.
  The excitement of an opposite  passion, or train of feelings, has
sometimes been accompanied with success; for there are instances
in which the  slave of imaginary pain and misery has  forever for-
gotten  his sense of visionary grievances under the stroke of poignant
and real affliction; and the miser, when reduced by a sudden re-
verse of fortune to actual beggary, and thus completely disencum-
bered of the load that has hitherto  so much oppresssed him, has re-
turned to his sober senses, and learned a juster estimate of worldly
possessions.
  The same  attempt has often been recommended  in disappoint-
ments  under  the passion of love; and, according to the concurrent
report  of the poets of ancient and modern times,  many of whom
profess to be  well versed  in this kind of discipline, it has very ge-
nerally been attended with success.  Where the emotion has more
of a corporeal  than a sentimental origin, this may  easily be con-
ceived ; and it is possible that it  may also sometimes  have occurred
under  a purer feeling : though, for the honour of the human  heart, I
do not think this is much to be trusted to.  Where the choice between
two  young persons of fair character is  really imprudent,  yet the
affections are so rivetted as to bid defiance to  all forcible attempts
to unfetter them, a promise of consent on the part of the reluctant
parent at the distance of a given  period of time,  as a year and a
half or two years,  with an undertaking on  the  part of the lovers
neither to see or correspond with  each other in the mean time,  an
engagement easily fallen into, has answered  in  many  instances  to
which  I have been privy.   The  ardour has gradually cooled on the
one side or the other,  the judgment has been more impressed with
the nature of the imprudence, or a more attractive form has inter-
posed, and settled the question irretrievably.   While,  on the con-
trary, if the fidelity  should hold on both sides to the end,  and the
passion be heightened instead ot depressed, as in this case there is
most reason to suppose it would be, hard, indeed, must be the heart
that would extend the restriction farther, and that would not wish
joy to so deserving a couple. 
92                       NEUROTICA.           [CL. IV.—OR. I


                        SPECIES  III.

                EMPATHEMA  INANE.

                 Hatr=2$ratneTr tyatmion.

WAYWARD AND UNMEANING PASSION, URGING TO INDISCRIMINATE ACTS
  of  violence:  air hurried and  tumultuous;  COUNTENANCE
  flushed; eyes glaring and PROMINENT.

This is the maniesans delire of M. Pinel: a case of frequent occur-
rence but incorrectly named in this manner since, in the opinion of
all other  nosologists, and perhaps all other pathological writers, the
character of delirium (that is of diseased  judgment, diseased per-
ception or both) is essential to mania.
  M.  Pinel ascribes this species principally, and with great force of
reason, to a neglected or ill-directed education upon a mind natural-
ly perverse or unruly : and gives the  following striking example :
An only son of i weak and indulgent mother, was encouraged in the
gratification of every caprice and passion of which an untutored and
violent temper was susceptible. The impetuosity of his disposition
increased with  his years.  At school he  was always embroiled in
disputes  and quarrels ;  and if a dog or a horse offended him he in-
stantly put it  to death.  The  wayward youth, however, when un-
moved by passions, possessed a perfectly sound judgment.  When
he came  of age, he proved himself fully competent to the manage-
ment of his family fstate as well as to the discharge of his relative
duties, and even distinguished himself by acts of benificence and
compassion. But his deep-rooted propensity to quarrel still haunted
him, and  wounds, law-suits, and pecuniary compensations were the
general consequence.  At last an act of notoriety put an end to his
career of violence.   Enraged at a woman who had used offensive
language to him, he tumbled her into a well.  A public prosecution
followed,  and, on the testimony of a great many witnesses who de-
posed as  to his furious deportment, he was condemned to perpetual
confinement at the lunatic asylum of Bicetre.
  On the commencement of  the French revolution, when the mob
broke open the doors of the prisons and  the lunatic  hospitals, to
liberate all whom  they  thought  unjustly confined and under re-
straint, a patient labouring under the present species in the  Bicetre
asylum, pleaded his own cause so  rationally, and pathetically, and
so artfully accused the governor of the asylum of cruelty, that the
armed rabble  commanded him to be instantly liberated, and scarcely
suffered  the governor to escape with  impunity.   The  patient thus
restored  to freedom was led about in triumph amidst the reiterated
shouts of vive la republique.  The sight of so many armed  men,
their loud and confused noise and tumultuous conduct, soon roused 
GE. II.—SP. III.]
NERVOUS FUNCTION.
03
the visionary hero to a fresh paroxysm of fury.   He seized, with a
vigorous grasp, the sabre of his next neighbour, brandished it about
with great violence, and wounded  his liberators indiscriminately.
Fortunately he was soon mastered;  when the savage mob  thought
proper to lead him back to his cell, and with shame and reluctance
acknowledged their own ignorance  and misconduct.
  The mode of treatment may be collected from the  preceding
pages.
                       GENUS III.

                        ALUSIA.

                 JHlum'ou.  f^allucf nation.

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

Alusia is here derived  from  the Greek «.Xv<ng, " oberratio," from
tcXva,  " errabunda  mente afficior,"—" inquietus oberro :" whence
the- Latin term allucinatio or  hallucinatio.  According to the rule
which renders the  Greek v, by the Latin  y, the name of this genus
ought rather perhaps to be alysis ; but as the Latins have themselves
retained the v in allwcinatio, it is here suffered to continue in alusia,
making a similar exception to that already observed in lues.   The
Greek term is preferred to the Latin, as the name of  the genus for
the sake of uniformity.  Sauvages, and after him Sagar,  have em-
ployed hallucinatio as the name of an order; Darwin and Crichton as
that of a genus, and consequently, running parallel with the genus be-
fore us.  Whenever  the genus exists, hypochondrias or hypochon-
driasis is usually placed under it.  It is so by Sauvages, Sagar, and
Crichton; and it occupies the same place in Linneus,  who  has
merely adopted the term imaginarii instead of hallucinationes.
  Alusia embraces the two following species:
1.  alusia elatio.                     sentimentalism.
                                     mental extravagance
:.      — hypochondrias-              hypochondrism.
                                     low spirits. 
94                       NEUROTICA.            [CL. 1V.-OR. I.


                         SPECIES I.

                   ALUSIA ELATIO.

        Seutimrotaltsm.  Rental Kptranagance,

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

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

   * Heroica.                 Chivalry.   Romantic gallantry.
   /3 Facetosa.                Crack brained wit.
   y Ecstatica.                False inspiration.
   S~ Fanatica.                Fanaticism.

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

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

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

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

  The third variety, or  ecstatic  illusion, is also a pleasurable
hallucination: and  consists in  a sense  of false inspiration,  or a
visionary boast of some preternatural endowment, in the course of
which the  judgment is so far perverted as to mistake the energetic
notions of  the imagination for realities ;  so that the victim of the
delusion believes  in apparitions,  affects an  intercourse with the
world of spirits, or lays claim to a power of working miracles. 
OE. IU.—SP. I.J       NERVOUS FUNCTION.
97
   The morbid afflatus has often been aped by cunning imposters to
 serve their own interests with the multitude: and there is no great
 difficulty, in conceiving that it is in many cases a real and  serious
 hallucination, when we reflect on the ease with which such impos-
 tors themselves are capable of deluding the  populace, and working
 them  up into false ecstasies, and especially of inveigling them  into
 a hearty belief of theirown miraculous powers.  When the passions
 of men are once set afloat, and the subject presented to them is full
 of the marvellous and the terrible, they are too apt to confound the
 false  with  the  real,  and  are prepared  to  proceed  to  whatever
 extremities the magician may choose  to lead them.   We are  told
 by Lucian that when Archelaus, a celebrated Greek actor,perform-
 ed the part of Andromeda  in  the tragedy of Euripides,  several of
 the  spectators were seized with delirium ; some at the time of
 performance, others a day or two afterwards; during which  they
 did  nothing  but  declaim  in  a theatrical manner,  and  piteously
 lament the fate of the persecuted princess.   Burton, therefore, has
 some reason for  remarking thai what the impostors  before us, or
 the  brain-sick enthusiasts whom they imitate, once broach and se*
 on foot," be it never so absurd, false, and prodigious the commo*
 people will follow and believe.  It will run  like murrain  in cattle,
 scab in sheep.  Nulla scabies superstitione  scabior; as he  that is
 bitten  by a mad dog bites others, and all in  the end become mad.
 Either out of affectation of  novelty,  simplicity, blind zeal, hope and
 fear, the giddy headed multitude will embrace it, and without farther
 examination approve it."*
   The genuine enthusiast is always possest of a warm imagination,
 and  generally of a nervous  temperament,  and  delicate frame;
 and  a long series of elevated abstraction  on  religious subjects
 combined with protracted fasting has ordinarily been the harbinger
 of the  fancied  afflatus.  Such was the discipline by which  the
 lovely and blooming and sincerely  devout Saint Teresa  was  pre-
 pared for ecstacies and visions, and led to impose upon herself  and
 all that beheld her;  and seriously to believe, in the fervour  of  her
 mind, that her body was lifted from the earth :  and that she heard
 the voice of God, saw our Lord with St.  Peter and St. Paul standing
 on her left hand ; by the first of whom the cross which was  at  the
 end of her beads was miraculously transformed into four large gems,
 incomparably  more precious  than  diamonds; with many other
marvellous revelations which we cannot find room to detail.  Though
it should be noticed  that devils appeared to  her as well as blessed
 spirits,  whom she always  kept at  a distance  by sprinkling holy
water; and that she  was an eye-witness to the joyful  escape from
the flame of purgatory of the purified souls of father Peter of Alcan-
tara, father Ivagnez, and a Carmelite friar.f
  It  is not necessary to produce other examples, though many might
       • Anatomy of Melancholy.  Part III. Sect. IV. 1. 3.
       f Butler's Lives of the Saints, in loco.
VOL. in.—13 
98
NEUROTICA.
|CL. IV.—OR. I.
be brought from our own times.  A cure is extremely difficult to
be obtained ; and I  am afraid that even Mr. Locke's  admirable
chapter on Enthusiasm would  be read to  no purpose.   In  one
instance the enthusiast seems to have been brought home to himself
by a pleasant and ingenious stratagem of his superintendant at
Venice.  This  visionary had conceited himself to be Elias,  and
like the prophet, had  determined  upon fasting forty days.   The
keeper fearful that he  would never hold out,  and that  he should
lose his patient, dressed up a man in the attire of an angel, who was
introduced to him in no ordinary manner, and informed him that he
was commissioned from heaven to bring him food. , The supposi-
titious Elias took it, was afterwards allowed to find  out  the  trick,
and thus,  at  the  same time, found out his own  imposition upon
himself.
  From the  influence which we have seen  such enthusiasts, or
even pretended enthusiasts, capable of producing upon the mind of
the multitude when roused by the solemnity and awfulness of the
revelations that are supposed to be disclosed to them, we can easily
see how fanaticism, constituting the fourth variety of the present
species, may obtain an ascendency, and even rage with all  the
ramifying power of an  epidemic: consisting of religious flights of
the imagination, predominant over the  natural feelings as well as
the judgment, excited by  the calls or doctrines of those who affect
to be  preternaturally  gifted, or who possess an equal influence
over the mind by the high sanction of priesthood, profound learning,
or any other  respected authority: and often urging to a voluntary
and inappropriate submission to severe privations, mortifications,
and tortures ; or to the torture and massacre of those who profess
different creeds.
   Examples  as in the last variety, may be found in every age  and
religion, but chiefly in times of gross ignorance and barbarism ;
where the general mind has been too little informed to distinguish
between truth and sophistry, and the passions have been undisci-
plined to restraint.   It  is hence of no importance what religion or
superstition is to  be inculcated, for those that are true  and those
that are false have  been  equally laid  hold of by  enthusiasts and
impostors to  produce the same end, and effect the same triumph by
means and machinery that could only be furnished from the infernal
regions.   Hence the blood and raving of  the prophets of Baal;
the Curetes  or Phrygian priests, and the delirious votaries  of the
Indian Juggernaut;  the cruel and senseless  penances and punish-
ments sustained in many  of the  convents and nunneries Lamism,
and still more so in  those of many catholic  countries.  Hence the
terrible sufferings of the Waldenses, the furies of St. Bartholomew's
day, the fires of Smithfield, and the dark and doleful cells, the  whips,
and wires, and pincers, and  pullies, and all the infernal parapher-
nalia of the Inquisition.   Hence, in ancient times, the matrons  of
Canaan and of Carthage were instigated to throw their own children
into the flames, and  sacrifice them to the gloomy deity whose anger 
WS. III.—SP. I.]
NERVOUS FUNCTION.
99
it was held necessary to appease; and hence in more modern days,
Philip II. of Spain, was goaded to impeach a son, of whom he was
little worthy, before the Chamber of Inquisitors, to bespeak their
condemnation of him,  and to take effectual care that he should be
poisoned, as soon as his sentence had been pronounced.
  The cure of these diseases belongs rather to colleges of general
instruction than of medicine.  Individual cases of enthusiasm and
fanaticism have existed, and  will probably continue to exist, in all
ages; but when the general mind  is well informed, and the social
feelings and virtues are duly estimated and widely cultivated, the
wild-fire will burn in vain, and meet with little or no fuel to support
its rage.
                        SPECIES  II.

             ALUSIA HYPOCHONDRIAS.

             I^ociiontrnsm.  &oto Sbtfrtt*.

gloomy ideas of real life ;  dejected  spirits ; anxiety ;  dys-
  pepsy; languid pulse; indisposition to activity; eye oblio.uk
  and scowling; countenance sad and sullen.

The term hypochondrias is taken from the anatomical compound
hypochondria, to which region the disease was formerly supposed
to be altogether confined.  Hypochondrias is here used instead  of
hypochondriasis, the common  name, because, as already observed
on various occasions, iasis as a termination is limited, nearly  with
this single exception, to denote  in the medical vocabulary a peculiar
family of cutaneous diseases, as pityriasis, psoriasis, ichthyasis, and
many others.  The author has felt the less difficulty in proposing
this change, as hypochondriasis is of comparatively modern invention,
and is not to be met with in the Greek or Latin writers; by whom
the complaint is  usually alluded to or described as a species of me-
lancholy, or rather as a  disease  of the melancholic temperament.
  It constitutes the third sort or species of this malady described by
Galen, and  which he regards as connected with  a peculiar state of
the stomach ; though, from its mental symptoms, he does not incline
to contemplate it as Diocles, a contemporary physician of reputation,
had done in his Book on Gastric affections, as a simple disease of
this organ.   The controversy has been in  different times continued
to our own  day; and it does not seem to be  even yet universally
settled whether hypochondrias  should be regarded as a mental or a
dyspeptic malady.  In Pinel the disease seems to  be included under
alienation menfale, and its different varieties to be distributed, though
without particular remark, amidst the five  species into which he has
divided  that genus. 
100
NEUROTICA.
|CL. IV—OR. I.
  The present species bears so near a resemblance lo several of the
varieties of genuine melancholy as to be often distinguishable from
them with great difficulty;  and  the more so as it is no uncommon
thing for hypochondrias to  terminate in melancholy, or for melan-
choly to be combined with hypochondrias.  Both may be the result
of a  predisposing constitution, or may be primarily induced by acci-
dental causes where no such constitution exists: and the predisposi-
tion  and the accidental causes of the one may become those of the
other: for the temperament known by the common name of melan-
cholic, and characterized by a lean and  dry corporeal texture, small
and rigid muscles, a sallow skin, brownish-yellow complexion, little
relieved by redness of any kind, deep-black and coarse hair,  eyes
sunk in hollow  sockets,  large prominent veins, especially in  the
hands and arms, with a tendency to solitude and private musing, is
a common precurser of both.  And in like  manner a sedentary life
of any kind,  and especially severe  study protracted to a late hour
in the night, and rarely relieved by social intercourse, exercise, or
nugatory amusements; a debauched and dissolute habil, or excesses
in eating and drinking, may become causes  of either of these mala-
dies, from  accessory circumstances that cannot be traced out even
where the predisponent temperament does not seem to exist.  But
it is  very justly observed by Sir A. Crichton, that even in those
'* whose health is much deranged, true melancholy seldom arises,
except mental causes of  grief and distress join themselves to the
corporeal  ones : and this constitutes one of the characters which
distinguishes melancholia vera from hypochondriasis.  The former
may be said to be always  excited by mental  causes, and consists in
various phenomena of grief, despondency, and despair;  whereas
the latter most commonly arises from corporeal causes, and its men-
tal phenomena consist  of erroneous ideas entertained about the
patient's own make or body."*
  The  corporeal causes  are usually a  diseased emotion of one or
more of the digestive organs, and especially, as we shall presently
have to observe, a displacement  of some part of  the colon.  It is
also  not unfrequently a result of the sudden cessation of some perio-
dical or other habitual discharge, as that of an issue, or of a hemor-
rhoidal flux, a chronic ulcer, or some external eruption.
  The  melancholy man seldom lives long, and his disorder often
commences in the meridian of life.  He frequently terminates his
days  by violence, or at  the utmost never attains old  age.  The
hypochondriac seldom becomes  affected till after the meridian of
life,  and very generally continues to the stage of longevity.
  The common corporeal symptoms area troublesome flatulency in
the stomach or bowels, acrid eructations, costiveness, a copious dis-
charge of pale urine, spasmodic  pains  in the head and other parts
of the body, giddiness, dimness of sight, palpitations, general sleep-
lessness, and an utter inability of fixing the  attention upon  any sub-
* Of Mental Derangement, Vol. III. p. 235 
GE. III.—SP. II.]       NERVOUS FUNCTION.
101
ject of importance, or engaging in any thing that demands vigour
or courage.   The mental feelings, and peculiar trains of ideas that
haunt the imagination and overwhelm the judgment, exhibit an in
finite diversity, and lay a foundation for the three following varie-
ties:

         « Autalgica.             Vapours.
         /3 Pertaesa.               Weariness of life.
         y Misanthropica.        Misanthropy.   Spleen.

   In  the  first variety,  which is commonly distinguished by the
name of vapours, or low spirits, the patient is tormented with a
visionary  or exaggerated sense of pains or some concealed disease;
a  whimsical  dislike  of particular persons, places or  things ;  or
groundless apprehensions of personal danger or poverty.
   Greding gives an account of a medical practitioner who applied
to him for assistonce, under an impression that his stomach was filled
with frogs, which had been successively spawning ever since he had
bathed, when a boy,  in a pool in which  he  had  perceived  a   few
tadpoles.   He  had spent his life in trying to expel this imaginary
evil, and  had travelled to numerous places to consult the first phy-
sicians of the  day upon  his  obstinate malady.  It  was in vain to
attempt convincing him that the gurglings or borborygmi he heard
were from extricated and  erratic wind.   He argued himself, says
M. Greding, into a great passion in my presence, and asked me if I
did not hear the frogs croak.
   I have  at this moment under my care, a hypochondriac of about
fifty years of age, who affords sufficient proof that Moliere drew his
Malade Imaginaire from nature, and hardly added an exaggerating
touch.  His profession is that of the law;  his life has been uniformly
regular, but far too sedentary and studious; without having anyone
clearly marked corporeal affection, he is constantly dreading every
disease in the bills of mortality, and complaining one after another
of every  organ in his body ; to each of which he points in succession
as its seat;  especially the head, the heart, and the testes.  He now
suspects  he  is going to have a cataract, and now frightens himself
with an   apprehension of  an involuntary seminal emission.  It is
rarely that I have left him half an hour, but I have a note to inform
me of some symptom he had forgotten to mention, and I have  often
five or six of these in the cou'se of the day. The last was to state
that shortly after my visit he had had a discharge of three drops of
blood from the nose—a change which he thought of great import-
ance, and requiring immediate attention. His imaginary symptoms,
however, soon disappear, provided they are listened to with gravity
and pretended to be prescribed for; but not otherwise.  Yet in disap-
pearing  they only yield  to others that can only be surmounted in
like manner.  His head  is too much confused to allow him to en-
 gage in any serious study, even if it were prudent to recommend it
to him :  but on all common subjects he is perfectly clear, and will
 converse with shrewdness and a considerable extent of knowledge, 
 102                     NEUROTICA.           [CL. IV.—OR. I.

 His bowels are sluggish: his appetite not good, though he eats
 sufficiently; his sleep is unquiet, but he  has  enough  of it with-
 out opiates; his pulse is variable, sometimes hurrying on abruptly,
 and without  any obvious cause, to a hundred  strokes in a minute,
 but ofien very little quicker than in a state of health.   His tongue
 varies equally, and is irregularly clean, milky, and brownish, and
 then  suddenly  clean again.   He is irritable in his temper, though
 he  labours to be calm; and is so rooted to his chamber that it is diffi-
 cult to drag him from it.  He has now been ill about ten weeks, but
 it is during the winter,  and the season is too severe and inclement
 for him to venture abroad.   I  look forward to his restoration in the
 spring from exercise, change of air, and a course of tonic medicines.
 I have not found him  complain of dysphagia globosa, or that sense
 of suffocation  from the feeling of a constringing ball in the throat
 which is so common to hysteric patients, and which, from its being
 often also traced in the present disease, has been called by Pechlin
 suffocatio hyfiochondriaca ;* but his spirits are in a state of almost
 perpetual depression.
  The whims that  are sometimes seriously entertained under this
 variety of the disease, are so truly ludicrous that " to be grave ex-
 ceeds all power of face."   One  thinks himself  a giant, another a
 dwarf; one is as heavy as lead, another as light as a feather.  Mar-
 cellus Donatus makes mention of a baker of Ferrara who thought
 himself a lump of butter, and durst not sit in  the sun nor come near
 the fire  for fear of being melted.  They are all extremely timid,
 and their fears are exercised upon trifles, or are altogether ground-
 less.  Some  suspect their nearest and dearest friends of designing
 to poison them: others dare not be alone in  the dark lest  they
 should be attacked with ghosts or hobgoblins.   They  dare not  go
 over a bridge or near a pool, rock, or steep hill, lest they should
 be tempted to hang, drown, or precipitate  themselves:  and if they
 come to a place were a robbery or a murde  • has been  committed,
 they instantly feat they are suspected.  Trincavellius had a patient
 that for  three years together, could not be persu ded but that  he
 had killed a man, and  at length sunk into a confirmed  melancholy,
 and made away with himself for fear of the gallows.t
  It is a melancholy reflection that the wisest md best of mankind
 are as open to this affliction as the weakest, and perhaps more so.
 Pascal himself was at one time so hallucinated with hypochondrism,
 as  to believe that he  was always on the  verge of  an abyss into
 which he was in danger of falling.  And under the influence of this
 terror, he would never sit down till a chair was placed  on that side
of him on which he thought he saw it, and thus proved the floor lo
be substantial.
  Under the  second variety  we meet with a totally distinct set of
morbid feelings and ideas; for  the patient is here oppressed with a
* Lib. I. Obs. 31.
t Consil. XIII. Lib. I. 
CE. Ill—SP. II.j        NERVOUS FUNCTION.
m
 general listlessness and disgust: an irksomeness and weariness of
  lie, often without any specific  reason  whatever.  This is the me-
 lancholia Anglica of Sauvages, who describes it as common to our
 own countrymen under the attack of which, says he, "languid, sor-
 "t\T  -n  remed,,CS °f QVevy kind'  they  settle  their affairs,
 «     tW  Mare le,aVeu°f their friends hy letters> ™«  then
 e^bhfnl   ?1CK,rtllV? by han/lng' P°ison' °r  some other means:
 exhibit mg a wish  to  die, not from insanity, or severe grief, but
 tranquilly, from a mere taedium vita, or irks'omeness of existence"'
 1 his may occasionally be the case ; but by far the  greater number
 o suicides m our own country proceed, not  from hypochondrism,
 but a despondency produced by real losses, and belong, therefore
 as I have already  observed,  to the genus empathema.  Yet this
 miserable upshot occurs in a few instances from  the feeling, or
 rather the want of feeling here assigned : the  perpetrators of the
 horrid deed being generally  those who having  been actively en-
 gaged in the heigh-day and  meredian of life,  have retired upon
 heir fortunes with a view of enjoying them  in quiet;  but who un-
 happily find themselves fitted for any thing  rather than for quiet-
 who have no  taste for reading,  reflexion, or domestic tranquillity!
 and are  too proud to return to the bustle of  the world and  the ex-
 citement of nicely balanced speculations.   There is here a want of
 the habitual  stimulus  to a secretion of  sensorial power; in conse-
 quence of which the individual sinks into a state of low spirits and
 becomes unhappy.   A like issue frequently follows upon a life de-
 voted to all the pursuits of sensual gratification, in  the course of
 which the individual has  exhausted his stock of enjoyments, and
 worn out his powers of body and mind before he has reached little
 more than  the midway of his existence.  Every thing now palls upon
 his senses, and  he has neither taste nor energy  to engage in more
 rational pursuits. « A ride out in the morning, and a warm  parlour '
 and a pack of cards in  the afternoon are all  that life affords," said a
 patient of Dr. Darwin's to him, a man of polished manners, about
 fatty years of age.  He got tired of these in a few months, and hav-
 ing no other resource,  shot himself.*
   Burton has well described the state of mind of many that are tor-
 mented with this most wretched malady :f  but still  more so those
 affected with the third variety, which  is  strikingly accompanied
 with peevishness, general malevolence, and an abhorrence of man-
kind.  " They are soon tired with all things; they will now tarry,
now be gone ; now in bed they will rise, now up, then go to bed -
now pleased, and then again displeased ; now they like, by and by
dislike all, weary  of all; sequilur nunc vivendi nunc moriendi cupi-
do, saith  Aurelianus :| discontented, disquieted;  upon every light

           * Zoonom. Vol. IV. p. 90.  Edit. 8vo.
           t Analysis of Melanch. Part I. Sect. HI. i. 2.
           t Lib. I. Cap. VI. 
  104                      NEUROTICA.            [CL. IV.—OR. I.

  occasion or no occasion object; ofien tempted lo make away with
  themselves; they cannot die, they will not live:  they complain,
  weep, lament, and  think they lead a most miserable  life :  never
  was any man so bad.  Every  poor man they see is most  fortunate
  in respect of them :  every beggar that comes to the door is happier
  than they are;  jealousy and suspicion are common symptoms in the
  misanthropic variety.  They are testy, pettish, peevish, distrustful,
  apt to mistake, and ready to snarl upon every occasion, and without
  any cause with their dearest friends.  If they speak in jest the hy-
  pochondriac takes it in good earnest; if the smallest ceremony be
  accidentally omitted he is wounded  to the quick.   Every  tale, dis-
  course, whisper, or gesture he applies to himself.   Or if  the  con-
  versation be openly addressed to him, he is ready to misconstrue
  every word; and cannot endure that any man should  look steadfastly
  at him, laugh, point  the finger, cough or sneeze.  Every question or
  movement works upon him, and is  misinterpreted, and makes him
  alternately turn pale and red, and even sweat with  distrust, fear
  or anger."
   As in  this species  the body is more affected than in any other di-
  vision of mental alienation,  more may often  be accomplished by
  medicine;  though we must by no means be inattentive to moral dis-
  cipline.  The skin is very frequently cold and without a free secre-
  tion, and hence, general friction with rubefacients, and the warmer
  diaphoretics have often been found serviceable.   The digestive or-
  gans are almost always torpid, and several of them,  especially the
  stomach  and liver, secrete their  respective fluids not only in too
  small a quantity, but of an unhealthy quality, so as to be  too viscid,
  too dilute or morbidly stimulant.  Some kind of acrimony, indeed,
  is almost always found in the stomach, and particularly that of  aci-
 dity.  And hence aperients, carminative, and particularly the tonic
 plan which has already been recommended under limosis Dysfiefisia^
 are manifestly called for and will often be found serviceable.
   Post-obit examinations have also frequently pointed out another
 local cause  which otherwise we should little expect;  and that  is a
 displacement of the transverse colon. M. Pinel, as we have already
 observed, regards this as a very common cause of insanity in all its
 forms: but  there can  be no question that it is a powerful  and ready
 cause of the present species of mental alienation. M.Esquiral, who
 has found it as frequently as M. Pinel, tells us that this displacement
 sometimes consists in an oblique, and sometimes in a perpendicular
^direction of the intestine, so that its  sinister extremity lies hehind
 the pubes ;  whilst it has sometimes descended into the form of an
 inverted aorta even below the pubes and into the pelvis. No disease
 of the organization has been found in  any  instance, and hence  the
 change of place must proceed  from  relaxation and  debility alone,
 where the misposition is not connate; on which account it  may, in
 some instances, be an effect, as it is certainly a cause in others.   It
 is under these circumstances that we chiefly meet with that pain in
 the epigastrium to which we  have  already adverted, and which 
6E. III.—SP. IX]       NERVOUS FUNCTION.
105
  gives the feeling of a tight cord surrounding the body in the line of
  distress; and when such a symptom, therefore, occurs, we have rea-
  son to suspect the cause of the disease to be produced by some de-
  rangement of the colon in respect to position.   Under the operation
  of such a cause the art of medicine can do but little:  temporary
  ease, however, may be obtained  by the pressure  of a  belt broad
  enough to support the whole of the lower belly; and it  is possible
  that the  intestine may gradually right  itself under a course of the
  warmer tonics, as columbo, canella alba and cassummuniar, or lose
  its morbid irritability by habit.   But these are rare terminations-
  tor  more generally the displacement increases and the disease itself
  gains ground and becomes more incurable.
   Congestions from weakness of vascular action in one or more of
  the abdominal viscera, are a frequent  result  of the present  com-
  plaint, and not unfrequently a primary cause : and  hence we may
  see why the bleeding piles should be  serviceable  in so many in-
  stances as to obtain from Alberti the name of medicina hyfiochondria-
  corum* and why leeches repeatedly applied to the anus, as  recom-
 mended by Schoenheyder, should often have a like beneficial  ef-
 fect.!  This is of  the  greatest importance where the disease has
 been preceded by a periodical flow of blood from the hemorrhoidal
 veins:  and should point  out  to us  the  necessity of renewing any
 other discharge or external irritation to which the system may have
 been accustomed.
   Opium is  a very doubtful medicine, though strongly recommend-
 ed by Deidier and other respectable writers; and readily  had re-
 course  to by hypochondriacs themselves to relieve their distressful
 sensations.   Dr. Cullen asserts peremptorily  that he has  always
 found a frequent use of opiates pernicious in hypochondriacs :\ and
 in many instances in which I have myself been  tempted to  employ
 it, I  have been  compelled to withhold its further use  from its doing
 more mischief than good.  It has often,  in such cases, been  ex-
 changed for other sedatives,  but  rarely with  any decided  advan-
 tage.
   Exercise of all kinds should be encouraged in every modification
 of the disease, but  especially exercise on horseback, though it is
 seldom  in the first and third variety we can succeed in getting a pa-
 tient to try  it.  The diet should  be governed by  the principles
 already laid down for treating indigestion.
   In the moral management, assiduous kindness and consoling con-
 versation produce a deeper effect than they seem to do.  Loquacity
 is always hurtful,  but a talent for cheerful discourse, intermixed
 with interesting and amusing anecdotes, frequently draws away the
patient's attention from himself, and becomes a most  useful  pallia-

           *  Dissert, de Hxmorrhoidibus. Halle. 1716.
           f Act Soc. Med. Hafn. II. p. 313.
           * Mat. Med. Vol. II. p. 245. Edit. 4to.
  vol. III.—14 
106
NEUROTICA.
[CL.IV.—OR. I
tive.  In the autalgic variety in which he  is perpetually haunted
with a feeling of some dreadful disease which exists no  where but
in his own fancy, the hallucination, when we possess his confidence,
should be removed by a candid statement of the fact, and if necessa-
ry, friendly expostulation:  but the moment we find  the  preposses-
sion is too strong to be removed by argument, it is better to humour
the conceit and to pretend to  prescribe for it.  It is sometimes ne-
cessary, indeed, for the hypochondriac is often possessed of great
cunning, to drop all pretensions whatever,  and to put him in good
earnest upon a course of medicines for a disease we know he is as
free from as ourselves.  Thus, a firm belief that he has an invete-
rate itch is a common delusion with a patient of this kind,  and it
will be often found impossible to persuade him that he is cured till
his whole body has been repeatedly  rubbed over with  sulphur or
hellebore ointment.  I had lately under  my care a special pleader
of considerable eminence, who in the course of this affection would
have it that he had the pox.  I  at first argued  the  point with him
day after day, but to no purpose ; he felt certain that he should never
be well  till  he was not only salivated, but had  used tonic  injec-
tions for a gleet which  he  said accompanied it, though  he  had  no
discharge whatever.  It was in vain to deceive him  by suppositious
medicines, for he was a  man of considerable learning, and well ac-
quainted with medical preparations,  and  I  hence allowed him his
heart's desire; he rubbed in  mercurial ointment every night, and
for an injection used a  solution of zinc.  In a week he  persuaded
himself he was well,  and begged permission to  desist  from a far-
ther use of the remedies :  a permission which was readily granted
him.
  In the second variety, or taedium vilae, where the time seems to hang
intolerably heavy on the patient's hands, from his haying, in a mista-
ken search after happiness,  relinquished a life of constant excitement
and  activity for  the fancied delights of rural retirement and quiet,
the best and most radical cure would  be a  return to the situation
that has been so unfortunately abandoned: but if this cannot be ac-
complished the patient must be put into a train of pursuits of some
pther kind.  If he be fond of  the sports of the country,  he  should
weary himself in the day-time with hunting or shooting, or  even
horse-racing  rather than be  hypochondriacal from idleness ; and
spend his evenings in the bustle of dinner-parties or cards.  And if
he be capacified for higher and  more useful occupations, let him
plunge headlong into the public concerns of the parish and its neigh-
bourhood, become a member  of its select vestries, a trustee of ;he
highways, or a magistrate of the district.  The habit of excitement
must for some time be maintained though it be afterwards let down
by degrees: and the intermediate steps are of no great importance
so far as they answer their purpose.  We are not at present argu-
ing the case upon a principle of  ethics or of religion ; but merely
upon a principle of moral medicine.  Yet I have often known per-
sons of the above description  broken in by degrees  to a love of do- 
«E. III.—SP. II.]      NERVOUS FUNCTION.
107
mestic quiet, for which they were by no means fitted when  they
first entered upon it: and who with a love of domestic quiet have
settled also,  as a soberer stage  of life has advanced, and reflexion
has gained ground upon them, into a love of strict moral order, and
the higher duties of a conscientious Christian, to which at one time
they seemed as little disposed.
                        GENUS IV.


                       VPHELXIA.



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

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

  1.  APHELXIA SOCORS.          ABSENSE OF MIND.
  2.  '         INTENTA.         ABSTRACTION OF MIND.
  3.  '  ■       OTIOSA.           BROWN  STUDY. 
108                     NEUROTICA.           [CL. IV.—OR. 1.

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


                 APHELXIA  SOCORS.

                    ^fosense of J&tirtr.

TRUANT ATTENTION ;  WANDERING FANCY; VACANT OR VACILLATING
                        COUNTENANCE.

This is an absence or vacuity of mind  too common at schools and
at church ; over tasks and sermons; and there are few readers who
have not frequently been sensible of it in some degree or other.
  In reading books in which we are totally uninterested, composed
in a tedious and repulsive style, we are almost continually immersed
in this species of revery.  The will does  not exert its power ; the
attention is suffered to wander to something of stronger attraction ;
or the  imagination is left  to  the play of its own nugatory ideas;
and,  though we continue to read, we  have not the smallest know-
ledge of the argument before us: and if the subject  to which the
train of our thoughts is really directed  be of a strikingly ludicrous
character, we  may possibly burst  into  a laugh in the middle of a
discourse of great gravity and seriousness,  to the astonishment of
those around us.
  This is a common  case,  and may lead to great embarrassment.
We have nevertheless thus far supposed that the will does not ex-
ert its  power, and sufficiently rein  in the  attention  to the subject
addressed to it. It not unfrequently  happens, however, that the will,
for want of a proper  habit, has lost its power either wholly or in a
very great  degree, and  cannot  with  its utmost  energy exercise a
due control over the  attention; and it also happens in other cases,
from a peculiarity of temperament, or  morbid state  of body, that
the faculty of the attention itself is so feeble that it is incapable of
being steadily directed  for more than a few minutes  to any object
of importance whatever, with all  the effort of the will  to give it
such direction.
  The mind under either of these conditions is in a deplorable state
for all the  high purposes  of reflexion  and knowledge for which
by its nature it is  intended; since it is upon the faculty of attention 
GE. IV.—SP. I.]       NERVOUS FUNCTION.
109
 that every other faculty is dependent for its vigour and expansion-
 without it the perception exercises itself in vain; the memory can
 lay up no store of ideas; the judgment draw forth no comparisons;
 the imagination must become blighted and barren : and where there
 fat ™ aUentl°n whatever the case must necessarily verge upon

   In early life the attention, like every other faculty of the mind,
 is weak and wandering, is often  caught with difficulty and rarely
 fixed upon any thing.   Like every other faculty,  however,  it  is-
 capable of being strengthened and concentrated; and may be made
 to dwell upon almost any object  proposed.  But  this is a work  of
 time, and forms one of the most important parts of education: and
 in the course of this discipline, it should not  be forgotten that the
 faculty  of attention,  when  it first  shows itself,  is more readily
 arrested by some  subjects than by  others, and  that it is hence  of
 great moment to ascertain those subjects, and to select them in the
 first instance.   The habit is what is chiefly wanted, and the quicker
 this is acquired the more time we gain  for transferring the same
 habit to other and perhaps more valuable purposes afterwards.
   This is a point seldom sufficiently considered  in the course  of
 education;  and for want of such consideration, far more than half
 the time of many boys becomes an entire blank and is lost, and not
 a  few are suffered to remain blockheads in the particular depart-
 ment to which their hours of study are directed, who might discover
 a considerable capacity and genius if the department were changed
 for one more adapted to their own taste, or in other words more
 attractive  to their attention.
   There is a very singular instance of habitual absence of mind
 related  by Sir A.  Crichton, in a young patient  under the care  of
 Dr. Pitcairn and himself, which, though some other  circumstances
 appear  to have  combined with it, is ascribed considerably  to the
 error of  education  we  are  now  speaking of, that of not duly
 studying the peculiar bent of a mind in many respects  singularly
 constituted, and drawing forth and strengthening the faculty  of
 attention, which  was in an  especial degree weak and truant, by
 an employment of such objects and  pursuits as were most alluring.
 This patient was a young gentleman of large fortune, who, till the
 age of twenty-one, and he does not  seem to have been much more
 at the time of describing his case, had enjoyed a tolerable share  of
 health, though of a delicate frame.  In his disposition he was gentle
 and  calm, but somewhat unsociable.  His absence of mind  was
 extreme,  and he 'would sometimes willingly sit for a  whole day
 without moving.  Yet he had nothing of melancholy belonging to
 him; and it was easy to discover by his  countenance that a  multi-
 plicity of  thoughts were constantly succeeding  each other  in his
 imagination, many of which  were gay and cheerful; for he  would
heartily  laugh,  at times not with an unmeaning  countenane, but
 evidently from mental merriment.  He was occasionally so strangely
inattentive that, when pushed by some want which he wished to 
110
NEUROTICA.
[CL. IV.—OR. I.
express, if he had begun a sentence, he would suddenly stop short
after getting half way through it, as though he had forgotten whajt
else he had to say.  Yet when his attention was roused and he was
induced to speak, he  always expressed himself in good  language
and with much propriety;  and if a question were proposed to  him
which required the exercise of judgment, and he  could be made to
attend to it, he judged correctly.  It was with difficulty he could be
made to take any exercise:  but was at length prevailed upon to
drive his curricle, in  which Sir  Alexander at times accompanied
him.  He at first could not be prevailed upon to  go beyond half a
mile: but in succeeding  attempts  he consented to  go farther.
He drove steadily, and when about to pass a carriage took pains to
avoid it: but when at last he became familiarized with this exercise
he would  often relapse into thought, and allow the reins to hang
loose in his  hands.   His  ideas  seemed  to  be for ever  varying.
When any one came across  his mind which excited anger, the
horses suffered  for  it; but the  spirit they exhibited  at such an
unusual and unkind treatment made him soon desist, and re-excited
his attention to  his own safety.   As soon  as they  were quieted, he
would  relapse into  thought;  if his ideas  were melancholy the
horses were allowed  to walk slow; if they were  gay and cheerful
they were  generally  encouraged to go fast.*
  Something may in this case perhaps be owing, as supposed by
Sir A. Crichton, to an error in the mode of education : but the chief
defect seems to have been in the attentive faculty itself and its la-
bouring under  a natural imbecility which  no mode of education
could entirely have removed.   We have had frequent occasions to
observe that the powers of the mind vary in different individuals as
much as those of the body: and we  have already  offered  examples
of weak or diseased judgment, weak or diseased perception, and
weak or vehement imagination.   In  the case before us, the mental
disease seems to have been chiefly confined to the faculty of atten-
tion :  and  we  shall presently have to notice a similar imbecility of
the memory, and even of all the mental faculties conjointly.
• Of Mental Derangement, Vol. I. p. 281. 
 GE. IV.—SP. II.]      NERVOUS FUNCTION.                 Jj j


                         SPECIES  II.

                APHELXIA INTENTA.

                   &frstvactfon o£ jHfutr.

 THE ATTENTION WOUND UP AND RIVETED TO A PARTICULAR SUBJECT,
   WITH SYMPATHETIC EMOTION OF THE MUSCLES AND FEATURES CON-
   NECTED WITW ITS GENERAL DRIFT.

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

 *  Aphelxia a pathemate.      From  some overwhelming passion.
 0  Aphelxia a studio.          From  intense study.

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

ment, as well as the attention, are jointiy called into action and kept
equally  upon the stretch.  Of the power of this variety of revery
in rendering an individual torpid and almost dead to all around him
we have a decided instance in Archimedes at the time of his arrest.
When the Roman army had at 1 ngth taken Syracuse by stratagem^
which the tactics of this consummate engineer prevented them from
taking by force, he was shut  up in his closet, and so intent on a
geometrical demonstration, that  he was equ.-.lly insensible to the
shouts of the victors, and the outcries of the vanquished.   He was
calmly drawing the lines of a diagram when a soldier abruptly en-
tered  his room, and clapt a sword to his throat.  " Hold, friend,"
said Archimedes, "one moment, and my demonstration will be finish-
ed."  The soldier, surprised at his unconcern at a time of such ex-
treme peril, resolved  to carry him before Marcellus ; but as the
philosopher put under his  arm a small box full of spheres,  dials,
and other instruments, the soldier, conceiving the box to be filled
with gold, could not  resist the temptation and killed him on the spot.
                       SPECIES III.


                 APHELXIA  OTIOSA.

                      ftroton=&tuttg.

LEISURELY LISTLESSNESS J VOLUNTARY SURRENDER OF THE ATTENTION
  AND THE JUDGMENT TO THE SPORTIVE VAGARIES OF THE IMAGINA-
  TION ; QUIESCENT MUSCLES ; IDLE GRAVITY OF COUNTENANCE.

The attention is equally summoned into action, and dismissed at the
command of the will.   It is summoned in the last species;  it is dis-
missed when a man voluntarily surrenders himself to ease and list-
lessness of mind; during which period, moreover, in consequence
of this indulgence in general indolence, the external senses them-
selves unite in a mental quiescence, and a smaller portion of ner-
vous fluid is  probably  secreted for  the very reason that a smaller
portion  is demanded ; and hence the active senses without  are as
vacant and unstrung as the active senses within, and as blunted to
their respective stimuli-  The first playful ideas that float over  the
fancy in this  case take the lead, and the mind relaxes itself with
their easy and sportive flow.  It is the studium inane of Darwin,*
who seems, however, to have in some degree misapplied the name,
or to have confounded the aberration  with that of  ecphronia or
alusia.   Cowper has admirably described it in the following verses:
* Zoonom. HI. I. ii. 2. and again IV. II. iv. 2. 
CE. IV—SP. HI.]       NERVOUS FUNCTION.
113
         Laugh ye who boast your more mercurial powers,
         That never feel a stupor, know no pause,
         Nor need one; I am conscious, and confess,
         Fearless, a soul that does not always think.
         Me, oft, has fancy ludicrous and wild,
         Sooth'd with a waking dream of houses, towers,
         Trees, churches, and strange visages, express'd
         In the red cinders, while with poring eye
         I gaz'd, myself creating what I saw.
         Nor less amus'd have I quiescent watch'd
         The sooty films that play upon the bars
         Pendulous, and foreboding, in the view
         Of superstition, prophesying still,
         Though still deceiv'd, some stranger's near approach.
         'Tis thus the understanding1 takes repose
         In indolent vacuity of thought,
         And sleeps, and is refresh'd.  Meanwhile the face
         Conceals the mood lethargic with a mask
         Of deep deliberation, as the man
         Were task'd to his full strength, absorb'd and lost.

   In the indolent mind such indulgence is a disease, and if not studi-
 ously watched and opposed will easily  become a habit.   In the
 studious and active mind it is a wholesome relaxation ; the sensory,
 in the correct language of the poet "sleeps and is refreshed," grows
 fertile beneath  the salutary fallow and prepares itself for new har-
 vests.
   This  is more particularly the case  where, in conjunction with an
 attention " screwed  up  to the sticking place" and long  continued
 there, a spirit of ardent emulation is at the same time stirring, and
 distracted between the hope  and fear of gaining or losing a distin-
 guished honour or reward.   I have seen  this repeatedly  in young
 men who have been striving  night and day, and week after week,
 for the first prizes of our English universities ; some of whom have,
 indeed,  succeeded, but with  a  hectic exhaustion  that has been re-
 covered from with great difficulty; while  others in the full prospect
 of success have been compelled to relinquish the pursuit and to de-
 grade.
  Yet even without this conflict of  feeling, where  the  attention
 alone has been  too long directed to one or to  a variety of recondite
 subjects without relaxation,  the  mind suffers considerably  and its
powers become shaken and confused ; of  which  we have  an inter-
esting example in the case of Mr. Spalding, a scholar of considerable
eminence in Germany,  as drawn  by himself and communicated to
the editors of the Psycological Magazine.*  His attention,  he tells
us, had been long kept upon the stretch   and  had been still  more
distracted by being continually shifted from one subject to another.
When being called upon to write a receipt for money paid  him on
account  of the poor, as soon as he had written the two first  words
he found himself incapable of proceeding farther.  He strove all
he could, and strained his attention to the utmost, but to no purpose;
       * Crichton's Inquiry into Mental Derangement, I. 237
vol. in.—15 
114                      NEUROTICA.           [CL. IV.—OR. I.

he knew the characters he continued to make were not those he
wished to write, but could not discover where the fault lay.   He
then desisted, and partly by broken words and syllables, and partly
by gestures, made the person who waited for the receipt understand
that he should leave him.   For about half an hour, a tumultuary
disorder reigned in his senses, so that he was incapable of remarking
any thing very particular, except that one  series of ideas of a  tri-
fling nature and confusedly  intermixed, forced themselves involun-
tarily in his mind.  At the same time his external senses continued
perfect and he saw and knew every thing around him.   His speech,
however, failed in the  same manner as his power of writing, and he
perceived that he spoke other words than those  he intended.  In
less than an hour he recovered himself from this confusion, and felt
nothing but a slight head-ache.   On examining the receipt on which
the aberration  first betrayed itself, he found  that instead of the
words "fifty dollars, being one half year's rate;" he  had written
" fifty dollars through the salvation of Bra—" the  last  word being
left unfinished, and without his having the least recollection of what
it was intended  to be.
                        GENUS V.

                     PARON1RIA.

                    Slee^trtstttrfeance.

THE VOLUNTARY ORGANS CONNECTED WITH THE  PASSING  TRAIN OJb
  IDEAS, OVERPOWERED BY THE FORCE OF THE IMAGINATION DURING
  DREAMING, AND  INVOLUNTARILY EXCITED TO THEIR NATURAL OR
  ACCUSTOMED AOTIONS : WHILE THE OTHER ORGANS REMAIN ASLEEP.

Paroniria, from nctpx and ovctpev, signifies, " depraved, disturbed or
morbid, dreaming."  So  in Dioscorides,* Pvo-ovupos. signifies, " tu-
multuosis et malis somniis molestans."
  In treating of the genus ephialtes, or night-mare,f I endeavoured
to explain its course and nature; and hereby pointed out the essen-
tial distinction which exists between that  disease and the present
and the impropriety of uniting the species which belong to  both of
them under one head, as Dr. Cullen  has done in his genus oneirody-
nia, since, with the exception of their occurring in the night and
during sleep, and therefore involuntarily, they have little  or no
connexion or resemblance in cause, symptoms, or even mode of
cure.
* Vol. ii. p. 127.
f Vol. I. Ord. II. Gen. V. p. 388. 
GE. V.]
NERVOUS FUNCTION.
116
  The three following species are so clearly and decidedly of one
and the same family, as to prevent all dispute in their present posi-
tion.  They are here, however,  associated for the first time  in a
genus distinct from ephialtes.
     1. PARONIRIA AMBULANS.           SLEEP-WALKING.
     2.----------LOQUENS.             SLEEP-TALKING.
     3.-----■ SALAX.               NIGHT-POLLUTION.
  The nature of these singular affections, and the means by which
they are produced, have never yet been explained, and rarely, so
far as I  know, has any explanation been attempted.  To understand
them fully, it would  be necessary for us to enter  into a minute de-
velopment  of the physiology of sleep and dreaming,  which the
limits of the present  work will not allow. On some future occasion
the author may, perhaps, follow it up into such a detail: but a few
general remarks must suffice for the occasion before us.
  In sleep, accompanied with dreaming, the faculties of the mind
bear a pretty close parallel with those of  the  body  as to the effect
produced upon  them.  Some of  them, as the  will,  the perception,
the judgment, are in a state of general torpitude like the voluntary
organs of ihe body; while the memory and the imagination, like
the vital or involuntary organs of the body, are in as  high  activity
as ever. The  sensory is hence  as  much crowded with ideas as at
any time ; but,  destitute of a controlling power,  they rush  forward
with a very considerable degree of irregularity, and would do  so
with the most unshapeable confusion, but that the habit of associa-
tion still retains some degree of influence, and produces some degree
of consonance and proportion in the midst of the wildest and most
extravagant vagaries. And hence that infinite variety that takes place
in the character of our dreams; and the greater regularity of some,
and  the greater irregularity  of others.  Hence  a  combination  of
thoughts or ideas sometimes only in a small  degree  incongruous,
and at other times most frantic and heterogeneous; occasionally, in-
deed, so fearful and extravagant, as to stimulate the external senses
themselves  into a sudden renewal of their functions,  and conse-
quently to break off abruptly the sleep into which they are thrown.
   Now, as the stimulant force of our ideas in dreaming is often suf-
ficient to rouse the external senses  generally,  and to awake us  all
of a sudden; it may be of such a kind, and just of such a strength,
as to excite into their accustomed action the muscles of those or-
gans or members only, which are more immediately connected with
the train of our dreams or incoherent thoughts;  while every other
organ may still remain torpid.  And hence the muscles chiefly ex-
cited being those of speech, some  persons  talk, or the muscles
chiefly  excited  being those of loco-motion, other persons walk,  in
their sleep, without being conscious, on their waking, of any such
occurrence.*  And by the same means we may  easily account for
  *  Hennings, Von den Traumem und Nachtwandlern. Weimar 1784.
    Horst, De Natura, Differentiis et Causis eorum qui dormientei ambulant,
&c.   Leips. 1593. 8vo 
116                     NEUROTICA.            [CL. IV.—OR. I.

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

              PARONIRIA  AMBULANS.

             Somnambulism.  Slcc^uiaUuiiQ.

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

In profound sleep all the faculties of the mind as well as all the
voluntary organs of the body, are in a slate of inactivity or torpi-
tude, and the only organs that preserve their active tenour are the
involuntary ones :  so that in this state there is neither thought nor
idea of any kind.  In dreaming, some of the mental faculties only
sleep or are  torpid, while the others, like the involuntary organs of
the body, continue wakeful or active : the somnolent faculties, we
have already observed, are the will,  the perception, and judgment;
the wakeful are the memory and the imagination.
   It would not be difficult, if we had time, to show why the involun-
tary organs do not require rest, or  in other words become torpid
like the  voluntary; nor why the will  and the judgment sooner
associate in the general sleep of the external senses than the ima-
gination, but this would carry us too far into the subject of animal
physiology.  There are two physiological remarks, however, which
it is necessary to make in explanation of the morbid affection im-
mediately before  us.  The first is, that sleep is a natural torpitude
or inertness induced upon the  organs of the body (with the excep-
tion of the involuntary)  and the faculties of the mind by fatigue
and exhaustion.  And the next is that,  in the production of sleep,
it is not necessary that all these powers of body and mind should
have been equally exposed to exhaustion : for, such is the effect of
association and habit, that as soon as one faculty or organ feels fa-
tigue, or  becomes exhausted, the rest participate in the same con-
dition, and the sleep or torpitude becomes  common to the whole.
It is hence the body is made drowsy by mental study and the mind
by corporeal labour; that muscular exercise wearies all the senses,
and the exertion of the senses wearies the muscles :  though there
can be no doubt  that the general tendency to sleep is also partly
superinduced by the indirect exhauslion sustained by the organs or
faculties that have been  less employed, in consequence of the share
of sensorial power which, as from a common  stock, they have them-
selves  contributed  towards the support of  the more active and
hence more debilitated powers.
  Now it sometimes happens, either from disease or peculiarity of 
GE. V.—SP. I.]
NERVOUS FUNCTION.
117
 constitution, that all the external organs of sense  do not associate
 in the general action that has taken place, or yield alike  to the
 general torpor to  which it  gives rise ; and that the auditory, the
 optical or some other sense, continues awake, or in vigour, while
 all the rest are become inert;  as it  does  also, that such particular
 sense, like the muscles of particular members, as observed  a page
 or two above, is  awoke or re-stimulated into action in the midst of
 the soundest  sleep by the peculiar  force and  bent  of the dream,
 while the rest still sleep on and are unaffected.
   If the external organs of  sense thus stimulated be that of sight,
 the dreamer may perceive objects around him, and be able  to dis-
 tinguish them ;  and if the tenour of the dreaming ideas should as
 powerfully operate upon the muscles  of loco-motion,  these also
 may be thrown into their accustomed state of action, and he may
 rise from his bed and make his way  to whatever place the drift of
 his dream may direct him, with perfect ease, and free from danger.
 He will see more or less distinctly in proportion  as the organ of
 sight is more or  less awake: yet from the  increased exhaustion,
 and of course, increased torpor of the other organs, in consequence
 of an increased demand of sensorial power from the common stock,
 to supply the action of the sense and muscles immediately engaged,
 every  other sense will probably be thrown into a  deeper sleep or
 torpor than if the whole had been quiescent.  Hence the ears may
 not  be roused even by  a sound that might otherwise awake the
 sleeper.  He may be insensible, not  only to  a slight touch,  but  a
 severe shaking of the limbs ; and may even  cough violently with-
 out being recalled from his dream.  Having accomplished the ob-
ject  of his visionary pursuit, he may safely return, even over the
most dangerous precipices, for he sees them distinctly, to his bed;
and the organ of  sight being now quite  exhausted, or there being
no longer any occasion for its use, it may once more associate in
 the general inactivity, and the dream take a  new turn, and  consist
 of a new combination of images.
   Somnambulism occurs in many persons without any manifest pre-
disponent cause, though it is generally connected with  a considerable
irritability of habit. A  morbid state of the stomach, where this habit
exists, has very  frequently proved  an  exciting cause:  of  which
Dr. Yeates has given us an example  in the case of  a  young gentle-
man of ten years  of age related in the Medical Transactions.*  He
was of a delicate  frame, often troubled with  sickness ; sometimes
rejected his food undigested, after having lain two days in his sto-
mach ; his bowels  were costive, and the  stools  were dark, offen-
sive, and  ill-formed.  The sympathetic symptoms were  frequent
head-aches with occasional stupor, general coldness of the skin and
limpid urine.   After being in bed for about two hours, he was wont
to  start up suddenly as in  a  fright, dart rapidly into  the middle of
the chamber, or of the room adjoining, and walk about with  much
* Vol. V. Art. XXVIII. p. 444. 
 118                    NEUROTICA.            [CL. IV.—OR. I

 agitation.   In this state he would run over quickly, but incorrectly.
 the transactions of the day; and he once attempted to spell a word
 which in the day time he had spelt wrong, in doing which he jum-
 bled a number of letters together.  When spoken to  he would make
 a rational reply; and in one of his sleeping perambulations he called
 for  an epitome of the History of England which  he was in  the
 habit of reading: the nurse brought him a book, but not the  one
 called for:  on  perceiving the difference he immediately threw  it
 from him with great violence, and with expressions of anger  and
 disappointment.   On  these occasions  his  eyes were wide open,
though he did not seem conscious of seeing, nor of his situation at
 the time. It was, says Dr. Yeates, a perfect state of dream through-
 out, though partaking of the acts of the waking state, for he would
 avoid objects walking about the room.  His face was quite  pallid at
 the time.
  In this case  much of the nervous hurry and agitation seems to
 have depended upon the debilitated  and irritable  state of the  pa-
 tient's frame.   But where the  affection proceeds from idiosyncrasy
 or there is  no disturbance of the general health, the dreamer often
 proceeds far more cooly and collectedly: and the eye-lids, instead
 of being wide open as though  staring, are often not  more than  half
 unclosed, in some cases even less than this : which has given occa-
 sion to marvellous stories of somnambulists walking over dangerous
 places, or avoiding dangerous  objects with their  eyes completely
shut all the time.
  The remedial treatment it may be necessary to pursue, we shall
defer till we have briefly noticed  the succeeding species,  as  the
same treatment will apply to the whole.
                        SPECIES II.


               PARONIRIA  LOQPENS.

                       Slceji'talufttfl.

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

It is not necessary to dwell upon this species, as we have already
explained the general principles of the  inordinate action in the pre-
ceding pages.  As the train of ideas which form the dream, when
peculiarly lively and immediately connected with the organs of loco-
motion, may stimulate those organs into their accustomed activity,
and thus give the dreamer a power of walking without conscious-
ness; in like manner if a similar train of dreaming ideas be imme 
GE. V.—SP. II.]       NERVOUS FUNCTION.
119
diately connected with the organs of speech, these may  also be
equally influenced, and the dreamer be able to talk  without being
conscious of it, or having any recollection of such exertion when he
awakes.  And so, for reasons already specified, the organ of sight is
sometimes, in the same way, roused from a state of sleep or torpi-
tude to a state of wakefulness, while all the other external senses
continue somnolent, or, from idiosyncrasy or some local or acci-
dental cause,  does not join in the general repose, but continues vi-
gilant during  its dominion;—the organ of hearing may be roused in
the same manner or exhibit the same anomaly; and, in this case,
the dreamer,  who under the influence of the last  species of affec-
tion, is able to see as well as to walk, is able, under the present, to
hear as well as to speak.  Examples, indeed, are given  in which a
byestander obtaining some clue into the train of thoughts of which
the dream is composed, has been able, not only to keep  up  an irre-
gular conversation, but, by dextrous management and the artful as-
sumption of a character which he finds introduced into  the dream,
to draw from  the dreamer ihe profoundest secrets of his  bosom, the
dreaming ideas generally consisting of those on which the dreamer
is most employed when awake, or which lie nearest  his heart.  I
have never met with a case of this kind in my own practice, but  it
is given as a fact by various physiologists from  the time of the
Greeks and Romans to our own day.
                        SPECIES III.

                 PARONIRIA  SALAX.

                      J£fgut=j)ollutfou.

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

By Sauvages this affection is absurdly placed among the species of
gonorrhoea, which, with great  looseness of generic character is de-
fined " passio cujus praecipuum symptoma est fluidi fiuriformis vel
seminiformis effluxus stillatitius ex urethr.;." This definition is, in-
deed, wide enough to embrace the affection before us; but the ab-
surdity consists in intermixing a natural discharge produced by the
ordinary orgasm  with morbid discharges, in which, in most cases,
there is no orgasm whatever.  Dr. Cullen, however, has continued
to assign the same place and the same name to the present species,
and this with still greater inconsistency; since he has struck out of
his definition of gonorrhoea the epithet seminiformis, and confined it
to  a " fluxus humoris ex urethra fireter naturam."  So that he has
been obliged to break his own bounds to introduce this natural flux 
120
NEUROTICA.
[CL. IV.—OR. I
into the place he has allotted it.  And hence in his lying down the
treatment of gonorrhoea in his Practice of Physic, he takes no no-
tice of his gonorrhoea dormientium, as though feeling that it was
altogether a different subject.
   We have already observed that whatever part of the animal frame
is immediately connected with the  tenour of the somnolent vision,
it is often roused, under particular  circumstances, from the general
sleep of torpitude in which it had participated, and becomes wakeful
while every other part perseveres in the common repose.  During
sleep, moreover, our ideas are often more lively and operative  than
during wakefulness, and this on two accounts; first, because from
the uninterrupted activity of the involuntary organs there is a more
ready secretion of sensorial, as well  as of most other  fluids, in a state
of perfect tranquillity ; and next, because the ideas that predomi-
nate at the time  are not broken in  upon or weakened by  exterior
impressions and disturbances.  It  is, on this account,  when  the
faculty of the judgment is stimulated into activity, instead of the ear
or eye or the motory powers, a man  has sometimes been able to
solve difficulties in dreaming which proved too hard for him when
vigilant.  And to this effect Dr. Spurzheim : " somnambulists," says
he, " even do things of  which they are not capable  in  a  state  of
watching;  and  some dreaming persons reason sometimes better
than they do when awake."*  A singular and amusing instance of
this occurred not many years ago to a very excellent and justly ce-
lebrated friend of the author's, the Reverend William Jones  of Nay-
land, Suffolk, who among  other  branches  of science, had deeply
cultivated that of music, to which indeed  he was passionately at-
tached.   He was a man of an irritable temperament, ardent mind,
and most active and brilliant imagination : and was hence prepared
by nature for energetic and vivid ideas in his dreams. On one occa-
sion during his sleep, he composed a very beautiful little ode of about
six stanzas, and set the same to very agreeable music: the  impres-
sion of which was so  firmly fixed in his memory, that on rising in
the morning he set down and copied from his recollection, both the
music and the poetry.
  It is hence not difficult to conceive that members so irritable  as
the sexual organs, when once the imagination leads energetically  to
the subject of concupiscence, should occasionally participate in the
vision, and prove their sympathy by the result.
  In some morbid states of the body, and  especially when  accom-
panied with local irritation, produced by inflammation, fibrous en-
tony, the debility of old age, or a habit of vicious indulgence, a se-
minal flux has sometimes  taken place without any connexion with
the dream, and sometimes without either erection or turgescence;
but this does not constitute  the affection immediately before us ;  in
which the stimulant power lies in  the  sensory  and is propagated
from that organ to those of  generation.
* Physiognomical System, p. 175, 8vo. Lond. 1815. 
GE. V.—SP. III.]
NERVOUS FUNCTION.
121
   The Roman poet who so admirably  unlocked the nature  of
things to his  contemporaries, by following the footsteps of nature
herself into most of her deepest recesses, directed his attention to
this subject, among other physiological facts, and has elegantly ex-
plained it in the above manner; adducing, at the same time, another
instance of the influence which the ideas of dreaming  sometimes ex-
ercise over the organs connected with them, derived from the eva*
cuation of the bladder which frequently takes place in children
whose dream  is directed to  this natural want,  and  who image to
themselves the ordinary vessel employed for such purpose, as at
hand for their  use.

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

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

                     • De Rer. Nat. IV. 1020.
  VOL. ill.—16 
122
NEUROTICA.
[CL. IV.—OR. I.
cumulation of the sensorial principle during sleep, and this may be
accomplished in two very distinct and opposite ways.  The first is
the use of a hard mattress, with so small a covering of clothing that
the sleep may be somewhat less sound than ordinary, and  conse-
quently more easily broken off. For the force of our dreaming ideas
will always be in proportion to a certain degree of soundness in our
sleep: I say a certain degree, for if the fatigue or exhaustion,  or
torpitude, be extreme, the sleep will become profound or lethargic,
all the  faculties of the mind will participate in it, and, as already
observed, there will be no ideas or dreaming whatever.
  And hence the second mode of preventing an accumulation of sen-
sorial, and especially of irritable  power, will be the employment of
narcotics  till the  morbid habit is destroyed; for these, when car-
ried to a sufficient extent,  diminish vascular action, and consequently
take off sense and motion so completely as to extinguish the vital
principle  altogether, and hence not only to suppress all power  of
dreaming, but even life itself.
  I had lately under my care for the last species, a very modest and
regular young man, who was a student of Christ's College, Cam-
bridge,  and was alarmed  at the idea of having  his constitution un-
dermined by its continuance.   He was rapidly  growing, of slender
make, and a relaxed habit.  Nitre, which has been so often recom-
mended as a sedative, in this case did no service : but under the use
of a pill composed of one grain of opium and five of camphor taken
nightly, and draughts of myrrh, and infusion of columbo acidulated
with sulphuric acid, he lost the tendency in a fortnight, after having
been subject to the discharge  for many  weeks.  His bowels were
kept at the same time constantly stimulated  by the pill of aloes
and  myrrh :  and  the cold bath formed a part  of  his  regimen.
Pagani  and De Cazelles* have recommended electricity; but the
author has never tried its effects, having uniformly succeeded with-
out it.
  When  either of these  species, but particularly the two former,
are connected with a morbid state of the stomach, the disease must
be attacked in this quarter, as it was with great judgment and a*'"
favourable issue in the case quoted from Dr. Yeats.
f Journ. de Medicine, Tom. LXXIV 
GE. VI.]
NERVOUS FUNCTION
123
                        GENUS VI

                         MORIA.

                         iPatufts.

          DEFECT OR HEBETUDE OF THE UNDERSTANDING.

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

         I.  MORIA IMBEOILLIS.          IMBECILITY.
         2.  ..... DEMENS.             IRRATIONALITY. 
i 24                      NEUROTICA.            j.CL. IV.—OR. I.


                         SPECIES  1

                 MORIA IMBECILLIS.

                    Rental Kmijectlttg.

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

We have already observed that all the faculties of the mind are as
subject  to  a diseased  disturbance as  the  organs of  the  body :
and hence  all of them are  liable to  be affected by the present
species.   The whole  of the  varieties,  therefore,  under  which
mental imbecility is capable of being contemplated might form an
extensive list: but it will be sufficient to confine  ourselves  to  the
four following:

* Stupiditas.             Dullness and indocility of the  appre-
  Stupidity.                hension;  torpitude and poverty of the
                           imagination.
o Amnesia.              Feebleness or failure of the memory.
  Forgetfulness.
-/ Credulitas.            Weakness  and undue  pliancy of  the
  Credulity.               judgment, with  a facility  of  being
                          duped.
^ Inconstantia.           Instability and irresolution of the will.
  Fickleness*

  In stupidity there is generally a dullness of several of the faculties
besides  the apprehension and  the imagination ;  and  sometimes,
perhaps, in all of them  : but then it originates in these, and the rest
are for the  most part only secondarily  dull, as not being furnished
with a sufficient number of ideas or in sufficient rapidity  for their
use.   Thus the judgment of a heavy or stupid man is often as sound
in itself as that of a man of capacious comprehension; and more so,
perhaps, for a reason we have already observed under alusia facetosat
or crack-brained wit, than that of a man of  facetious quickness of
parts: but the heavy man requires time and patience to collect his
ideas, and  compare  them with  each  other;  for they are neither
furnished to him in a free current from his memory or his imagina-
tion, nor does he readily apprehend or lay hold of them as they are
offered from external objects to  his perception, which, in  effect, is
little more than a synonym for the apprehension, the apprehension
being the perception in a state of exercise,  or exertion.  There is
hence a material difference in physiology, though, perhaps little in
practice, between ignorance and  stupidity.  The former is want of
knowledge  from want of its ordinary means ; and by the use of such
means may,  perhaps,  soon be gotten  the better of:  the latter is 
GE. VI.—SP. I.]
NERVOUS FUNCTION.
125
dullness  in the use of such knowledge as by ordinary means  has
been  acquired  and  exists in  the  sensory, though in a state of
stagnation or dormancy. Mr. Locke has made the same distinction,
though he has justly enough observed that, for all practical purposes
the man of stupidity had almost as well be without his knowledge as
with it.  "He," says this admirable writer, "who, through  this
default in his memory, has not the ideas that are really preserved
there, ready at  hand  when need and  occasion calls for them, were
almost as good be without them quite, since they serve him to little
purpose.  The  dull  man  who loses the opportunity  whilst he is
seeking in his mind for those ideas that should serve his turn is not
much  more  happy in his knowledge  than one that  is perfectly
ignorant.  It is the business of the memory to furnish those ideas
which it has present occasion for, and in  the  having them ready at
hand on all occasions, consists that which we call invention, fancy,
and quickness of parts."*
  Stupidity or dullness of apprehension may be idiopathic; but it
may also proceed from want of education, or education irregularly
conducted ; for all the faculties of the mind like the muscles of the
body, become invigorated  and are rendered  more  alert by a well-
disciplined exercise.  And hence stupidity is a natural result of
idleness; as it is more particularly of idleness in conjunction with
an undue use of wine and fermented liquors,  which have a prover-
bial power of besotting  the understanding.  It is also produced
temporarily or  habitually  by various corporeal diseases; as hemi-
crania, chronic  inflammation  or dropsy of the head,  gout in the
head, and sometimes repelled cutaneous eruptions or  habitual dis-
charges.
  Stupidity,  like wit, is propagable;  and hence we frequently see
it run from one generation to another; and not unfrequently it forms
a distinctive mark in the mental character  of districts or nations:
in many cases,  indeed, where they border closely on each other.
The Dutch have at least as much  solid sense as their neighbours
the French; but they are  certainly less quick ;  or, in  other words,
they have a duller fancy and apprehension.  Boeotia  in respect to
chorography was merely separated from Attica by Mount Citheron ;
but in  respect to genius the two countries were as far apart as the
poles.   So in the Pacific ocean the natives of Otaheite learn every
thing with facility; the  natives of New  South  Wales have no
aptitude, and learn nothing.  The  residence of a few missionaries
amongst them  for a short term of years,  has nearly civilized the
former ;  the actual possession of the country for a far longer period,
by  a  British public and a  British government, with a perpetual
intercourse, and the  kindest encouragement,  has made little or no
impression upon the latter.
  A failure of memory, however, which forms the second species
of mental imbecility  before us, is a far severer evil  than dullness of
* Essay concerning Hum. Unders. B. II. Ch. X. Sect. 8, 
126                      NEUROTICA.            [CL.IV.-OR. I

perception with poverty of imagination: for as all the sources of
information to which we have been privy cannot be always imme-
diately before us to excite the perception, we must necessarily draw
upon our recollection for those which are not so, and whose ideas
or impressions we stand in need of.  And hence the memory is the
great  store-house of intelligence; and in one sense at least  the
Platonic doctrine is universally true that " all knowledge is remi-
niscence "  There are some minds in whom this faculty has been
peculiarly retentive, as that of  Newton, who made it answer  the
purpose of intuition ;  and of Pascal, who is said never to  have
forgotten, till his health  failed  him,  any thing he had ever done,
read, or thought of.
  Retention of memory, however, is a different property from that
of quickness.  They may and often do co-exist; but  they are also
found separate: for there are many persons who can well catch hold
of an  entire song, an  entire  sermon, or a series of speeches in
parliament, and can recite them almost, if not altogether, verbatim
immediately afterwards, but who lose all recollection  of them in a
day or two;  while there are others who are obliged to pause over
the subject submitted to them,  or to have  it repeated for  several
times before they can get it by heart, yet who when they have once
fixed it  in the memory, retain it as long as they live.   Mr. Wood-
fall, the celebrated reporter of  the parliamentary  debates,  was an
instance of the former of these talents:  the well-known Jedidiah
Buxton of the latter.
  Failure of memory takes place in a variety of ways.  It is some-
times general, and extends to every subject; but it is frequently far
more manifest on some subjects than on  others.   Salmuth men-
tions a case in which the affected person had forgotten to pronounce
words, but could nevertheless write them.*  Mr. J. Hunter was sud-
denly attacked with a singular affection of this kind in December
1789, when on a visit at the house of a friend in town.  " He did not
know in what part of the house he was, nor even the name of the
street when  told it, nor where  his own house was: he had not a
conception of any thing existing beyond the room  he  was  in,  and
yet was perfectly conscious of the loss of memory.   He was sensi-
ble of impressions of all kinds  from the senses, and  therefore looked
out of the window, although rather dark, to see if he could be made
sensible of the situation of the house. The loss of memory gradually
went off, and in less than half an hour his memory was perfectly re-
covered, "f  This might possibly be  connected with a gouty habit
to which Mr. Hunter was subject, though not at this time labouring
under a paroxysm.  The late bishop of Landaff, Dr. Watson, gives
a singular case  of partial  amnesia in  his father, the  result of an
apoplectic attack.  " I  have heard him ask twenty times  a-day,"
 * Cent. II. Obs. 41.
 f Sir Everard Home's Life prefixed to his Treatise on the Blood, Inflamma
ion, &c. 4to. 1794, 
UE. VI.—SP. I.]
NERVOUS FUNCTION.
127
 says Dr, Watson, " what is the name of the lad that is at college ?
 (my elder brother;) and yet he was able to  repeat, without a blun-
 der, hundreds of lines out of classic authors."* And hence, there
 is no reason for discrediting the story of a German  statesman, a
 Mr. Von B. related in the seventh volume of the Psycological Ma-
 gazine, who having called at a gentleman's  house, the servants of
 which did not know him, was under the necessity of giving in his
 name;  but unfortunately at that moment he had  forgotten it, and
 excited no small laughter by turning round  to a friend  who accom-
 panied  him, and saying, with great  earnestness, " pray  tell me who
 I am, for I  cannot recollect."
   From severe suffering of the head in many fevers a great inroad is
 frequently made upon the memory, and it is long before the conva-
 lescent can rightly put together all  the ideas of  his past life.  Such
 was one  of the effects of the  plague at Athens, as we learn from
 J-hucydides, rov$ Je text At)6ti eXxpJZxve 7tx£xvtikx xvxb-txvtxs tm vxtrm
 ofMtw Kcti vyvovG-xv <r0xq re xvtovs, x.xi rov% iiriTfiS'etovs : " and many, on
 recovery, still experienced such an extraordinary oblivion of all
 things that  they knew neither themselves nor their friends." A few
 years ago a  man with a brain-fever was taken  into  St.  Thomas's
 Hospital, who as he grew better spoke to his attendants, but in a
 ianguage they did  not understand.   A Welsh milk-woman, going
 by  accident into the ward, heard him, answered  him and conversed
 with him. It was then found that the patient was by birth a Welsh-
 man, but had left his native land in his youth, forgotten  his native
 dialect, and used  English for the  last thirty years.   Yet in con-
 sequence of this fever he had now  forgotten the English tongue,
 and  suddenly recovered  the Welsh.
  Boerhaave, however, gives a still  more extraordinary instance of
 oblivion in the case of a Spanish tragic author who had composed
 many excellent pieces, but so completely lost his memory in conse-
 quence  of an acute fever, that he forgot  not only the languages he
 had  formerly learnt, but even the alphabet :  and was hence  under
 the necessity of  beginning to read again.  His own poems and com-
 positions were shown to him, but he could  not  be persuaded that
 they were his production.  Afterwards,  however,  he  began once
 more to compose verses;  which had so striking a resemblance to
 his former writings that he at length become convinced of his be-
 ing the author of them.f
  The memory may also be prematurely impaired (for in age it is
 a natural defect) by various other causes. Idleness or inattention
 will  do it, as in the case of stupidity, as will also an over exertion
of the faculty, injuries of the head, rheumatic, or gouty pains in it,
  * Anecdotes of the Life of Richard Watson, D. D. Bishop of Landaff.
  f Prslect. Acad, in Justit. Med. ex Edit. Hallen. Tom. IV. p. 463.  See
;»lso Cricht.  Of Ment. Derangement, I. 370. 
128                     NEUROTICA.            [CL. IV.—OR. I.

dyspeptic maladies,  various narcotic poisons, prostrating hemor-
rhages, or want of food, and libidinous indulgence.*
  Dependent upon this last cause Sir Alexander Crichion has given
a single example of what may be called perverse oblivion in an old
attorney, nearly seventy years of age, who, though married to a lady
much younger than himself, kept a mistress whom he visited every
night.   He was suddenly seized with great prostration of strength,
giddiness, and forgetfulness; but the last was of a peculiar kind and
consisted in the mistaking the name of one thing for that of another;
so that if he wanted  bread he would ask for his boots, and though
enraged at the latter being brought to him, he would still call out
for  his boots or shoes.  In like manner  if he wanted a tumbler to
drink out of,  it was a thousand to one but he would call for the or-
dinary chamber utensil, or, if this were wanted, he would call for a
tumbler or a dish. This gentlemen,  however, was cured of the
complaint by  large doses of valerian and other cardiacs.
  In credulity, constituting the third variety, of the imbecility be-
fore us, the faculty of the judgment is the chief seat  of disorder.
It is unquestionably  more generally to  be found  among ignorant
people than those whose minds are well stored with the elements of
knowledge ; but, as we also frequently perceive among the former
a most obstinate and  wilful incredulity, and among the latter extra-
ordinary proofs of the present  failing, it cannot be regarded as alto-
gether an effect of a  general want of ideas : it is in reality a hebe-
tude or indolence of  the judgment or power of ratiocination, which
induces a man to take things upon trust and allow others  to think
for  him, not for want of ideas, but for want of comparing one idea
with another, those of probability with those of improbability, and
fairly striking the balance;  in  consequence of which, under the in-
fluence of this mental oscitancy, he readily yields himself, body and
soul, to the opinions  of others, and follows such opinions blindfold;
as those who shut their eyes must be led by those that see, or else
fall  into the ditch.
  This is voluntary credulity ; yet many have been so long accus-
tomed to it, that it has all the  effect of a chronic disease, and is as
difficult of cure as the most obstinate.  There are some men, how-
ever, whose judgment  is more morbidly dull  by nature, than from
inactivity  or  a neglected education;  or  may possibly have been
rendered so by intemperance;  who are deficient in natural skill  to
use the evidence they possess of probabilities : and being incapable
of carrying on a train of consequences in their heads, and weighing
exactly the preponderance of  contrary proofs  and testimonies, are
easily misled, and rendered the dupes of every plausible  sophist,
and the playthings of every  impostor.   " There are some men,"
says Mr. Locke, " of one, some but of two syllogisms, and no more;
and others that can  but advance one step farther.   These cannot
• Dissert, de Memorize lacsione ex nimis Vener. usu. Alt. 1695. 
GE. VI.—SP. L]
NERVOUS FUNCTION.
129
always discern that side on which the strongest proofs lie; cannot
constantly follow that which in itself is the more probable opinion."*
  There is another imbecility we have noticed, as strangely inter-
fering with the integrity of the understanding; and that is fickle-
ness, or an instability and irresolution of the will.   The  faculty of
the will requires not only to be directed aright in infant life, but to
be fortified and strengthened by  a course of exercise and  discipline
as much as any faculty whatever.   This we may say as physiolo-
gists; but a moralists we may speak a bolder language, and main-
tain that it demands the spur and trammels of education even more
than all the other faculties  put together, since it  is designed by na-
ture to be the governing power  and  to excercise an absolute sway
over the rest, even  over the desire itself,  by which, however, it is
moved in all ordinary cases.
  A child whose inclinations have never been reined in, is perpetu-
ally letting the will and the desire run together, and changing both
every moment; and if this  disposition  be  suffered  to grow into a
habit, it will produce the fickleness of which we are  now  speaking,
and form a character on which there can be no reliance; whose de-
termination of to-morrow cannot be known  from that of to-day : be-
cause the will itself, void of all firmness or resolution, is the sport
of every transient incident, every, interposing uneasiness or plea-
sure : and which,  hence, becomes its own torment still more than
the torment of those around it;  since being ever instigated  by the
feelings of the moment, and sacrificing the future to the present, it
often purchases a fleeting gratification and of subordinate value at
an expence of permanent and subtantial happiness.
  Upon the remedial process for the mental infirmities which ap-
pertain to this species, little is to be said in a work of medical in-
struction.   So  far as they  relate to corporeal  causes, and we have
pointed out various causes of this kind that apply to several of
them, those causes should be minutely inquired into, and, as far as
possible, removed or palliated; and whatever will tend to invigorate
the entire frame, as the metallic tonics,! regularity of diet, sleep,
exercise, and above all cold bathing} must supply the rest.  To the
arms of mental and moral instruction, however, the sickly under-
standing must  be chiefly entrusted ; and where these are properly
applied the mind may often be rendered sufficiently sound for all
the ordinary purposes of life, and even some of its elegancies, though
it may never be distinguished for terseness, brilliancy, or compre-
hension.   The leading aim should  be to lay hold of the strongest
faculty, and to make the direct cultivation of this an indirect culti-
vation of the rest.
       * Human Understand. Book II. Ch. XIX. § 5.
       f Agricola, commut. in Poppium, Tr. de Argento, p. 136
       t Dauter, Vom Gebranche des Kalten Wassers.
vol. in.—17 
130
NEUROTICA.
[CL. IV.—OR. I
                        SPECIES II.

                   MORIA DEMENS.

               aMttoness.  Xrrattoualttg.

defect or hebetude of all the faculties of the understanding.

Of this species we have three varieties that seem to require a  dis-
tinct notice :

*  Stultitia.                   Shallow knowledge,  vacant coun-
   Silliness.  Folly.             tenance, light  frivolous fancy ;
                               for the  most part with  good na-
                               ture ; sometimes with obstinacy.
«  Lerema.                   Impotence of  body  as  well as
   Dotage.  Superannuation.     of mind  from  premature  old
                               age;  childish desires  and pur-
                               suits :  drawling speech or  gar-
                               rulous babble, composed of ideas
                               .for the  most part  associated by
                               previous habit.
y  Anoca.                     General obliteration of the mental
   Idiotism.                     powers  and  affections;  paucity
                               or  destitution  of ideas;  obtuse
                               sensibility; vacant countenance ;
                               imperfect or broken articulation;
                               with  occasionally  transient  and
                               unmeaning gusts of passion.

   The difference between the understanding of some men and that
of others is extreme : yet it is not every minute variation from the
standard of soundness that constitutes a disease whether in mind or
body; but as soon  as, in either case, such variation becomes a mark-
ed or serious evil  it is entitled to this name, and falls within the
range of the first of the preceding varieties.
   This, which is what we ordinarily denominate silliness, is gene-
rally a natural infirmity, and in  some families appears to be here-
 ditary.   A well directed education, however, may do much, as there
 is commonly some faculty that will bear cultivation better than the
 rest, and which points to the particular line to which the  study of
 the individual should be especially addressed, and in  which he may
 appear respectable.   He may have  imitative  powers and make a
 good painter or engraver, though he may not have creative powers
 and make a good orator or poet.  He may be fond of arithmetic,
 and fitted for trade and  accounts, though he may not possess a  taste
 for scientifiic subtleties, or  be well calculated for any one of the
 professions. 
 GE. VI.—SP. II.]       NERVOUS FUNCTION.                 13|

   Dotage, when a mere result of old age, is hardly to be regarded
 as a disease, and is rarely accompanied by any effervescence of the
 passions.  But it often appears prematurely,  and is especially ac-
 celerated by  excessive  indulgence  in corporeal pleasures; some-
 times by violent mental  emotion, as anger, or by long continued
 grief.  Under the two former of these causes, there is often com-
 bined with it an incessant garrulity, a very high degree of passion-
 ate, but unmeaning effervescence, and puerile mobility.  M. Pinel
 gives a striking example of this in a person whom he had frequently
 an opportunity of seeing. " His motions," says he,  " his ideas, his
 broken sentences, his confused and momentary glimpses of  mental
 feeling appeared to present a perfect image of chaos.   He came up
 to me, looked  at me, and overwhelmed me with a  torrent of words
 without order  or connection.   In a  moment he turned to another
 person, whom, in rotation, he deafened with his unmeaning babble,
 or threatened with an evanescent look of anger ; but as incapable
 of determined  and continued excitement of the feelings as of a just
 connection of ideas,  his emotions were the effect  of a  momentary
 effervescence,  which  was immediately succeeded by a calm.  If he
 went into a room, he quickly displaced or overturned the furniture,
 without manifesting  any  direct intention.   Scarcely could one look
 off before he would  be  at a considerable distance,  exercising his
 versatile fondness for bustle in  some other way.   He was quiet only
 when food was presented to him.  Even at night he  rested but for
 a few moments."  A strong desire of food, however, is by no means
 common under this species ;  it is perhaps most frequently  met in
 the dotage of old age; but in premature lerema we often find the ap-
 petite entirely banished,  and a resistance to food of  all kind when
 offered.
  Idiotism, the third variety, is often the result, as we have already
 observed, of an original misformation of the cranium, sometimes in
 respect to thickness,  more frequently in respect to shape ; by both
 which the internal cavity, and  consequently the capacity of the
 brain, is  unduly diminished.
  The internal causes are habitual inebriety, excessive and enervat-
 ing pleasures,  violent agitation of the passions, whether pleasurable
or painful, as overwhelming joy, startling terror, deep and protract-
 ed grief, or furious anger ; tumours within the cavity of the cranium;
injudicious management  in ecphronia, and especially an  excessive
 use of the lancet.   To which  some add  suppressed discharge  or
 eruptions, as blennorrhoea,* and itch,t and the drinking of  human
blood.*
  Idiotism, however, is more frequently congenital, than accidental;
 and it is  melancholy to think that it is also sometimes hereditary.
* Ehrmann, Beytrage zur anfklarung des Trippers.
f Wantner, Journ. de Medicine, Tom. LVI. p. 115.
t Sennert, Institut. cum Paralis. Vitel. 1667. 4to.
  Zacnt. Lusit. Prax. Med. Adm. I. III. Obs. 79. 
1S2                      NEUROTICA.            [CL. IV.—OR. I.

Of those who are idiots from birth many are sooner or later afflict-
ed also with palsy or epilepsy,'or both, a clear proof of the  exist-
ence of some organic affection of the brain or nerves :  the former
being sometimes partial, and confined to the face only or extending
down one of the sides.   Idiots rarely attain old  age ; they seldom
exceed the term of thirty years; and when paralysis or epilepsy
are concomitants, they  usually  die at a much earlier period.
  In idiotism the ideas of sensation and of reflexion appear  to  be
equally inaccurate.  There  is a  vague, unsteady, wandering eye
seldom fixed for any length of time upon  any one object; a  stupid
expression of countenance in which no sign of  intelligence is por-
trayed; a gaping mouth from which the saliva flows constantly: a
perpetual rolling and tossing of the head; no memory, no language,
no reason.   The idiot has all the animal instincts, and some of the
passions.  Of the  last, joy, fear, and danger, are those with  which
he is most frequently affected, but these are of a very limited  kind.
His  joy is unmeaning mirth : his fear a transient qualm ; his anger
a momentary fit of violence.  The toys of children, and the gratifi-
cation  of hunger  and thirst, are  his only pleasures: bodily pain or
fear of bodily pain his only distresses.   It  is said that  idiots have
sometimes shown a strong sexual appetite  : but this is not common,
for they rarely seem to attend to any distinction of sex.*
  The treatment where medical assistance can be of any use, must
chiefly depend upon the nature of the cause; blistering and internal
stimulants to increase the action of ihenervoussystem,and argument
the habitual torpitude of the abdominal viscera which  are usually
affected in this malady, offer the  fairest chance of advantage.  Ac-
cidental commotion of the brain, an occasional cause, has occasion-
ally also proved serviceable, as has likewise a fracture of the cranium;
hence too fevers  have  relieved the disease ; and active paroxysms
of mania have proved a complete cure; and I  once knew a cure
effected in a lad  who fell  from the first floor of a house into the
street; the torpitude or  obstruction, or whatever was the cause being
hereby removed.
* Crichton, Of Mental Derangement, I. p. 314. 
    CLASS  IV

NEUROTICA.
                          ORDER II.

                      ^STHETICA.

             Btseases affectttifl the Stusattou,

 dulness, depravation, or abolition of one or more of THE OR-
                   GANS OF CORPOREAL SENSE.

 jXrfSTHETicA is derived from xie-ixvoftui " sentio, et, proprie, sensu
 corporis.  The term applies, however, to all  the external senses,
 and, in the language of Galen peculiarly expresses j> xia-6»TtKti }wxf*,i$
 " the power or faculty of sensation."  It must, also, be admitted that
 it is occasionally applied to mental sensation, as in Isocrates to De-
 monicus outu ryv ixtivm yvuftw xt<r6t)G-n, " thus will you feel their mind
 or inclination."
   The  term has hence been used in different significations by dif-
 ferent medical writers.  It has seldom, indeed, been applied to the
 mind, but has strangely varied between expressing sensation gene-
 rally, and the sense of touch alone. In Dr. Young's excellent volume
 on Medical  Literature, it runs  for the most part parallel with its
 meaning in the present work, and imports diseased action of all the
 corporeal senses,  but with this appropriation of the term  there
 seems to be an incorrectness in applying it, as the same author does
 immediately afterwards, to defective memory, which he names dyses-
 thesia interna, and ranks in the same list or genus with defect of the
 external senses.  Sauvages, and  after him Sagar and Cullen, have
 applied  dt/saesthesiae to a morbid  state of the corporeal senses gene-
 rally; whence anaesthesias  should in their hands have expressed
 atony or total inactivity of these senses generally. But while dysxs-
 thesiae extends to all the senses,  anaesthesia is by the same writers
limited  to the single sense of touch; with no  small perplexity to
the young student. 
134                      NEUROTICA.           [CL. IV.—OR. II.
   In the Physiological Proem to the present class we have taken
so full a survey of the  connexion which exists  between the brain
and  the corporeal  senses by means of the nerves, that it is not ne-
cessary to say more upon the subject at present:  and I  shall only
therefore further observe in these preliminary remarks that where
one  of the  senses  is deficient, and  especially where naturally defi-
cient, the rest have very  frequently been  found  in a more  than
ordinary degree of vigour  and acuteness, as though  the sensorial
power were primarily derived from a common source, and the pro-
portions belonging to the organ, whose outlet is invalid, were dis-
tributed among the other organs.*
  The  genera, under the order before us,  are  taken in a regular
series from  the  corporeal  senses themselves in a state of morbid
action, and are in  number  six: of which the first  five are  derived
from the five external senses, and last from a diseased state of par-
ticular branches of the nerves distributed over the frame generally
for the common and pleasurable feeling of health in the different
organs through which they are dispersed.

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

                       PAROPSIS.

                      ^Uorfcft Statu.

               SENSE OF SIGHT VITIATED OR LOST.

Paropsis is literally " diseased or depraved vision" from irxgx, male,
and oipts, visus ; as paracusis," diseased or depraved hearing," from
7rx%x and xx.ovn.
  The ophthalmic monographist, by making every variety of affec-
tion  a distinct disease, have most unmercifully enlarged the list
under this genus.f To say nothing of Campiani, Taylor has  in this

  *  Trinckhusius, De Csecis sapientia ac eruditione, claris mirisque cacorura
quorundam actionibus.  Gerae. 1762.
  Meckren, Observ. Med. Chir. cap. XX.
  f  Campiani, Raggionamenti sopra tutti i moli degli occhi descritti, &c. Ge-
noa, 1759. 
GE. I.—SP. I.]
NERVOUS FUNCTION.
135
manner mustered  them  at two hundred  and forty-three,* while
Plenck  has  contrived to multiply them to  nearly  six hundred.f
Upon a comprehensive view of the subject, it will, I think, be found
that th;s formidable number may be reduced to the thirteen species
following:—

     1, PAROPSIS LUCIFUGA.             NIGHT-SIGHT,
     2.--------NOCTIFUGA.             DAY-SIGHT.
     3. -------- LONGINQUA.             LONG-SIGHT.
     4---------PROPINQ.UA.             SHORT-SIGHT.
     5---------LATERALIS.             SKUE-SIGHT.
     6---------ILLUSORIA.             FALSE SIGHT.
     7•--------CALIGO.                OPAKE CORNEA.
     8' --!-----GLAUCOSIS.             HUMORAL OPACITY.
     9* "--- CATARRACTA.           CATARACT.
    10. -------- SYNIZESIS.
11,
                      CLOSED PUPIL.
AMAUROSIS.            DROP SERENE.
    12- ------:--  STAPHYLOMA.           PROTUBERANT EYE.
    13.--------STRABISMUS.           SQUINTING.
  Most of these fall rather within the province of the ophthalmic
surgeon than of the physician ; but as their general nature ought to
be known to every practitioner, we shall proceed to give a glance
at each of them in their order.
                         SPECIES I.

                PAROPSIS  LUCIFUGA


VISION PAINFULLY  ACUTE IX A  STRONG LIGHT;  BUT  CLEAR AND
   PLEASANT IN A DEEP SHADE OR THE DUSK OF THE EVENING.

The  specific term  lucifuga is so distinct as at once to point out
the general nature  of the affection while constituting a very pro-
minent system.   The author, however, has  found a necessity for
introducing this new name, not more from its own clearness than from
the confusion  which  has taken place among  earlier writers in dis-
tinguishing the  disease by two directly opposite terms, nyctalopia
andhemeralopia, according as these terms have been used in a lite-
ral or a technical and implied sense.  The Greeks called it by the
former name, literally  night-sight, in consequence of the person
  *  Catalogue of two hundred and forty three diseases of the Eyes. Edin.
Vol. 1749.                                             3
  t  Doctrinade morbis oculorum, 8vo. Vienn. 2d. Ed. 1783 
 136                      NEUROTICA.           [CL. IV.—OR. U

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

               PAROPSIS NOCTIFUGA.

                         23as=mgut.

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

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

               PAROPSIS LONGINQUA.

                        2Lonfl=sfgut

       VISION ONLY ACCURATE WHEN THE OBJECT IS FAR OFF.

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

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

               PAROPSIS  PROPINQJJA

                        <SuOVt=Sf0ftt.

        vision only accurate when the object is near.

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

               PAROPSIS LATERALIS.

               Sucto^m'snt.   <Strjiit askrto.

  VISION ONLY ACCURATE WHEN THE OBJECT IS PLACED OBLIQUELY.

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

               PAROPSIS ILLUSORIA.



IMAGINARY OBJECTS FLOATING BEFORE THE SIGHT ;  OR REAL OB-
         JECTS APPEARING WITH  IMAGINARY  QUALITIES.

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

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

  Both  these  varieties  offer a very numerous family of distinct
illusory perceptions, which require to be noticed in their order.
  Of the ocular spectres, constituting the first variety, one of the
most frequent forms is that of dark spots. Thee are the muscae
volitantes  of mam authors; and " are sometimes," as Dr. Young
observes,  " if not always occasioned by an opacity of some of the
vessels of  the vitreous humour, near the retina.   Th.y are  een  in
a full light, and cannot, therefore,  as Sauvages has justly remarked,
be caused  by  any thing in the anterior part  of the eye;  and  they
may often  be observed to change their form with the mot ons of the
eye;  which they  could  not  do if they did  not  depend on some
floating substance.  Their apparent change  of position, when we
attempt to  follow them with the eye, is a necessary i onsequence  of
the motion of the eye itself which  contains them."*
  Another form these ocular spectres exhibit is that of net work;
hence called  suffusio reticularis by Sauvages, and visus reticularis
by Plenck.  This is sometim s permanent; sometimes transitory;
and is probably, as conjectured by  Sauvages, produced  by a morbid
affection of the arteriolar of the retina.
  A third  form is  that of sparks ; and hence called by Sauvages
suffusio scintillans.  It proceeds generally from a blow or excess  of
light.
  The ce is  also troubled with  an imaginary sense of dazzling,
constituting 'he myrmaryge of the Greek writers   Its usual cause
is supposed to be a plethora of the minute vessels of the eye.
  Sometimes  from the same cause the ocular spectres assume an
irridescent appearance ; or exhibit, in splendid succession, all the
colours of the rain-bow.  This Sauvages calls suffusio coloris.  It is
occasionally a regularly intermittent affection, or returns at stated
  * Delius, Diss. Phantasmata ante oculos volitantia affectus oculorum singu-
laris.  Erlang. 1751. 
 144                     NEUROTICA.            [CL. IV.—OR. II.

 periods, and  particularly in the evenings; and  occasionally the
 morbid appearance is confined to a single colour.  Dr. Heberden
 has given a curious example of an affe< tion of this kind in a lady of
 advanced age, who took lodgings on the eastern coast  of Kent in a
 house that looked immediately upon the sea, and was of course very
 much exposed to  the glare of the morning sun.  The curta ns of
 the bed in which she slept, and of the windows,  were of white
 linen, which added to the intensity of the light.  When she had
 been  there about ten days, she observed one evening at the time of
 sun-set that, first  the fringes of the clouds appeared red, and  soon
 after  the same colour was diffused over all the objects around her,
 and especially if the objects were white, as a sheet of paper, a pack
 of cards, or a lady's gown.  This lasted the whole night; but in the
 morning her sight was again perfect.  The same  alternation  of
 morbid and sound sight continued the whole time the lady was on
 the coast,  which was three weeks, and for nearly as long after she
 left it; at which time it ceased  suddenly and entirely of its  own
 accord.  Excess of light upon a delicate and irritable habit, appears
 to have been the cause of  this singular  affection.   The retina was
 too strongly excited to throw off the impression easily—and that of
 the red rays of the descending sun, constituting the last impression
 communicated, remained  after the sun himself  had disappeared.
 The circle of action  may be easily accounted for by an uniform
 return of the same cause.
  The second variety of false sight or that in which the real objects
 appear changed in  their  natural qualities, is by Plenck denominated,
 in consequence of such change, metamorphopsia.
  Sometimes the change exhibits error of form : and the objects
 appear too  large, too small, cut in half, or distorted.
  Sometimes  error  of motion :  in  consequence of which  they
 seem  to be dancing, nodding, or in a rapid succession.
  Sometimes  error of number : and then they appear double,
 triple, or otherwise increased or multiplied ; constituting the diplo-
 pia of Sauvages and many other writers.
  Sometimes error of  colour, in which case one hue is mistaken
 for another, as red for  green, or green for yellow, or  every hue
 appears alike.  Examples of this imperfection ar-- not unfrequent.
 Mr. Scott has  given a singular instance of  it in one of  the volumes
of the Philosophical Transactions,* and  Dr. Priestley in another.f
 The last is especially worthy of notice as  in some degree a family
defect;  and was communicated to Dr. Priestley by Mr. Huddart of
 North America.  Of five brothers and two sisters, all adults, three
of the former were affected  with  it in a greater or  less degree,
 while the remaining two  and the  two sisters possessed  perfect
 vision.   One  of the  brothers could  form no  idea whatever  of
 colours, though he judged very accurately  of the form and other
• Vol. LXVIII. 1778. p. 611.
fid. LXVII. 1777. p. 260. 
CE. I.—SP. VI.]
NERVOUS FUNCTION.
145
 qualities of objects; and hence he thought stockings were sufficiently
 distinguished by the name of stockings, and could not conceive the
 necessity of calling some red and others blue.  He could perceive
 cherries on  cherry-trees,  but only distinguished them, even when
 red-ripe, from  the  surrounding leaves  by their size and shape.
 One of  the  brothers appears to have had a faint sense of a few
 clours, but still a very imperfect notion:  and upon the whole they
 seem to have possessed no other distinguishing power than that of
 light and shade, into which thy resolved all the colours  presented
 o them; so that dove and straw-coloured were regarded as white,
 and green, crimson, and purple, as black, or dark.  On looking at a
 rain-bow one of them could  distinguish it as  consisting of stripes,
 but nothing more.
   Dr. Nicholl of Ludlow has published a case in the Medico-chirur-
 gical Transactions,* of the same kind, though the imperfection seems
 to have been confined to one or two  colours  alone.  The patient
 could easily distinguish the green of  the grass or the leaves of the
 trees, but, like those in Mr. Huddart's statement, he confounded with
 the green the red-fruit or flowers which happened  to be intermixed
 with  it.   The false-sight in  this case was also connected with pa-
 ropis longinqua ; for the patient saw objects  at a  greater distance
 than  other people, and  more distinctly  in the dark.  The  irids
 were here, also, grey, with a yellow tinge round the pupil.
   The causes of these varieties  are not always assignable: many of
 them, however,  are the same as have been pointed out under the
 variety of ocular spectres.   Diplopia, or  errors of number, have
 often been occasioned by long exposure to severe cold, sometimes
 by  local spasm, sometimes by hydrocephalus.!  Baumer gives a
 case  produced by a  wrong position of the  pupiLf Raghellini
 another  caused by a double pupil.§  In  Lentin is  a singularly
 complicated example of objects seen  triply.||
   Where the disease is not structural, but dependent upon anentonic
 or atonic condition of the optic nerve, muscular  fibres or blood-
 vessels, benefit has been derived, in  the  first instance, from  local
 bleeding, blisters, and sedatives; the  sedatives being employed
 both generally and topically:  and in  the last instance  by  stimulant
 collyriums, and general tonics.
  Many of these varieties of false-sight, and especially ocular spec-
 tres, are also found as symptoms in several species of dinus, syspasia,
syncope, plethora, cephalitis, and various fevers.
  * Transact, of the Medico-chir. Soc. Vol. IX.
  f Justi, Baldinger, N. Mag. Band. XI. p. 446.
  t Art. Hafn. I. Art. XXVII.
  § Lettera al S. Coechi sopra 1' offesa della vista in una Donna. Venet. 1748
1749.
  ||  Libr. II. Obs. 20.
  vol. in.—19 
NEUROTICA.            [CL. IV.—OR. II.
                        SPECIES  VII.

                  PAROPSIS CALIGO.

                      ©jrafte  Cornea.

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

The Latin term caligo sufficiently explains the nature of the disease,
by importing " dimness, darkness, cloudiness, obscurity."  In  old
English this filmy opacity was denominated "a  web of  the eye:"
whence Shakspeare in King Lear, " This is the foul fiend Flibber-
tigibbet; he gives the web and the pin, squints the eye, and makes
the harelip."  The pin  is a variety of the synezesis, " closed or
contracted pupil," or of one species of amaurosis, and will be no-
ticed in its proper place.
  The exciting or immediate cause of this disease is rarely disco-
verable, as for the most part it makes its approach imperceptibly; it
is ofien, however, a common  consequence of old  age.   Judging
from the last species, we may place the usual proximate  cause in a
torpitude of the  absorbtnts of the cornea, whence the finer and
more attenuate parts of the secerned fluid are alone  carried off, and
the denser and grosser left behind.   Hence stimulants and tonics,
as blisters, weak solutions of brandy, campbor, alum, and nitrate of
silver,  are  often found useful  in the present day;  as  the saffron-
coloured, or golden acrid juice of the chelidonium majus,  or greater
celandine diluted with water or milk, was formerly.
  The disease  is often accompanied  with or preceded by conges-
tion of the vessels of the head, and consequently a stupid pain and
heaviness : and in some cases there is reason to apprehend that this
affection of the head is itself the cause, or rather that an obstructed
liver is the primary cause, from which the overloaded state of the
blood-vessels in the head originates.  Leeches or cupping-glasses
should be here freely applied in the first instance, as well as  brisk
cathartics and mercurial alterants, and afterwards the stimulant plan
just  noticed.  It is, however, generally a tedious disease at  best:
and the author has at this moment a patient who has  laboured under
the whole of the above symptoms for some months, though it  is not
long that he has had the care of her.  She has tried local bleeding,
purgatives,  and at night an  equal mixture of Plummer's and the
mercurial pill; with the vapour of ether applied to the eyes  three
times a-day, and apparently with  advantage.
  Baron Stoerck strongly recommended an extract  of the pasque-
flower, Pulsatilla nigricans, the anemone Pulsatilla of Linneus, for
internal use; and from the success he ascribed to it, the plant found
its way into the Edinburgh Pharmacopoeia. The anemone firatensis 
GE. I.—SP. VflL]
NERVOUS FUNCTION.
141
would probably answer as well.   These plants in their recent state
have very little smell; but their taste is extremely acrid, and when
chewed thty erode the tongue and fauces.  Other German practi-
tioners, however, as Schmiicker, Bergius, and  Richter, have tried
even the pulsatilla without success,  though they have carried their
doses to a larger extent than Stoerck ventured upon.   Small and
frequently repeated doses of tartarized antimony appear, upon so
many testimonies, to have been successful in various cases,  that it
is a remedy well worth the trial.  Dr. Rowley used it with success
upon an extensive field of practice.*  Gleize employed it with equal
success aIone,f and Hufeland as satisfactorily in combination with
warm  bathing, and the internal use of  millepedes :f the last of
which, however, may be spared  without any serious risk. The dis-
ease has sometimes disappeared spontaneously or  without  any
known cause.
  In newly born infants, spots on the cornea are occasionally met
with, which soon vanish spontaneously :§ probably the rays of light
acting as a salutary stimulus upon the occasion.
                       SPECIES VIII.

               PAROPSIS GLAUCOSIS.

                     tumoral <©jjacftg.

DIMNESS  OR ABOLITION OF SIGHT FROM OPACITY OF THE  HUMOURS.

Glaucosis is a Greek term from yXxvuoi," bluish or greenish-tint-
ed," from the common colour of the obscurity.  It was also called
by the Greeks glauc6ma, and by the Romans glaucedo.  Glaucosis
is here preferred to glaucoma, because the final oma imports usual-
ly, and, for the sake of simplicity and consistency, ought always to
import, external protuberance, as in staphyloma, sarcoma, and vari-
ous others noticed in detail in the volume of Nosology.
  This species is probably  produced in most instances by a torpitude
of action in  the absorbents that carry off the  waste  fluid of  the
humours, similar  to that  described under the last species; and is
sometimes  benefited by a like stimulant and  tonic plan of treat-
ment.  Senncrt calls it indeed a caligo, and distinguishes it by its
proceeding from a defect of the aqueous humour—caligo a defectu
humoris  aquei; by which  he seems to mean that the torpitude be-
* On the Principal Diseases of the Eye8.
\ Nouvelles Observations, &C.
* V,n Blathern. p. i59.
§ Farr. Med. Common. II, 
148
NEUROTICA.
[CL. IV.—OR. II
longs rather to the excretory than the absorbent vessels; but,  in
this  case, the cornea would appear depressed or flattened, which
is rarely if ever a symptom.
  Both this and the preceding species have sometimes ceased spon-
taneously,* without any apparent cause; and  Helwigf gives an in-
stance  in which the cessation was not only spontaneous but sudden.
They have also been carried off by fever.
                       SPECIES IX.

             PAROPSIS CATARRACTA.

                         Ctatavact.

DIMNESS OR  ABOLITION OF SIGHT  FROM OPACITY OF THE CHRYSTAL-
                          LINE  LENS.

The cataract as  it is now  called, was  by old English writers,
named pearl-eye or pearl in the eye, and is  so denominated by
Holland, the faithful translator of Pliny.  Catarracta, as  a  Greek
term, is usually derived  from x.xrxppx<s-<rv, " to disturb, destroy,  or
abolish."  Kxrxppxxrm or vxTxpxxTtn, however, was  employed by
the Greek writers themselves, to signify a gate, door, or loop-hole,
and the bar which fastens it, and becomes the impediment to its be-
ing opened.  And it is probably from this last sense that the term
cataract was first applied to the disease in question, as forming a bar
to the eyes which were called the loop-holes or windows of the
mind by various philosophers, as we learn from Lucretius, who thus
closes his opposition to their view:
         Dicere porro  oculos nullam rem cernere posse,
         Sed per eos animum ut foribus spectare reclusis
         Difficile est.+—
         To deem the  eyes, then, of themselves survey
         Nought in existence, while th' interior mind
         Looks at all nature through them, as alone
         Through -windows, is to trifle—

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

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

   The Greeks themselves, however, called this disease indifferent-
* Hagedorn, Observ. Med. Cent. I. Obs. 56. Franc. 1698, 8vo.
  Eph. Nat. Cur. Dec. I. Ant. II. Obs. 166.
f Obs. 23.
t De Rer. Nat. III. 360. 
CE. I.—SP. IX.]        NERVOUS FUNCTION.                 149

ly hypochyma, apochysis and hypochysis.   The earlier Latins suf-
fusio :  while catarracta seems first to have been made use of by the
Arabian writers, and was probably introduced into the medical no-
menclature by Avicenna.  Yet the more common  name among the
Arabians  was gutta obscura, as that for amaurosis was gutta serena ;
the pupil,;,in this last species, being serene or transparent.
   The Arabians, who had adopted generally the humoral pathology
of Galen, conceived  both these diseases to  be the result of a mor-
bid rheum or defluxion  falling on a particular part of the visual orb,
in the one case producing blindness with  obscurity, whence the
name of an obscure rheum or gutta ; and in the other without obscu-
rity, whence the contrary name of a transparent or serene rheum or
gutta.  But  as various other  diseases, and  particularly  of the
joints, were also supposed to flow from a like  cause, and were far
more common, the terms gutta, and rheuma were afterwards empha-
tically  applied, and at length  altogether limited,  to  these  last
complaints ; whence the terms gout and rheumatism which have de-
scended to the present day, as the author has already had occasion
to observe under arthrodia podagra. For gutta the Arabian wri-
ters sometimes employed aqua ;  and hence cataract and amaurosis
are described  by many of them under the names  of aqua  obscura,
 and aqua serena ; and the  former, by way of emphasis, sometimes
 under the name of aqua or arqua alone.
   The opacity producing a cataract may exist in  the lens alone, the
 capsule alone, or in both;  thus laying  a foundation for the three
 following varieties:
« Lenticukris.                 The opacity  existing in the lens
   Lenticular Cataract.            itself and confined to it.
 (3 Capsularis.                   The opacity confined to the cap-
   Capsular or membranous       sule, or membrane of the lens.
     Cataract.
 y Complicata.                  The opacity common  to the lens
    Complicated Cataract.         and its capsule.
    We are told moreover by Ritcher* of a  cataract of the humour
 Morgagni, or the interstitial fluid which lies between  the  capsule
 and the lens :  whence this  has also been copied by  Plenck and Sir
 William Adams into the list of modifications : but rather as a possi-
 ble than an  actual case: for neither of these practitioners  give a
 single example of such a variety ever having occurred to them.
    Cataracts are of different colours and of  different degrees of con-
  sistency from circumstances influencing the morbid  action, with
  which we are but little acquainted.  They  are, therefore, black,
  white, leaden-hued, ferruginous, green, amber; as they are also fluid
  or milky, soft, firm, hard, horny, and even  bony, for they have been
  sometimes found of this last texture.f  They are not unfrequently

    * Von der Ausziehung des grauen Staars. Gott. 1773.8vo.
    \ Wenzel, Traite" de la Cataracte avec des Observations, Paris, 1726 
150                      NEUROTICA.           [CL. IV.-r-OR. II

the result of an hereditary taint, adhering to generation after gene^
ration, and appearing either congenitally, or by a very general pre-
disposition afterwards.
  From the colour of the cataract no conclusion, in the opinion of
that acute observer Mr. Pott, can be drawn in regard to its consis-
tence; but he  thinks that when the opake crystalline is perfectly
dissolved  so as to form a soft cataract, it is somewhat enlarged ; and
that when such dissolution  does not take  place, and a hard cataract
is produced, the crystalline is in some degree lessened.  The hard
cataract has also been distinguished by the name of ripe, as the soft
by that of unrifie.  " But if we would think and speak of this mat-
ter," observes Mr. Pott, " as  it  really is, we should say that a disso-
lution or softening of the crystalline lens is by much the most common
effect; and that seven times out of nine, when it becomes opake, and
tends to form a cataract,  it  is more or less softened: the  softening
sometimes extending through the whole range of the lens and some-
times through only a part of it; while, however, the part that re-
mains undissolved is  rarely,  if  ever, so firm as the centre of the
sound crystalline."  Mr. Pott proposes it as a question, whether cata-
racts, which  have been  found  perfectly soft,  have not in general
grown opake by slow degrees?  and whether those which have been
discovered to be firm have not become opake hastily, and  been pre-
ceded by, or accompanied with, severe and deep-seated pain  in the
head, particularly in the back part of it ?*
  We have already  observed,  that cataract is  occasionally the re-
sult of an  hereditary  taint; in other instances it originates spontane-
ously or from causes we cannot trace.  It has,  however,  often fol-
lowed upon convulsions,  chronic head-ache, syphilis, rheumatism,
suppressed perspiration,  and in a few instances trychosis  Plica,
or matted hair.f  It  has also  appeared as an effect of inflammation
produced  by a thunder storm4
  Like paropsis Glaucosis  or humoral opacity, it  has sometimes
ceased spontaneously, or  without any manifest cause ;§ and Helwig
gives an instance in  which the cessation was not only spontaneous
but sudden.||   It has also, at times, been  carried off by a fever.H
  There is hence, specious ground for conceiving that some  medi-
cine might be discovered capable,  by some general  or  specific ac-
tion, of producing a like  change, and proving a remedy for the dis-
ease; and the more so as  we find ganglions and  other accidental
deformities frequently removed from the extreme parts of the sys-
* Chirurgical Observations relative to the cataract, &c. 8vo. 1775. London.
f De la Fontaine, Chirurg. Med.
tRichter, Chir. Bibl. Band. VI. 158.
§ Hagedorn, Observ. Med. Cent. I. Obs. 50. Franc. 1698, 8vo
  Ludolf, Miscell. Berol. Tom. IV. 258.
  Walker, On the Theory and Cure of a Cataract.
H Observ. Physico-med. 23, Aug. Vind.  1680, 4to
f Velschius, Episagm. 20. 
GE. I.—SF. IX.]        NERVOUS FUNCTION.
151
tern by external or internal applications.  But  no such remedy has
hitherto  been  descried, or at least none that can be in any degree
relied  upon: for recourse has been had to  mercurial preparations
both external and internal, as well as almost every other metallic
salt, aconite, the pasque-flower, or pulsatilla, to protracted vomiting,
electricity, and puncturing the tunics of the ejPfcs, but without any
certain advantage.  This is the more to be lamented, because what-
ever surgical operation may be determined upon  as most advisable,
there  is  no guarding, on all occasions, against the mischievous ef-
fects which  may result, I do not mean from the complication or se-
verity  of the operation;  for this, under every modification, is sim-
pler and  less  formidable than the uninitiated cap readily imagine,
but from the  tendency which is sometimes met  with from idiosyn-
crasy,  habit, some peculiar  acrimony, or other  irritable principle,
to run rapidly into a state of ulcerative inflammation, and in a sin-
gle night, or  even a few hours, in spite of the wisesi  precautions
that can be adopted, to endanger a total and permanent loss of vi-
sion.   I  speak from personal  knowledge, and have,  in one or two
instances, seen  such  an  effect follow, after the operation had been
performed with the utmost  dexterity, and with every promise of
success;  and where a total blindness has taken place in  both  eyes,
the operation having been performed on both ; neither of them be-
ing quite opake antecedently, and one of them in nothing more than
an incipient state of the disease, and the patient capable of writing
and reading with it.  And  hence it  is far better, in the author's
opinion, to have a trial made on one eye only  at a time, and that
the worst where both are affected  and one is still useful, than to
subject both to the same risk;  for the sympathy between them is
so considerable, that if an inflammatory process  from any constitu-
tional  or accidental cause should show itself in either, the other
would be sure to associate in the morbid action.
   The usual modes of operating for the cure of a cataract are three;
that of couching or depression :  that of extract.on : and that of ab-
sorption.  The  first was well known to the practitioners of Greece
and Rome; and is ably described by Celsus, who advises,  in  cases
where the  lens cannot be kept down, to cut it into pieces with the
sharp-edged acus or needle, by which mean it will be the more rea-
dily absorbed.   And from this last remark we have some reason for
believing that even the third  of the above methods, that of absorp-
tion,  was also known at  the same time; as it is probable, indeed,
that the  second, or the operation by extraction, was likewise ; since
we find  Pliny recommending the pro'cess of simple removal or de-
pression  in preference to that of extraction  or drawing it forth ;
" squammam  in oculis emovendam potius quam extrahendam,"*
which Holland has thus honestly, though paraphrastically translated
" a cataract or pearl in the eye is to be couched rather, and driven
down  by the needle, than quite to be plucked forth."
* Nat. Hist. Lib. XXIX. Cap. I. 
152
NEUROTICA.
[CL. IV.—OR. II.
  In the East, however, both these plans appear to have been pur-
sued through a much longer period.  Both are noticed by the Ara-
bian writers in general, and especially by Avicenna and Rhazes;
and both seem to have been practised from time immemorial in In-
dia, and, according to the account of the cabirajas, with wonderful
success.  Dr. Scott was informed by one of the travelling opera-
tors, who, however, spoke without a register, that in the operation
of depression this success was in proportion of a hundred who were
benefited to five who obtained no advantage whatever.
  The operation of extraction seems to have derived no small im-
provement from the method of Sir William  Adams, who, after de-
taching the cataract, first passes it through the opening of the pupil
into the interior chamber by means of his needle, and then extracts
it by an opening on the outer side of the cornea, instead of by one
in its inferior part.
  The simplest and least irritating of these operations, however  is
that by absorption; but it should be known to  the operator that
while the solvent power of the aqueous humour is wonderfully ac-
tive, that of the vitreous is weak and inconsiderable :  and hence the
absorbent plan,  as  practised by Sir William Adams, and to which
he is  much  attached, consists in dividing the cataract, after its se-
paration, into small fragments, and passing them with the needle,
by which they are thus divided, through the  pupil into the anterior
chamber, which constitutes the seat of the aqueous humour.   The
fragments thus deposited are usually dissolved'in a few weeks; and
where  the cataract is fluid  they have often been dissolved and ab-
sorbed in a  few seconds; and sometimes even  before the needle
has been withdrawn.
                       SPECIES  X.


                PAROPSIS  SYNIZESIS.

                      eioscti  $U])il.

DIMNESS OR ABOLITION OF  SIGHT FROM CONTRACTION OR OBLITERA-
                    TION OF THE PUPIL.

The term synizesis is derived from rwtga, " consido, coeo, coales-
co;" and was used amongst the Greek grammarians before it obtained
an introduction into the medical vocabulary, to signify the coales-
cence of two or more syllables into one.  This species exhibits two
varieties:

a Simplex.                 Simple  closure of the pupil.
  Simple closed pupil. 
GE. L—SP. X.]
NERVOUS FUNCTION.
153
P Complicata.                 Closure of the pupil  complicated
  Complicated closed pupil.     with cataract,  or  opake cornea.

  The pupil becomes closed or obliterated from a gradual contrac-
tion and at length coalition of the muscular fibres of the  iris; from
inflammation of surrounding membranes;  or from protrusion of the
iris.  In all these cases it is a simple obliteration of the pupil.
It is complicated when the obliteration is  combined with an opacity
of the cornea, or with a cataract.
  The natural form of the human pupil is circular,  this being  the
natural form of the fine fringe of the iris by which it is surrounded.
But in a very few instances the fringe or rays of the iris has evinced
a different figure, and the pupil,  in consequence, has been found
oblong, or heart-shaped.*   The first has occurred most frequently :
and according to Albinus has sometimes preceded loss of vision .f
Block gives an instance in which the disease was congenital and  he
reditary4
  If the iris contract irregularly sometimes only  a few of its fibres
spread across the pupil while others are retracted : and  hence  we
have examples of double  or more than double pupils, though of
smaller dimensions than the natural circle.  Solinus gives an instance
of two pupils hereby produced,§  and Janin of not less than five.||
Dr. Plenck, who very unnecessarily multiplies diseases, confines  the
term synizesis to a total contraction of the  pupil; and makes its par-
tial contraction a distinct affection, which  he calls mydsis : and  the
second or complicated variety, another distinct affection which he
denominates synechia.   But this is to perplex rather than to simplify
the subject.
  Medicines in this disease are of little avail.   In the  first variety
the external application of the tincture of belladonna has occasion-
ally effected a cure by destroying the contractile action; and dilute
solutions of brandy, camphor, or sulphate  of zinc, by their tonic or
stimulant  power.  The complicated variety belongs manifestly to
the art of surgery, and its removal must be sought for in books on
that subject.
* Eph.Nat. Cur. Bee. III. Ann. VII. VIII. Obs. 21.
f Anat. Acad. Lib. VI. cap. 3.
| Medinische Bermerkungen, p. 1.
§ Vide Marcel. Donat. Lib. VI. cap. ii. p. 619,
| Memoires, &c.
vol.. III.—2© 
154
NEUROTICA.           [CL. IV.-OR. If.
                         SPECIES XI.

                PAROPSIS AMAUROSIS.

                        Broj) Serene.

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

 This is the gutta serena of the Arabic writers, whence the term
 " Drop Serene," of our  own tongue ;  terms we  have already  ex-
 plained under paropsis catarracta.  Milton is well known to allude
 to this affection in his beautiful address to light, as he does also  to
 the cataract by him called  suffusion, as the Latins call it suffusio :
 but it is singular that, in the course of this allusion, he seems doubt-
 ful as  to which of the two diseases he ought  to ascribe his own
 blindness:

                      Thee I revisit safe
         A nd feel thy sovereign, vital lamp ; but thou
         Revisit'st not these  eyes, that roll in vain
         To find thy piercing ray, and find no dawn.
          So thick a drop serene has quench'd their orbs,
         Or dim suffusion veil'd.*

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

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

  It would be easy to admit other varieties if we were to attend to
all that has been  written on the subject, and adopt all the opinions
that have been delivered ; for we are told of cases in which the pu-
pil has not  been permanently  immovable, but has contracted on
exposure to  an intense light;{  and of others in which the pupil in-
* Par. Lost, III. 21.
f Caldani ad Haller. V. Richter, Nov. Comm. Soc. Goett. Tom. IV. p. 77
  Hey, Medic, Observ, andlnquir. Vol. 5. p. 1, 
GE. I.—SP. XL J        NERVOUS FUNCTION.
15S
 stead of being black has evinced a pale or nebulous appearance.*
 In the first of these exceptions the disease has not acquired comple-
 tion : and the other is allowed for occasionally in the definition.  It
 will often be found nothing more than an incipient cataract.
    Plenck makes a distinct disease of an unalterable pupil with  or
 without injury of the vision under the name of mydriasis.  When
 accompanied with injured vision it is evidently a variety of amau-
 rosis; and it is questionable whether an  unalterable pupil is ever to
 be traced without defective vision.
    Under the one or other of these varieties amaurosis is also found,
 occasionally, as a  symptom  or  sequel  in hysteria, syspasia, and
 lues.
    It is probably to the spasmodic variety of this species,  that Shak-
 speare chiefly alludes  by the term pin or  pin-eye, the  pupil being
 sometimes contracted to nearly the diameter of a pin's-head; though
 the synizesis is equally entitled to the name. I have quoted one ex-
 ample already under P. Caligo, which he calls web-eye : another is
 contained in the following couplet:

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

   The existence of an amaurosis  is know by the  specific symp-
 toms of the pupil being peculiarly black and dilated, and the want
 of contractibility in the iris on exposure to a strong light. Its com-
 mencement is often accompanied with pain in  the  head, which di-
 minishes as the disease  increases. Yet it occasionally steals  on with-
 out pain; and if it be  confined  to one eye  only, it will sometimes
 exist for months or perhaps years, without a person's being sensi-
 ble of it;  as, in such cases, it is  only traced by the  patient's acci-
 dentally closing  his sound eye alone and  then finding himself in
 darkness, or by some other incident.
   The black cataract has sometimes  been confounded with it, or
 mistaken for it, of which we have  just noticed an instance  in Milton,
 as has also lhat modification of the capsular cataract, in which  the
 posterior lamina of the  capsule is alone opake.
   The occasional cause is, therefore, for the most part incapable of
 being followed up.  Richter contends that it is often dependent upon
 a dyspeptic state of the  digestive  organs;  and  it has often occurred
 suddenly upon a plethoric state of the vessels, apoplexy, cephalsea,
 a blow on  the head, or  some other injury of the sensorium.  It is
 also well known to be temporarily produced by the juice  of the  so-
 lanum or atropa  Belladonna ; and in one or two instances  prema-
 nently from an accidental immission into the eye of the poison of a
 serpent or spider.f  It has likewise been induced by a flash of light-
ning, by insolation or undue exposure to the rays of the sun, by a
* Richter, Nov Com. Soc. Goett. Tom. IV. p. 77. Gooet, Cases, Ed. II. p. 52.
f Bosman, Beschreibung von Guinea, p. 369.
 Boyle, Tract, de Concord. Medic. Specific. 
156                      NEUROTICA.            [CL. IV.—OR. H

suppressed catarrh, suppressed haemorrhages, or venesection when
rendered habitual,* suppressed exanthems and erupiions of various
kinds, especially porrigo, herpes, and scabies, by some sudden strain
or other violence; or by some overwhelming passion of the  mind
as wrath or terror.f  It has also  appeared as a sequel or metastasis
upon fevers;  and succeeded to the use of  poisonous  cosmetics.
There are a few cases in which it has proved hereditary.\
   The prognostics are generally unfavourable, except where the
disease exists as a symptomatic affeciion. Where we can decidedly
trace its existence to plethora,  whether entonic or atonic, or  to
some violent injury to the head, bleeding and purgatives are clearly
indicated, but have frequently failed s for in the  exquisitely tender
organ of the eye, palsy is often induced before these evacuations
can relieve the oppression.  In the spasmodic variety active  eme-
tics frequently repeated, and resolutely persevered in  at each time
till the  system becomes weakened, as  in the treatment for the
epidemic ophthalmy, have certainly been at times found successful.
Blisters and sternutatories also demand  attention : the first should
be applied to  the temples;  the second is best  formed of turbeth
mineral with about ten times its proportion of mild  snuff, or any
other light powder.  The vapour of ammonia, ether, or camphor,
mixed with hot wa*ter, has sometimes also afforded benefit.
   Where it has followed on repelled eruptions, it has been occasion-
ally found to yield to setons  and blisters, or  a  resloration of the
suppressed efflorescence : and, as in other diseases, what has some-
times proved the sources of its production, has been found its best
remedy, so that  the cause has become  the cure.  Thus it has at
times yielded to the violence of a fever,  to that of a sudden blow on
the head, to a strong light, to a paroxysm of convulsions.  Elec-
tricity,  and especially voltaism, have probably been serviceable in
some instances;  at  least the  assertions to  this effect are  very
numerous, though in various cases these have sometimes been alto-
gether unsuccessful; nor is the magnet without its recommendations,
having  been applied to the upper part  of the spine, while minute
bags filled with  iron filings were placed on the eyes ;§ and in an
imperfect case of the complaint Weher conceives he derived benefit.
The chief dependencies besides have  been on  camphor, cajeput,
musk, mercury,  iron,  bark, arnica, and externally the pulsatilla
nigra. Of the arnica or German leopard's bane. Pellier, as well as
Collier, speaks warmly.   The latter recommends it in all nervous
atonies, whether  general or local.  He employed the flowers of the
  * Heister, Wahrnehm. B. II. p. 441. Bresl. Samral. 1726. I. 503.
  f Herculanus, Comm. in RhazisLib. IX. Richter L. C. p. 81. Schaarschmid,
Med. und Chir. Nachrickten III. n. 18.
  $ Redlin, Curat. Med. Millenar. n. 822.  Oehme de amaurosis, p. 20.
  § Wiirkung des Kunstbichen Magnets, &c. p. 24, 25.  Hell. v. Nootnagel, 1.
c. § 22. Eph. Nat. Cur. Dec. II. Ann. v. Obs. 247. 
 <*E. I.—SP. XI.]       NERVOUS FUNCTION.                 J57

 plant in decoction* in the proportion of about half an ounce to a
 pint of the strained liquid, which may be taken in a day or a day and
 a-half.  Richter, Schmucker and other German writers declare it
 to be of no  avail.  The Pulsatilla  is certainly better entitled  to
 attention.  "I  would recommend it,"  says Dr.  Cullen  with his
 usual liberality, «to the attention of my countrymen, and particu-
 larly to a repetition of trials in that disease so frequently otherwise
 incurable,  the amaurosis.  The negative experiments of Bergius
 and others  are not sufficient to discourage all trials, considering that
 the disease may depend upon different causes, some of which may
 yield to remedies though others do not."f  When distilled with
 water it gives forth a terebinthinate substance resembling camphor,
 which  necessarily possesses  a  stimulant, and hence a medicinal
 power.  Whence the euphrasia officinalis, or eye-bright, obtained
 the character it once possessed as a specific  in this disease, it  is
 difficult to to say.  By Hildanus and Lieutaud, however, it was chiefly
 confined, even in its zenith of popularity, to the amaurosis of old
 age.   Its chief sensible quality is that of being a mild astringent.
 Rue, which rivalled it at one time, and by Milton is put upon a level
 with it, has far better pretensions when used externally in the form
 of a potent infusion:  for it  unites the properties of volatile  pun-
 gency and bitterness: both which, as concentrated in strong chamo-
 mile  tea, I  have occasionally found highly serviceable in an  inci-
 pient state  of this disease produced by weakness.
   The  narcotics, if they have ever been  serviceable  in  any way,
 can only have been so in the spasmodic variety.  Of these aconite
 has been chiefly popular in Germany: it has been strongly recom-
 mended by many writers of reputation, and  has  sometimes  been
 given by gradual augmentation to the amount of a drachm daily.J
 Cheyillard combined the use of antimonials with blisters :  but cold
 applied externally, and cold  bathing as recommended  by  Warner,
 will often be as much entitled to our attention, as any other process.
   Dr. Powell  relates a case of sudden loss of vision, preceded by
 an acute cephalaea, in which an emetic was found, during the act
 of vomiting, abruptly to  restore sight to the right  eye (for  hoth
 were affected) with a sensation as if a flash of lightning had taken
 place, but the vision was soon again lost.  More  than a  twelve-
 month afterwards the patient tried emetics again : when, after the
 use of the second, the pupils of the eyes recovered the power of
 dilating and contracting on exposure to light, and preserved it till
 death, but the power of vision was not restored.  During the whole
 of this case  of blindness, the sense of hearing was peculiarly acute.§

  * Prodigious enlargement and dropsy of the eye.  Dr. Layard Phil. Trans.
1757-8. Vol. 50. p. 747.
  f Mat. Med. Vol. II. Part O. Ch. V. p. 216.
  t Beobachtungen und Untersuchungen, &c. Band II. Nurmb. 1767,
 £ Trans. Med. Vol. V. p. 226. 
158                     NEUROTICA.           [CL. IV.-OR. II.
                       SPECIES XII.

             PAROPSIS  STAPHYLOMA.

                    Protuberant  Ege.

ENLARGEMENT OF THE BALL OF THE EVE  ; PROTUBERANCE OF THE COR-
                NEA ; SIGHT DIM OR ABOLISHED.

The term staphyloma is derived from o-rxtpuXn, " uva," agrape,irom
the resemblance of the tumour to the pulpy and semi-transparent
appearance of this fruit.   Richter seems first to have pointed out
the real nature of this disease; which from the difference of its cause
and prominent symptoms, may be considered as affording three va-
rieties:

« Simplex,                     From increased secrelion of the
  Simple protuberant eye.         aqueous or other  humour ;
                                 pupil transparent.
p Purulentum.                  From flow of pus from an  abscess
  Purulent protuberant eye.        in one  of  the  membranes:
                                 pupil cloudy.
y Complicatum.                 Complicated  with  a rupture of
  Complicate protuberant eye.      the iris, and  its  protrusion
                                 upon the cornea constituting
                                 a  grape-like  tumour:  sight
                                 abolished.

  Plenck, who makes staphyloma a genus, and, as we have  already
observed, multiplies the  diseases of the eyes almost  without end,
has several  other subdivisions which are easily reducible into some
one of these; as he  has  also several  other  genera which  do not
essentially differ from the present, as exophthalmia, ophthalmop-
tosis, and ptosiridis.  All  these  proceed  from  similar  causes,
exhibit a like appearance, and, when manageable, are to be  treated
by the same means.
  The staphyloma,  therefore, embraces all  morbid collections of
fluids within the cavity of the eye, producing an enlargement of
the eye-ball, and, in most instances, a protrusion of the transparent
cornea from its  being the weakest part of the eye; sometimes,
indeed a partial protrusion into the sclerotica or opake part of the
eye.
  The first variety has occasionally  been called hydrophthalmia,
or dropsy of the eye, as being formed  by an increased secretion of
the aqueous humour, or a torpitude of the absorbents that  should
carry off the fluid when secreted  in its healthy proportion.  Where
it is from the first accompanied with a slight pain, we have reason
to infer augmented action, and, consequently, the  first of these 
6E. I.—SP. Xn.]       NERVOUS FUNCTION.
159
 causes;  where there is no pain, which  is usually the case,  the
 second.
   In the second and third varieties the pain is frequently severe
 and shoots backward into the head, attended with constant restless-
 ness, heat, and other febrile -ymptoms, and at  times with a sense of
 tension and fiery sparks, which frequently continue, not only till the
 sight is  lost, but  till the eye bursts of itself, or its contents are dis-
 charged by an opening.
   The  causes are  for the most part internal, as inflammation and
 abscess, which  break down the membranous septa by which one
 part of the ball is so curiously divided from the rest, and throw the
 whole- into confusion, with an increase of effused fluid.  They are
 sometimes, however, dependent on external violence ; and in a few
 instances are resolvable into  severe  strains  from  vomiting,*  the
 hooping-cough,t or vehement muscular action.J
   In the first variety, and where the cause consists in an atony of
 the absorbents of the membranes, it may sometimes  admit of a cure "
 by external stimulants, and particularly by illining the opake cornea
 with a minute drop of butter of antimony on the tip  of a small pen-
 cil brush, as first recommended by Janin, and afterwards by Richter.
 It rarely happens, however, that the use of the eye can be  preserv-
 ed, and  hence says Mr. Bell,§ our chief objects in general are to
 abate the  violence  of the pain, which is often very severe, and to
 remove  that deformity which an enlargement of the eye is always
 sure to produce.   The  last intention belongs to the art of surgery.
 For the first, blood-letting, blisters, cooling applications to the eye
 and opiates, are principally to be depended upon in  the commence-
 ment of  the disorder.  But if these and similar means do not prove
 effectual; if suppuration take  place, and the pain still continue se-
 vere, nothing will  more certainly afford  relief than taking away
 the painful distention of the eye by making an  incision into th- ball,
 and thus evacuating the contents : as has been recommended indeed
 ever since the time of Celsus.  It  is sometimes necessary, as in
 dropsies of other  membranes, to repeat the puncture, as the effused
fluid is apt to re-accumulate.   Some practitioners have repeated
 the operation to the fifth  time, and effected a radical cure at last.
  A singular instance of this disease, produced apparently by mus-
cular exertion and accompanied  with the mode of treatment adopt-
ed, is given by Dr.  Layard, in one of  the volumes  of the Philoso-
phical Transaciions.||  The patient  was  a  lad thirteen years of
age, engaged at the time in beating dung about a pasture.  He fell
all at once  a violent pain in his eye, which increased, and was ac-
• Act. Nat. Cur. Vol. H. Obs. 194.
  Saint Yves. Noveau Traite" des Maladies des yeux. Paris 1722.
| Layared, Phil. Trans. Vol. I. 1758.
t Prochaska, Mohrenheim Weiherischen Beytrager, B. n.
§ Surgery, Vol. III. p. 319.
1 Tract, de ductibus oculorem aquosis p. 120. Vol. 1.1758. 
 160                     NEUROTICA.          [CL. IV.—OR. It

 eompanied with inflammation, and a swelling of the  entire ball,
 which  in a  few months protruded so considerably  that the whole
 eye was out of its orbit, and hung down over the cheek to the up-
 per lip.  The coats  were greatly discoloured, all the vessels tur-
 gid, the sight totally lost, and the humours appeared like fluctuating
 pus.  An incision was made, the accumulated fluids were discharg-
 ed, a great  portion of the eye extirpated, and the  remaining part
 reduced within the  orbit; the wound soon assumed a healthy ap-
 pearance.   But the patient having caught cold before it was healed,
 a second inflammation ensued, a new and very large  cyst was form-
 ed, filled with a transparent fluid, and constituting a very protube-
 rant dropsy.  This on being punctured, discharged a large tea-cup
 full of the accumulated liquid.   The cyst, consisting apparently of
 a part of the sclerotic tunic which had been left, collapsed, and  the
 next day was easily removed: when the wound healed without fur-
t ther inconvenience or disfigurement than that of appearing to have
 the eye closed.
                       SPECIES  XIII.

              PAROPSIS  STRABISMUS.

                         Squinting.

    OPTIC AXES OF THE EYES NOT COINCIDING  ON AN OBJECT.

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

et Habitualis.             From  a vitiated habit; or the  custom
   Habitual squinting.       of using one eye, and neglecting the
                            other.
5 Atonicus.              From  debility  of  the  affected  eye,
   Atonic squinting.         whence the  sound  eye  possesses a
                            different  focus and power  of  vision;
                            and  is alone  trusted to:  in  conse-
                            quence of  which the  weak  or ne-
                            glected eye  insensibly  wanders as al-
                            ready stated.
y Organicus.             From the eye being differently construct-
   Organic  squinting.        ed in form or position.

   The  first of these varieties constitutes the nystagmus of Dr.
 Plenck, and its cause is sufficiently obvious.  In the second the sound
 eye is alone trusted to, because it is the only  eye on which  any de-
 pendence can be placed; and hence the weak eye, neglected by the
 will, wanders insensibly, as in the preceding order  we  have seen
 that any one of the  mental faculties  will wander in  like  manner
 under the same  want of discipline.  In the third variety the differ-
 ence of form or position, respects the situation or figure of the one
 eye compared with the  other, or of the particular parts of  the one
 eye compared with those  of the other: in consequence of winch
 the one is favoured and the other thrown into disuse.
   In this last variety a complete cure is  hardly to be expected
   vol. in.—21 
 162                     NEUROTICA.           [CL. IV.—OR. II

 In the second it is attended with considerable difficulty ; and in the
 first is rather to be accomplished by what, in mania, we have called
 moral treatment than by medicine.   A constant and resolute  exer-
 tion on the part of the patient to obtain a command over  the  weak
 or irregular eye is of absolute necessity, while the neglected  eye
 itself, if weak, should be strengthened by tonics and gentle stimu-
 lants.   Goggles, though, often recommended, are  seldom service-
 able, and especially lo children ; for although the sight must hereby
 be restrained in each eye to a common line, the child will still  use
 the sound eye alone, and leave the irregular eye  unemployed.   It
 is a  better plan to  affix  some object near the  orbit of the affected
 eye  at such a distance that it may constantly catch and draw off the
 pupil from the inner angle to the  outer.  But  the method  that I
 have myself found  by far the most effectual, is to blindfold the sound
 eye with a blink for  a  considerable part of  every day; and thus
 force the affected eye into use, and a subserviency to the will.  I
 recommend this simple  plan most  strongly, and especially in  the
 case of children; and we  may venture to predict that it will be sure to
 succeed in the first variety of the  disease,  that of habit,  and fre-
 quently in both the others.


                        GENUS II.

                      PARACUSIS.

                     Jttorfcft Rearing.

              SENSE OR HEARING VITIATED OR LOST.

 Paracusis is a term  of Hippocrates derived from -xxpxxovu " perpe-
 ram, depravate, vitios£ audio."   The mechanism of the  ear  is as
 complicated as that of the eye, and as admirably adapted, in all its
 parts, to the perfection  of the sense  which constitutes its function.
 Its lobes, its entrances,  its openings, its various drums, its minute
 and multiplied foramina, its  delicate bones, all contribute to one
 common effect.  Even the surrounding bones, and still more than
 this, the teeth, are  in no  small degree auxiliary to the same object:
 as the experiments of M. Perolle,  given in the fifth volume of the
 Turin Transactions, have abundantly established : as they have, al-
 so, that bone in general  is a far better conductor of sound than air,
 alkohol, or water.
  We may hence learn one very  important use of the four minute
 bones deposited in the  posterior chamber of the  tympanum, the
 loss of any one of which  impairs the  hearing, and,  in some instan-
 ces,  has produced total  deafness : of  which we  have a  striking
proof in the case of a lad, described in  the Philosophical Tansac-
 iions, who had parted with the incus on one  side, and both the  in-
r.us and malleus on the other, by means of an ulcerated sore throat 
6E. II.]
NERVOUS FUNCTION.
163
 that opened a passage from the fauces  into each ear, and through
 which the bones were discharged. The  tympanum, on the boy's re-
 covery, seems not to have lost its vibratory power, for he was sen-
 sible of violent or sudden sounds, but altogether insensible to con-
 versation, and apparently as  deaf in the  ear that had only parted
 with the incus as in that which had parted with both bones.*
   From the complicated organism of the ear it follows necessarily
 that, like the eye, it must be subject to  a great variety of diseases;
 while many of the diseases of the one sense must bear a striking
 analogy  to those  of the other.  Thus painful and obtuse hearing
 and deafness, may be well compared with painful and obtuse vi-
 sion and blindness. As the eye is at times  affected with illusory ob-
 jects so is the ear with illusory sounds ;  and as, when  the optic axes
 do not harmonize, as in strabismus, the same object may be  seen
 double, so may the same sound be j^ard double when the action of
 the one ear is inaccordant with that of the other.
   And hence it is not at all to be wondered at that a peculiar de-
 gree of sympathy should exist between  these senses, and the  state
 of the one be frequently affected by that of the other.  Bartholine
 gives a case in which deafness and blindness alternated with  each
 other,! and we shall presently have to observe  that a temporary
 affection of the  eyes may sometimes be  produced  by particular
 noises.
   As the organ of the ear, however,  is less exposed than that of
 the eye,  we are far less acquainted with the immediate seat of its
 diseases, and even with  the  exact bearing which every particular
 part sustains in the general phenomenon of hearing.  It was at one
time supposed that the nicest power of discriminating sounds, or in
other words, that accuracy of distinguishing which  constitutes
what is called a musical ear, is seated in the cochlea ; birds, how-
ever, whose perception is equisite have  no cochlea.  It has since
been conceived by Sir Everard Home that it is the membrana tym-
pani in which this fine feeling is peculiarly lodged,J and that it de-
pends upon the muscularity of this membrane: yet the same feeling
has remained, and in a high  degree, in persons  whose membrana
tympani has been ruptured.
  Paracusis as a genus includes the following species :

  t.  PARACUSIS ACRIS.             ACUTE HEARING.
  2.---------OBTUSA.            HARDNESS OF HEARING.
  3.---------PERVERSA.          PERVERSE HEARING.
  4.---------DUPLICATA.        DOUBLE HEARING.
  5.      -      ILLUSORIA.          IMAGINARY SOUNDS.
  6.  ———----- SURDITAS.         DEAFNESS.
• Vol. LI. No. 50.1761.
f Epist. Cent. IV. No. 40.
* Phil. Trans. Year 1800. 
164                      NEUROTICA.           [CL. IV.-OR. II.


                         SPECIES I.

                   PARACUSIS ACRIS.

                      &cttte f^earins.

HEARING PAINFULLY ACUTE AND INTOLERANT OF THE LOWEST SOUNDS.

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

                 PARACUSIS ORTUSA.

                  f^artmesa of, f&earins,

 HEARING DULL AND CONFUSED ;  AND DEMANDING A CLEAR AND MODU-
                     LATED ARTICULATION.

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

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

              PARACUSIS  PERVERSA.

                    $erfoerse Hearing.

THE  EAR ONLY SENSIBLE TO ARTICULATE SOUNDS WHEN EXCITED BY
      OTHER AND LOUDER SOUNDS INTERMIXED WITH THEM.

This is a very extraordinary hebetude of the organ,  though it has
occasionally been met with in most countries : where it exists, the
ear,  as in other cases of imperfect hearing, requires to be roused,
in order to discriminate the articulate sounds addressed to it, but
finds the best excitement to consist in a great and vehement noise 
GE. II.— SP. III.]       NERVOUS FUNCTION.
I6V
 of almost any kind* It consists, according to Sauvages, who seems
 to judge rightly concerning it, in a torpitude or paresis of some parts
 ol the external organs which in consequence of this additional sti-
 mulus, convey the proper sounds addressed  to them beyond  the
 membrane of the tympanum, in the same manner as the drowsy or
 those who are sluggish  in waking, do not open ttfeir eyes, or ad-
 mit the light to the retina unless a strong  glare first stimulate the
 exterior tunics.  It seems, however, sometimes to depend upon an
 obstruction of the Eustachian tubes.
   Under the influence of this species it sometimes happens  that
 particular sounds or noises  prove a better stimulus  than others
 though equally loud or even  louder : as  the music of a pipe, of a
 drum, or of several bells ringing at the same time.  Holder relates
 the case of a man who never heard but when he was beating a
 drum ;f and Sauvages a similar case of a woman who, on this ac-
 count, always kept a drum in the house, which  was constantly play-
 ed upon while she was conversing with  her husband.   The latter
 gives another case of a person who was always deaf except when
 travelling in a carriage, during which time, from the rattling of the
 wheels, he  was perfectly  capable of hearing and  engaging in con-
 versation.  And Stahl gives an instance of like benefit derived from
 the shrill  tones of a pipe.}:
   In  ordinary cases of practice if we can once hit upon a stimulus
 that succeeds  in giving temporary tone to a debilitated organ,  we
 can often  avail ourselves of it to produce a permanent benefit,  and
 sometimes a complete restoration, by raising or lowering its power,
 continuing its power for a longer or shorter term of time, or modi-
 fying it in some other way, so as to adapt  it to the particular exi-
 gency.  And it is hence probable that if any of these sonorous sti-
 muli  were to be employed  medicinally, and with a due respect to
 length of time, and acuteness of tone, they might, in some instances,
 be  made the medium of obtaining a perfect success.  Dr. Birch,
 indeed, gives  an instance of such success in  a person who  only
 heard during the ringing of bells;  and who, by a permanent use of
 this stimulus, recovered his hearing altogether.§  Voltaism may
 here also be employed in many cases with a considerable promise
of advantage;  and especially in connection  with the ordinary rou-
tine of general and local tonics and  stimulants, as cold, and cold-
bathing, pungent masticatones, and injections, bark, valerian, alone
or with ammonia, and a free use of the  siliquose  and coniferous
plants as a part of the common diet.

           * Feiliz in Richter Chir. Bibl. Band. IX. p. 555.
          f Phil. Trans. 1668. No. 26.
          * Colleg. Casual. N. 76.
          § Hist. Vol. IV. 
168
NEUROTICA.
tCL. IV.—OR. II
                       SPECIES IV.

             PARACUSIS  DUPLICATA.

                     Honfcle Rearing.

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

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

              PARACUSIS ILLUSORIA.

                   Xmaflinarg Sonn&s,

     INTERNAL SENSE OF SOUNDS WITHOUT EXTERNAL CAUSES.

This is in most instances strictly a nervous affection, and bears -•> 
OE. II.—SP. V.]       NERVOUS FUNCTION.
169
striking analogy to paropsis illusoria, or that illusory or false sight,
in which unreal objects of various  forms, colours, and other sensi-
ble qualities, appear before the eyes.   The  morbid state is often
confined to the auditory nerves,, or some of the branches alone; yet
it is not unfrequently the result of a peculiar irritability that extends
through the whole of the nervous system. And occasionally it pro-
ceeds from an obstruction of one or  both the Eustachian tubes. The
sounds hereby  produced  differ  greatly in  different  persons,  and
sometimes in the very same person at  different  periods: but it  is
sufficient to contemplate them under the three following varieties :

* Syrigmus.                A sharp, shrill, successive sound.
  Ringing, or tinkling.
fi Susurrus.                 An acute, continuous, hissing sound.
  Whizzing.
y Bombus.                  A dull, heavy, intermitting sound.
  Beating.

  Heister recommends, in cases arising  from a  debility of the
local nerves, to  fumigate the ears with the vapour of a hot vinous
infusion of rosemary and lavender ; and, where a spasmodic affec-
tion of the inner membrane may be supposed to follow upon such
debility, he advises a simultaneous use of diaphoretics internally.
If it proceed from an obstruction of the Eustachian tubes in conse-
quence of spasm or inflammation, the fumes of tobacco drawn into
the mouth, and forcibly pressed against these tubes by closing the
lips and nostrils, and then  urgently sniffing the vapours upward to
the palate, have often  proved serviceable by taking off the  irrita-
bility  on which the spasmodic or inflammatory action is dependent.
Stimulating the external ear by blisters, or aromatic injections has
sometimes availed though  not often.  Chronic cases are extremely
difficult of cure ; though I had lately an elderly lady for a patient,
who after having at different times suffered from  each  of these
modifications of  illusory sounds for several years, and tried  every
remedy that could be suggested in vain, at length lost the distressing
sensation by degrees, and without the assistance of any medicine.
                        SPECIES VI.

               PARACUSIS SURDITAS.

                         ErafnTss.

     TOTAL INABILITY OF HEARING OR DISTINGUISHING SOUNDS.

In the preceding species  the sense of  hearing is in various ways
  vol. m.—22 
170
NEUROTICA.
[CL. IV.—OR. U
depraved or impaired; in the present it is  altogether abolished;
and may proceed from causes  which offer three distinct varieties of
affection :

x Organica.                From organic defect or impediment.
  Organic deafness.
£ Atonica.                  From local debility or relaxation.
  Atonic deafness.
y Paralytica.                From local palsy.
  Paralytic  deafness.

  The organic defect or impediment may exist in the outer or
inner entrance, or in  the  cavity of the ear.   The outer  entrance
has in a few instances  been imperforate ;*  but far more generally
illined and  blocked up with  indurated wax, or some other sub-
stance.   The inner entrance  or Eustachian  tube has been some-
times also found imperforate  on both sides, but more frequently
obliterated by ulceration,! or closed by the  mucous secretion  of
a catarrh, or the pressure of the tonsils in  whatever way morbidly
enlarged.  If the defect or impediment exist in the cavity of the
ear its precise nature  can seldom  be known during  the life of the
patient, and if  known would rarely admit of  a remedy.
  Atonic deafness, or that dependent on  local debility or relaxa-
tion, may be superinduced by  a chronic cold, abruptly plunging the
head into cold water in a heated state, a loiu exposure to loud and
deafening noises, or the sudden and unexpected burst  of some vehe-
ment  sound upon the ears}:  as that of a cannon, or a thunder-clap§
where the constitution is in a state of great nervous  irritability: in
which state  moreover it has in a few instances been  produced by a
violent fright.||  It has also proceeded from an atony  of the excreto-
riesof the outer ear, in  consequence of which there has been neither
wax nor moisture of any kind.  And it has followed as a sequel upon
various  fevers, and inflammations, especially cephalitis and otitis,
rheumatic hemicrania,  and other nervous head-aches, repelled gout,
and repelled cutaneous eruptions.
  Paralytic deafness may be regarded in many cases as nothing
more  than an extreme of atonic deafness; and almost all the causes
producing the one, when operating with  greater violence or upon a
feebler frame, may also produce the other.   It  has  not only been
induced suddenly by loud sounds, and violent  frights,  but by a vehe-
ment  fit of sneezing, and, from sympathy,  by the use of powerful
sternutatories.1f
  Deafness has often been transmitted hereditarily; of which nume-
* Cels. De Medicin. Lib. VII. c. 8. Biichner, Miscell. Phys-med. p. 318. 1727
fHaller. Eletn. Phys. Tom. V. p. 286.
\ Schulze, Diss, de Auditus difficultate. Sect. 23.
§ Borelli, Observ. Cent. IV. Par. 1656.
\ Eph. Nat. Cur. Cent. IX. Obs. 6.
% Ephem. Nat. Cur. Dec. 11. Ann. IX. Obs. 26. 
QE. II__SP. VI.]
NERVOUS FUNCTION.
171
  rous and unequivocal instances are to be found in Hoffman,* Mor-
  gagni.f and other writers of established reputation.
    The most usual causes of total deafness are beyond the power of
  the medical art to relieve; and hence the disease runs verv eene-
  rally through the whole period of life.   Where the cause is an im-
  effeSed'00^  ^^^ ^ »assa*es>an  °P^ng has been  of£n
  w!x  or mfaJTT'  Mar  °ther imPedil»enl*>  ^ of indurated
  ^SI m«r     ."  7"" inflammatlon' are  in general rernoveable
  sbilmoie easily; and some obstructions have been suddenly carried
  off by a fall or  other violent concussion of the head.      *
  tJil deafnesis  fr°m atonic relaxation  almost all the stimulant and
  ionic methods pointed out under the preceding species have  been
  meci in  turn, occasionally with palliative success, sometimes alto-
  gether in vain.  The fumes of tobacco sniffed up the Eustachian
  luoes horn the mouth, in the manner described under the last spe-
  cies were recommended by Morgagni4 and many other  writers of
  earlier times, and have occasionally been found beneficial in  our
  own daj, the spasm  or other obstruction of the«ne tubes  ceasing
 ot a sudden, and with the sensation of a smart snap that almost
 startles the patient.  And as sight has sometimes been restored in
 amaurosis by a  violent fever, or a flash of lightning, so has deafness
 nom atony approaching to paralysis been recovered by a  like fever
 or a thunder clap ;§ ordinary  causes being thus transferred into ex-
 traordinary modes of  cure.
   Among the stimulants most useful, where the deafness is depend-
 ent upon debility of the membrane of the tympanum, or the nerve
 ot  hearing,  have  been the aura of voltaic  electricity, applied two
 or  three times a-day for half an  hour or longer each time, and  per-
 severed in for many weeks; a series of blisters continued for a long
 ptnod, and a diluted  solution of nitrate of silver.  Yet a chronic
 ulcer forming in the ear, and discharging plentifully has often prov-
 ed  more effectual than any of these.
  . Mr. Gordon in the Edinburgh Medical Commentaries, relates a
 ease of total deafness produced suddenly on a soldier in good health
 by  plunging overhead into the sea:  which, after  a long routine of
 medicines had been tried in vain for  three  months, yielded to the
 use of mercury as soon as the mouth began to be affected.  A  gen-
 tle  salivation  supervened,  his hearing was gradually  restored,  and
 in  six weeks from its commencement he  returned to his duty per-
 fectly cured.|| The excitement of the salivary glands seems, in this
case to have  extended by sympathy to the  Eustachian  tubes,  or
whatever other parts of the organ of hearing were diseased.

           * Consult et Kespons. Cent. I cas. 40.
           f De Sed. et caus. Morb Epist. XLVIII. Art. 48.
           i  Epist. Anat. VII. Art.  14.
            Eph. Nat  Cur. Dec. I  Ann. VI. Obs. 110.
          § Bresl. tSamml. 1718. p. 1541.
           D Edin. Med. Com. Vol.  HI. p. 80. 
172
NEUROTICA.          [CL. IV.-OR. II
  When  the  Eustachian  tubes are imperforate or irrecoverably
closed, which  may commonly be determined by an absence of that
sense of swelling in the ears which otherwise takes place on blow-
ing the nose violently, Mr. now Sir Astley, Cooper has ingeniously
proposed a  substitute for the canal by making a small perfora-ion
through the membrane of the tympanum ;  and as this does not de-
stroy the elasticity of the membrane, it has occasionally been at-
tended with success.
                      GENUS  III.

                     PAROSMIS.

                     JHorijOi Smell.

              SENSE  OF  SMELL VITIATED OR LOST.

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

         1. PAROSMIS  ACRIS.          ACUTE SMELL.
         2._________OBTUSA.        OBTUSE SMELL.
         3._________EXPERS.        WANT OF SMELL.
                       SPECIES I.


                 PAROSMIS ACRIS

                      &crttr Smell.

SMELL  TAINFULLY ACUTE OR SENSIBLE  TO ODOURS NOT GENERALLY
                        PERCEIVED.

Generally speaking the sense of smell in all animals is in propor-
tion to  the extent of the Schneiderian or olfactory membrane with
which the nostrils are lined, and over which  the branches of the ol-
factory nerves divaricate and ramify.  And hence this membrane is
much more extensive in quadrupeds and birds, which chiefly trust to 
GE. HI.—SP. I.]       NERVOUS FUNCTION.                 173

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

                 PAROSMIS OBTUSA.

                       (®utuse &meli.

         SMELL DULL, AND  IMPERFECTLY  DISCRIMINATIVE.

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

                  PAROSMIS EXPERS.

                      OTant of Smell.

     TOTAL INABILITY OF SMELLING OR DISTINGUISHING ODOURS.,

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

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

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

                 .   PARAGEUSIA


                      JHorbft ftaste

               SENSE OF TASTE VITIATED OR LOST.

Parageusis is derived from vxget, male, and ycvu. gustum prabeof
whence vrxgxytvu, and  consequently irxfxyevTis.  The author has
preferred wilh Vogel,  the present termination to  parageusia, as
analogous to the names of the preceding genera of the order before
us.
   In the senses of taste and smell there is a considerable association,
partly  perhaps  resulting from the proximity of their organs and
partly from an affinity iu the modification of the sentient fluids with
which they are supplied.  The young lady I have just noticed who
was  destitute, or  nearly so,  of  the sense  of  smell, was equally
destitute of that of taste, and could not distinguish by this criterion
between  beef, veal, and pork,  and consequently in  respect to all
these had no preference.
   The chief organ of taste is the tongue, but  this is not the only
organ,  nor is it absolutely necessary for an existence of the sense.
The Philosophical Transactions give  us examples of persons who
possessed a perfect taste after the tongue had been wholly destroyed;
and professor Blumenbach in his Comparative Anatomy, affords us
a similar example in an adult whom he  visited, and who  was born
without a tongue.  Consonant  with which  many insects appear to
have a faculty of taste, though they have  no  organ of a  tongue :
and among these the gustatory function is supposed by professor
Knoch to be  performed by the posterior pair of palpi or feelers.
While, on the other hand, there are many, animals possessing a
tongue who do not use it as an organ of taste.   All birds possess a
tongue, for even  the pelican, which has  been said to be tongueless,
has a rudiment of this member:  yet there are but few birds, com-
paratively, that taste or are able to taste with this organ.   Parrots,
predacious, and swimming birds are an  exception to this remark :
for they possess a soft thick tongue covered with papillae and mois-
tened wilh a salivary fluid, and select that which is the most agree-
able.  Yet in by far the greater proportion of birds we do not find
the tongue appropriated^ this purpose. In many of them, indeed,
it  is stiff, horny, and destitute of nerves.  The tongue of the toucan,
though sometimes several inches in length, is scarcely two  lines
broad at its root: it has throughout the appearance of whale-bone
and its margins are fibrous.  The tongues of the wook-pecker and
cock of the woods are equally hard and  horny :  in themselves they 
CE. IV.]
NERVOUS FUNCTION.
179
 are short, and in a quiescent  state, lie backward in the mouth, and
 are covered with a sort of sheath issuing from the os hyoides or the
 oesophagus: but  they possess  a mechanism which  renders them
 extremely extensile, and capable of being thrust forward to a consi-
 derable distance.   That of the  wood pecker is  sharp-pointed  with
 barbed sides, and is darted with great rapidity out of the mouth to
 an extent of some inches ;  by which  means  it follows  up  such
 insects as the animal is in pursuit of, through all their crannies in
 the bark of trees ; sticks them through with its apex, and in this
 state drags them  out for food.  The camelcon has a tongue of a
 somewhat similar kind, which in like manner, answers the purpose
 not of taste, but of preying for food.  It is contained in a sheath at
 the lower part of the mouth, and has its extremity covered with a
 glutinous secretion.   It admits  of being projected  to the length of
 six inches; and is used in this manner by the animal in catching it*
 spoil, and especially in catching flies.  It is darted from the mouth
 with wonderful  celerity and precision; and the viscous secretion on
 it extremity entangles minute animalcules, which constitute another
 portion of its food.
   The tongue, when it  forms  an organ of taste, as in  man,  is
 studded, and especially on its upper surface and  lateral edges, with
 innumerable nervous papillae issuing from a peculiar membrane that
 lies beneath, and has a near resemblance to the skin in other parts,
 but is softer and more spongy.   Its external tunic  or cuticle is an
 exquisitely fine epithelium, which is moistened,  not by an oily fluid
 like that of the surface of the  body, but  a peculiar mucus which
 proceeds from the foramen caecum of Meibomius, and the rest of
 the glandular expansion of Morgagni.
   We have here, therefore, a more exquisite sense of touch than
 on the general skin, whose papillae are not only smaller but dry.
   There can be no question, also, that the sentient fluid with which
 they  are supplied is differently modified,  from  that of the skin;
 and  hence the provinces of the two senses, though  they occasion-
 ally approach each other, are still kept distinct; and  the tongue
 becomes a discerner of certain qualities, which the skin cannot dis-
 criminate : as sour, sweet, rough, bitter, salt, and aromatic.
   Thus  much we  know, but we do  not know  the cause of  that
 different effect, or,  in other words, of that  variety of tastes which
 different substances produce upon papillae of the tongue, and which
 constitute their respective flavours.  It was supposed by the Epi-
 cureans, and  the doctrine has descended to  the present day, that all
 this depends upon the geometrical figure of the  sapid corpuscles;
 and particularly so with respect to saline bodies, which is cubic in
 sea-salt, prismatic in nitre, and equally diversified in vitriol, sugar
 and other crystals.  It is sufficient, however, to annul this explana-
 tion to observe, that many crystals of very different forms are alike
 insipid ; while others of the same, or nearly the same shape possess
very different flavours; as also  that  the flavour in any of them
continues the same even where we are able to change the figure; 
180
NEUROTICA.
[CL. IV.—OR. II.
 as for example, by rendering common nitre cubical.  The cause of
 flavours, therefore,  appears to reside in ihe elementary principles
 of substances that lie beyond the reach of our senses.
  But the variable condition of the peculiar covering of the papillae
 of the tongue, together with the condition of  the adjoining organs,
 which concur in the purpose of  the tongue, as also the changeable
 nature of the saliva, and of the substances lodged in the stomach, all
 concur in  influencing the taste and  giving a character  to  the
 flavour.  And hence the same flavours do not affect persons of all
 ages nor of all temperaments;  nor  even the same  person at all
 times.  In general whatever contains less salt than the saliva does,
 seems insipid.  The spirituous parts of plants are received, in all
 probability, either into the papillae themselves, or into the absorb-
 ing villi of the tongue;  and hence the rapid refreshment and reno-
 vation of strength, not easy to be accounted  for otherwise, which
 these stimulating materials produce even when they are not taken
 into the stomach.
  It is from  the diversity of flavours by  which nature has distin-
 guished  different substances,  that animals are taught instinctively
 what is proper for their food :  for speaking generally, no aliment is
 unhealthy  that is of an agreeable taste; nor is any thing ill tasted
 that is fit for the food of man  We here take no notice of excess by
 which  the most healthy  foods  may be rendered prejudicial, nor of
 mineral preparations  which are  not  furnished by nature but pre-
 pared by art.   And hence the wisdom of Providence incites man to
 select the nutriment that is best fitted for his subsistence equally by
 the  pain of hunger, and the pleasure of tasting. Man, however, is
often guided by instruction and  example as well as by his own in-
 stinct : but animals which are  destitute of such collateral aids, and
 have to depend upon iheir instinct alone, distinguish flavours, as we
 have already  observed they do  smells,  with  a far nicer  accuracy
 than mankind; and, admonished by this correct and curious test,
 abstain more  cautiously than man himself from eating what would
 be injurious.  And hence herbivorous animals whose vegetable food
 grows often intermixed with a great diversity of noxious plants, are
 furnished with much longer papillae and a more delicate structure
 of the tongue than  mankind, as they are endowed  also  with a
 more  accurate sense  of smell;  both  which, indeed,  they jointly
 rely upon for the same purpose.
  The sense of taste, therefore,  which possesses  so close an ana-
 logy to that of smell, is subject  to a similar  train of  specific dis-
 eases, and  consequently the genus parageusis must contain the
 three following species:

    1. PARAGEUSIS  ACUTA.             ACUTE TASTE.
    2. ————— OBTUSA.            OBTUSE TASTE.
    3.        ' '  ■' EXPERS.            WANT OF TASTE. 
GE. IV.—SP. I.]       NERVOUS FUNCTION.                 181


                        SPECIES I.

                PARAGEUSIS  ACUTA.

                        Mtutt 3Taste.

TASTE PAINFULLY ACUTE OR SENSIBLE TO SAVOURS  NOT GENERALLY
                          PERCEIVED.

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

               PARAGEUSIS OBTUSA.

                      (Etrtuse Eastt.

         TASTE DULL, AND IMPERFECTLY DISCRIMINATIVE.

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


                        SPECIES HI.

                PARAGEUSIS EXPERS.

                      Want of  Easte.

     TOTAL INABILITY OF TASTING OR DISTINGUISHING SAVOURS.

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

                      PARAPSIS.

                      JttorbOr 2Toucn.

     SENSE OF TOUCH OR GENERAL FEELING VITIATED OR LOST.

Parapsis is derived from the Greek terms *■*%x, and xirro^xi, " per-
peram tango."   The  common technical name for the genus is
dysaesthesia, but not quite correctly; since this word, as we have 
184
NEUROTICA.
[CL. IV.—OR. 11.
already had occasion to observe, is also employed to express morbid
external sensation of any kind, whether of touch, taste, smell, sight
or hearing : while by Dr. Young it is equally applied to one at least
of the faculties of the mind, as in dysaesthesia interna,  which he
characterizes as " a want of memory,  or confusion of intellect."
  This genus embraces  three species as follow :

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

                   PARAPSIS ACRIS.

                  &cute Sense of Couch.

THE SENSE OF TOUCH PAINFULLY ACUTE OR SENSIBLE OF IMPRESSIONS
                  NOT GENERALLY PERCEIVED.

This  species of morbid sensibility shows itself under  almost in-
numerable modifications: but the four following are the  chief:

        u  Teneritudo.                    Soreness.
        /3  Pruritus.                      Itching.
        y  Ardor.                        tleat.
        ^ Algor.                         Coldness.

  In the first variety or that of soreness there is a feeling of painful
uneasiness or tenderness, local or  general on being touched with a
degree of pressure that is usually unaccompanied with any trouble-
some  sensation.  This is often an idiopathic  affection; but  more
generally a symptom or sequel of  fevers in their accession or first
stage, inflammations, or external  or internal violence,  as strains,
bruises, or spasms.
  It is not always easy to account  for this feeling,  and perhaps the
cause is in every instance,  more complicated than we might at first
be induced to suppose.  It occurs where there is distention of the
vessels, where  there  is contraction of  them, and where  there is
neither.  Wherever it exists, however, it is a concomitant of de-
bility, and may, in many instances, be regarded as the simple pain
of debility, the  uneasiness  of an organ thrown off from  its balance
of health.   The general health of  the body  depends in a very con-
siderable degree upon the harmonious co-operation of its respective 
GE. V.—SP. I.]
NERVOUS FUNCTION.
185
 organs ; insomuch, indeed, that this harmony of action, as we had
 occasion to observe in the Physiological Proem prefixed to the pre-
 sent class, was supposed by a distinguished school of ancient philo-
 sophers, and is still supposed by many physiologists of the present
 day, to constitute the principle of life itself.  Regarded as an uni-
 versal principle  the hypothesis is unfounded, though in many re-
 spects beautiful  and plausible.*  Yet notwithstanding  that the life
 of the animal frame does not altogether depend upon an harmonious
 co-operation of the whole of the organs that enter into its make,
 much of the comfort of life has such a dependence : and  we trace
 the same principle in the minutest and comparatively  most trivial
 parts of the animal functions as manifestly as in the  largest and most
 complicated organs.  Where every portion of a member  however
 subordinate in itself,  as a toe or a finger, works well or healthily,
 there is a feeling of ease  and comfort, but  wherever it  works ill or
 with difficulty, there  is a sense of disquiet, and, under particular
 circumstances, of tenderness or soreness.   A change in the diame-
 ter of a vessel whether by dilatation or contraction, provided it be
 moderate arfd gradual,  is accompanied with no uneasy sensation
 whatever; but if either be violent or sudden, a feeling of soreness
 is a certain result, of which we have daily  examples in strains and
 spasms.   There  may perhaps be  no great difficulty in accounting
 for this : but the more common cause of tenderness is of a different
 kind, and a cause which often operates when neither of these are
 present though it is often combined with them.
   In order that every part of an organ may play upon every other
 part with a feeling of ease and comfort, it is well known that through-
 out the entire system, not only every surface, but every, even the
 minutest, interstice in the tunics  of the minutest vessels, is sup-
 plied by a soft and lubricous fluid, which is poured forth by secer-
 nents of exquisite subtilty, and  having executed its purpose and
 become waste matter, is carried off by equally  subtile absorbents,
 and succeeded by a fresh secretion of the same fluid.
   Now in all cases of external or internal  violence these are the
 vessels that first  give way and are rendered incapable of fulfilling.
 their function.  The secernents that supply this lubricous fluid be-
 come weakened  and  pour forth  a smaller quantity of it than is
 sufficient for a free and easy play of  one  part of an organ upon
 another part, and hence there is a tenderness or soreness from the
 friction of sides or surfaces against each other, and their coming in-
 to naked contact.  But as the corresponding absorbents are equally
 weakened, they cannot carry  off the whole of the fluid that is actu-
 ally secreted, how much soever diminished  in quantity: and hence,
 while they imbibe the subtler and more attenuate particles,  they
 leave the grosser behind; which not only become so many  sources
 of impediment, but, from forming part of a mobile and lubricous
effusion, are transformed into so many harsh and stationary goads.
                        • Vol. HI. p. 30.
vol. in.—24 
386
NEUROTICA.
LOL. IV.—OR. II
And hence another cause of that soreness  which accompanies all
cases of violence, as well internal as external, and particularly upon
external  pressure.  The effect of such  pressure, as forcing upon
each other naked and highly sensible surfaces, may be easily con-
ceived ; but there can be little doubt that the chief sense of soreness,
in the case of external pressure, proceeds, from thus forcing against
each other the naked and unlubricated sides of the  vasa vasorum,
which, in this manner deprived of their usual inunction, are incapa-
ble without uneasiness, of yielding  even to the ordinary impetus of
avis a tergo, or the touch of the common fluid they convey.
   It appears probable that some such morbid change in the natural
powers of these excretories and absorbents takes place occasionally
without any strain or violence whatever, and from causes we cannot
follow up; for we  sometimes meet with a like sense of soreness
without any forcible injury; but that these are the  vessels which
primarily and most readily give way under the operation of violence
is clear from their being frequently,  even from slight accidents,
altogether deprived of tone and rendered completely torpid ; so that,
while the absorbents carry off no part of whatever fluid is effused,
the excretories open without resistance, and from mere relaxation
to the impetus behind, and admit  fluids of almost  every kind, as
coagulable lymph, yellow serum, and occasionally even red blood:
whence the extensive swelling that sometimes takes place almost
immediately upon a strain or bruise, and the diversified hues it ex-
hibits : the diversity of hues, however, appears chiefly as the swell-
ing subsides; for as the subtlest, which are the most limpid, parti-
cles are first carried off by themselves, as  soon as the absorbents
begin to resume a healthy action, the grosser, which are the colour-
ed particles, as the yellow  and  the red  or  purple, are left nearly
alone, and consequently in a more  concentrated state, and acquire
an elaborate subdivision before they can be fitted for removal.
   From all which  we may easily trace the principle that render;.
warmth, gentle friction, and such stimulants as spirits, balsams, and
essential  oils, of general advantage  wherever the kind of tenderness
we are now describing occurs,  and is  unconnected with inflamma-
tion.
   The sense of itching, which may be  defined a painful titillation
local or general, relieved by rubbing, is commonly a result of some
mechanic; 1 or morbid irritant applied externally or internally to the
part affected;  though sometimes, unquestionably, dependent upon
a morbid sensibility of the nerves of feeling themselves.  If the sum-
mit of the nerves or their extreme points be alone touched, the effect
is tickling or titillation, as in the vellication of the skin by a
feather;  if it descend a little below the summit it is accompanied
with a vibratory feel which we call tingling, as when the beard of
barley-corns creeps unobserved by us up the  arms; and if it reach
still deeper, it is combined with a sense  of piercing, which we call
>ricking, as when the keen hairs  of several species of dolichosor
cowhage are handled or blown upon the skin  by a light breeze. 
GE. V.—SP. I.]
NERVOUS FUNCTION.
181
   In many cases all these modifications of itching are the effect of
some acrimonious secretion on the surface of  the body,  or  of an
acrimonious change in the common matter of perspiration in con-
sequence of its lodging in the cutaneous follicles longer than it
should do.  The papulous efflorescences we shall have to treat
of under the third order of the sixth class will afford abundant ex-
amples of both these causes of itching, as they  will also of an intole-
rable itching, apparently produced by, or closely connected with, a
morbid sensibility of the cutaneous nerves themselves.  For the
present we can do nothing more  than refer generally to various
species of exormia, as lichen and prurigo; and  of ecpyesis as impe-
tigo and  scabies.   It is, moreover, highly probable that that  disor-
der called fidgets is sometimes chiefly  dependent on a morbid sen-
sibility of the summits  or extreme ends  of the cutaneous nerves.
  This affection is also found  as a very troublesome symptom in
pernio and.other cutaneous inflammations, as likewise in urticaria
and other rashes.
  The sensations of heat and cold may be explained atthe same
time. An easy and pleasurable warmth depends, in a state of health,
upon a moderate temperature  of the atmosphere,  which cannot be
very accurately laid down, because, from habit or constitution, or
some other circumstance, different persons enjoy very different tem-
peratures.  Now it is the well known property of heat and cold to
disturb the temperature, whatever it may be, that affords  ease and
comfort to the nerves of feeling; and to produce disquiet as they
either raise or depress it.   And this both of them do in two distinct
ways.  Heat is a strong irritant, and even if it made  no change in
the bulk of a living organ, or the juxta-position of its particles, like
all other  irritants it would still excite a troublesome feeling, amount-
ing at length to acute pain,  if  raised to a considerable range be-
yond the ordinary scale.  But il does in every instance,  excite  a
change in the  bulk of living organs and the juxta-position of their
particles ; for it enlarges the former in every direction,and only does
this by separating the particles from each other ; in which forcible
and sudden divellication we have a second source of the troublesome
and acute sensation which so constantly accompanies a temperature
when carried very considerably above the  point of health.
  Heat, as an  idiopathic affection, occurs chiefly in  plethoric  and
irritable  habits.   In the former it is relieved by blood-letting, and
evacuants of neutral salts : in the latter  by mild diaphoretics, and
afterwards cold bathing and other tonics.
  As a symptom it is found, also, in the second stage of fever, in
inflammation,  and entonic empathema.
   Cold is also a strong irritant, though it acts by the opposite means
of heat.   When the atmospheric  temperature  is  too  high it is a
pleasant  and reviving agent, inasmuch as it both reduces the heated
medium, and restores the particles of the affected organ from a state
of disquieting  tenseness to their usual scale of approximation.  If
the cold  be pushed farther it may go a  little beyond this and still 
1S&                      NEUROTICA.          [CL. IV.—OR.  II

be pleasant and healthful: for the organ or the general system may
be in a state of morbid relaxation, and, consequently, in their actual
scale of approach, the  living particles may be  too  far remote for
the purposes of high elasticity and vigour. And it is in such a con-
dition as this that cold chiefly shows its stimulant power, and is  so
generally resorted to as a tonic.  But if the agency of cold be car-
ried farther than  this, it produoes uneasiness to the nerves of feel-
ing by a process  precisely the reverse of that we have just shown
to be pursued by  heat, and consequently in a two-fold manner.  First
by lowering the warmth of the organ, or of the system, below  its
scale of ease and comfort, and next by forcing  the living  particles
into too close and crowded a state, and not allowing them sufficient
room for play.
   Cold, as an idiopathic affection, is chiefly local, and most common
to the head and feet.   It  is temporarily  relieved  by warmth and
stimulants, and particularly by the friction of a warm hand :  and,
where it can be used, the exercise of  walking.  It is permanently
relieved by the warmer tonics, as sea-bathing and aromatic bitters.
   Considerable mischief has often been produced by a sudden ex-
posure of the feet to severe cold and  especially in  delicate and  ir-
ritable  habits, unused to such applications:  as colic, cephalaea,
catarrh,  fevers of various kinds, and, in a podagral  diathesis, gout.
But the application of severe and sudden cold to the head or sto-
mach by drinking ice  or cold water,  and especially when the indi-
vidual is heated and perspiring, has been followed with more alarm-
ing effects, and even with death itself.  Mauriceau relates an in-
stance of death produced during baptism, by applying to  the head
the  water of the  baptismal font.*  But this must be a rare occur-
rence ; while the fatal effects of drinking ice or  iced water in a
 state of heat are  innumerable.
   It is observed  by Dr. Fordyce,t and the observation is quoted and
 called curious by Dr. Darwin, " that those people who have  been
 confined some time in a very warm atmosphere, as of  120 or 130
 degrees of heat,  do not feel cold, nor are subject to paleness of their
 skins, on coming into a  temperature of 30 or 40 degrees; which
 would produce great paleness and painful sensation  of coldness in
 those who had been for  some  time  confined in an atmosphere of
 only 86 or 90 degrees."  The cause is not difficult of explantion.
 The sensorial power is exhausted and the nerves of feeling render-
 ed torpid by a long exposure to a heat of 120  or 130 degrees, and
 the turgid capillaries, whose dilatation produces the general blush,
 lose their power of constriction  or collapse ; while in the heat of
 86 or 90 degrees neither of such effects takes place.
   Cold, as a symptom, is found in the first stage of fever, in syncope,
 hysteric syspasia, nausea, and atonic  empathema ; in all which the
 affection is general.
* Tom. II. p. 348.
t On Simple Fever, p. 168. 
GE. V—SP. H.]       NERVOUS FUNCTION.
189
                        SPECIES II.

                 PARAPSIS EXPERS.

       Xttstntfirilftg ot South, General jFeelfns.
THE ORGAN OF TOUCH  TOTALLY IMPERCIPIENT  OF OBJECTS AF-
PLIED TO IT.
 Under this species, by some writers denominated amblyaphia, we
 may mention the two following varieties :

 «  Simplex.                     Confined locally or generally to
   Numbness.                     the organ of touch: sometimes
 e                                 accompanied with uneasiness.
 <o  Comphcata.                  Complicated with insensibility in
   Complicated insensibility.        several of, or  all, the  other
                                  senses.
   Occasional and local numbness is common to most persons.   A
 tight bandage or accidental pressure of one limb upon another, by
 obstructing the flow  or activity of the nervous fluid  will often pro-
 duce this, when the limb is commonly and emphatically asserted to
 be asleep.  A very slight motion, however, takes it off,  when  the
 irregular flux of the  sensorial power, on its first return, produces a
 sense of pricking,  as though a ball  of needles was in the limb and
 pushing in every direction. Where such numbnesses, however, occur
 without pressure or any manifest cause, they well deserve watching
 and resisting by tonics or stimulants local or general; for they clear-
 ly show a tendency to paresis if not to paralysis.
   But there are some persons who possess by nature  a numbness or
 privation of the sense of feeling in particular organs or parts of the
 surface, which appears to depend  on a natural destitution of the
 nerves of touch wherever such insensibility is to  be found.  And
 hence they are able in such  parts of the body, to prick or cut them-
 selves, or to run pins to any depth below the skin without pain.   I
 have seen several striking examples of this peculiar affection. Some-
 times the numbness has been limited to a single limb, but common
 to the whole of it, as the hand, for example, which at  the same time
 has possessed a full power of motion.  Sometimes the insensibility
 has been universal, or extended over the whole surface.   Lamarck
 relates a case in which this want of feeling was confined to the arm;
but at the same time  was so complete, that the man who laboured
 under it had no pain during the progress of a phlegmon; and on an-
 other occasion in which he broke his arm, felt nothing more than a
crash, and merely thought he had broken the spade he was at work
with. Dr. Yelloly has described another  interesting case  in the
third volume of the Medico- Chirurgical Transactions.  The  patient
 aged 58, had  been  first affected in Jamaica about three years be- 
IliO
.NEUROTICA.
[CL. IV.—OR. II.
 fore, and the affection had become permanent.  " The hands," says
 Dr. Yelloly, " up to the wrists, and the feet half-way up the legs, are
 perfectly insensible to any species of injury, as cutting,  pinching,
 scratching or burning.   The insensibility, however, does not sud-
 denly terminate; but exists to a certain degree nearly  up to the
 elbow, and for some distance above the knee.  He accidentally put
 one of his feet, some time ago, into boiling water, but was no other-
 wise aware of the high temperature, than by finding the whole sur-
 face a complete blister on removing  it.   The  extremities are in-
 sensible to electrical  sparks taken in every variety of mode."
   As an example of the second  modification or insensibility in
 the  organ of touch, complicated with insensibility in several other
 senses, we may mention the following which Sauvages has copied
 from the Academy Collections : " The patient, a delicate young man,
 was suddenly in the morning deprived equally of speech and of the
 sense of touch, without any assignable cause or premonition. Punc-
 tured and pricked in different parts of his body, in his head, neck,
 back, shoulders, breast, arms, abdomen, he felt  nothing  whatever,
 and even laughed at the singularity of the phenomenon; as, with
 the exception of numbness, and cutaneous insensibility, he laboured
 under no kind of disease.  The complaint continued two days, and
 seems to have yielded to venesection."
   Insensibility of touch, either simple or complicated, is also felt as
a symptom of apoplexy, palsy,  catalepsy, epilepsy, syspasia, and
syncope.
   Where the numbness is complete and constitutional,  it lies be-
yond the reach  of medicine : where it is recent and less  extreme,
it will often yield to friction alone, or with camphorated oil or spirits,
heat, especially that of the warm bath : ether,  volatile alkali and
water, and the voltaic  stream, or small shocks of electricity.
                        SPECIES III.

               PARAPSIS ILLUSORIA.

                Kllusorg Sense of 5Toucft.

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

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

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

                     * Vol.U.p. 476.etalib; 
 192                     NEUROTICA.           [CL.IV.—OR.1I.


                        GENUS VI.

                     NEURALGIA

                        Berfce=ache.

 ACUTE SENSIBILITY AND LANCINATING PAIN IN THE COURSE OF ONE OR
  MORE BRANCHES OF NERVES IN AN ORGAN ; MOSTLY WITH AN IRRE-
  GULAR MOTION OF THE ADJOINING MUSCLES ;  RECURRENT IN SHORT
  PAROXYSMS WITH INDETERMINATE INTERVALS, OR REMISSIONS.

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

    1. NEURALGIA FACIEI.     NERVE-ACHE OF THE FACE.
   2.----------PEDIS.      NERVE-ACHE OF THE FOOT.
   3. ---------- MAMMiE.    NERVE-ACHE OF THE BREAST.

  The Corporeal senses which have hitherto passed within the
 range of our observations, as the seats of different genera of diseases

  *  Recherches et  Observations  sur la Neuralgie faciale, oule Tic doulou
reux de la face. 
GE. VI.—SP. I.]        NERVOUS FUNCTION.
193
 are external, and serve to  convey impressions peculiar to them-
 selves.   It is, however, sufficiently known to every one that there
 is not an organ in the body  but is possessed of nerves productive of
 a very different kind of sensibility from any of these, less  distinct,
 perhaps  and elaborate, but the index  of its weal or wear, its com-
 fort or disquiet: and which may be sufficiently expressed  by  the
 name of general J'ering.  It is possible, indeed, that this general feel-
 ing may, in some degree, be differently modified in every organ •
 but as the distinctions, whatever they  may be, are not nice enough
 to trace out and arrange, as  they are in the local senses, it is suffi-
 cient for all the purposes of pathology  to regard this feeling as com-
 mon to all the sentient organs, and consequently as one and the same.
 We have already taken some notice of it in the  proem to the pre-
 sent class,* and have observed that it  has been described by some
 physiologists under the name of caenesthesis, and by the Germans is
 denominated gemeingefiihl, or general feeling.   Dr Hubner pub-
 lished an  inaugural dissertation on  the subject in 1794, in which he
 enumerates its  properties at  some length.f  I have never seen this
 treatise, but Sir Alexander Crichton, who has, describes it as a very
 ingenious production.
   It is these nerves of general sensibility that seem to constitute the
 seat of disease in the three species  we are now about to enter upon,
and consequently indicate that the present is their proper place in
 a system of physiological nosology.
                         SPECIES I.

                  NEURALGIA FACIEI.

                  J£erbe=aene of the iPaee.

 LANCINATING PAINS SHOOTING FROM THE REGION OF THE MOUTH TO
   THE ORBIT, OFTEN TO THE  EAR,  AND OVER THE CHEEK, PALATE,
   TEETH,  AND  FAUCES ;  WITH  CONVULSIVE  TWITCHINGS OF  THE
   ADJOINING MUSCLES.

 This is the trismus maxillaris. or t. doloriflcusof M. de Sauvages, for
 it is not necessary to make a distinction between them as Sauvages
 himself has done; by Dr. Fothergill it is denominated dolor crucians
 faciei.  As the French give the name of tic to trismus or locked-
 jaw, they distinguish the first species of neuralgia, affecting the
 nerves about the jaw, by the name  of tic doloureux, by which term
 the disease is, perhaps, chiefly known even  in our own country in

  • Ante, p. 18.
  f Commentatio de Csnesthesi Dissert.  Inaug.  Medica.—Auctore,  C. F
Hubner, 1794.
  VOL. Ill,—25 
194                      NEUROTICA.          [CL. IV—OR. II.

the present day.  1 shall have occasion to observe, more at large
under the genu stri smus, that the word tic is commonly supposed to
be an onomatopy or a sound  expressive of the action it imports;
derived,  according to  some, from the pungent stroke with which
the puin  mukes its assault, resembling the bite of an insect; but,,
according to Sauvages and Solcysel, from the sound made by horses
that are perpetually biting the manger when labouring under this
peculiar  affection.   We do not, however, appear to be acquainted
with the  real origin of the term.
  From the symptoms by which this complaint is distinguished it
is not difficult to decide concerning both its seat and nature.  The
character of the pain is very peculiar, and its  course corresponds
exactly with that of the nerves.  The second  branch of the fifth
pair is, perhaps, more frequently affected than either the  first  or
the third.  But the portio dura of the seventh pair, which  is dis-
tributed more extensively upon the face, under the name of pes
anserina, is more frequently the seat of affection than any of the
branches of the fifth pair seem to be; which is a matter of no
small regret as it is difficult for any operation to reach this quarter
effectually, although it is a difficulty which we shall presently find
has in  one instance, at least,  been encountered  and surmounted.
WThcn, however, the disease is seated in the seventh pair of nerves,
we  can be at no loss to decide concerning it, in consequence of the
couise and divarications of the pain which commences with great
acuteness in the fore part of the cheek towards the mouth and alse
of the  nose, sometimes spreading as high as the forehead, and rami-
fying in the direction of  the  ears.   At other  times the forehead,
temple and inner angle of the eye on the side affected, and even the
ball of the eye itself, form the chief lines of pungent agony, while
from irritation of the lachrymal gland the eye weeps  involuntarily.
In this case we may reasonably suspect the disease to be seated in
some part of the superior maxillary nerve, constituting the second
branch of the fifth pair.  And it is  hence obvious that the radiation
of the  pain must vary according to the nerves or nervous twigs that
are affected.
  The disease has been  occasionally mistaken for rheumatism,
hemicrania and tooth ache :  yet the brevity of  the  paroxysm,  the
lancinating pungency of the pang, the absence of all intumescence
or inflammation, the comparative shallowness, instead of depth, of
its seat, and its invariable divarication in the course  of  the facial
nerves or their offsets, will always be  sufficient to distinguish it
from every other kind  of pain.
  Of its  exciting causes we know  but little.  It seems sometimes
to have been produced by cold, and sometimes by mental agitation
in persons  of an irritable temperament.  But it  has been found in
the robust as well as in the delicate, in the middle-aged, as well as
in the  old.
  Andre appears  to have been  the earliest writer who remarked
ihis painful affection with accuracy, and he succeeded in removing 
CE. VI.-SP. I.]
NERVOUS FUNCTION.
195
it permanently by applying a caustic to the infra-orbitrary, or max-
illary branch of nerves in one case in which a previous division of
the nerve by the scalpel, as practised by Marechal, had produced
only a temporary cure.  Andre, who resided at Versailles, published
his account in 1756, whimsically enough intervening it .in a treatise
on diseases of the urethra.  A few unsatisfactory experiments and
operations were given to the public in the course of tht: next fifteen
years, chiefly by French practitioners,  from which  little of real
value is  deducible; in 1776, Dr. Fothergill, in the fifth volume  of
Medical  Observations and Inquiries, communicated a very full and
elaborate description and history of the disease: since which time
M. Thouret, and Pujol have each published a valuable paper on the
same subject in the Memoirs of the Society  of Medicine of Paris,
containing various cases collected and described with great minute-
ness ; and we have already adverted to the more recent publications
of Dr. Meglin and professor Chaussier.
  It has  of late been suspected that in some cases of this disease, at
least, the seat of irritation might be at the origin instead of at the
extremity of the nerve ; an idea that  has arisen from the powerful
sympathetic action  manifested by the eye and the stomach forming
the boundaries of the chain, upon which subject we shall have  to
speak at  large when treating of the genus  entasia in the ensuing
order.  " The  nerves,"  remarks  Dr. Parr, " that supply the eye
externally, and the slight connexion of the intercostal with the
brain, are nearly from the same spot in the  cerebrum, and it did not
seem improbable, in the case alluded to, that the disease may have
really been at the origin of the nerve, although  felt as usual at its
extremity."  Dr. Parr was, in consequence, induced to try arsenic,
and in o*ne instance, he tells us with a decidedly good effect.  It is
also said  to have been since found serviceable in  a few other cases.
In Mr. Thomas's hands, however, we shall presently perceive that
it completely failed.  Mercury is also reported to have  occasionally
proved successful, and especially  when carried to the extent of sali-
vation ; though in numerous instances it has been tried even  to this
last effect without any benefit whatever.
  When about thirty years ago animal magnetism was a fashionable
study in France, it was had recourse lo for this disease among others,
and had its day of favour as a popular remedy.  Of late, however,
neuralgia has been attempted to be cured in France by an external
use of acetic ether; while in Germany  Dr. Meglin has  employed
pills composed of the extract of henbane, and sublimed oxide of zinc,
and according to his own statement with great success: but farther
trial is desirable upon this subject.
  In effect neither narcotics, nor tonics, nor any other class of medi-
cines that has hitherto been employed,  can be depended upon for
a radical  cure, though some of them seem occasionally to afford tem-
porary benefit.  " My father," says Dr. Perceval of Dublin, " in his
manuscript comment on the present author's Nosology, was subject
to neural gia faciei for several years, and used a variety of medicines 
19b'
NEUROTICA.
[CL. IV—OR. If.
without relief.  He was worse  in close damp weather, and much
worse when his mind was occupied.   At length he had an issue in-
serted in the nucha, kept his bowels free with James's analeptic
pills, and exchanged a town residence for the country.  In this si-
tuation he soon threw off the disease, from which he was free for a
considerable time before his death."   Change of scene, a transfer
of morbid action, and a recruited cheerfulness of spirits are valua-
ble auxiliaries  in the present as in every other nervous affection:
but 1 much question whether these alone have ever operated a cure.
A spontaneous cure is the work of time alone;  and  time, though
often a long and tedious  period is requisite, will generally accom-
plish it, and probably did so in the case before us.   The fact is that
the nervous system in every part, and every ramification, becomes
gradually torpefied by excess of action; and as the eyes grow blind
and the nostrils inolfacient by strong stimulants applied to them, so
the nervous twigs of every kind, after a long series of irritation
from the present disease, become exhausted of power and obtuse in
feeling.
   In the mean while the only artificial  cure is to be found in a di-
vision of the affected branches, provided they can be followed home.
Dr.  Haighton completely succeeded some years ago in a case in
which he divided the suborbital branch of the fifth pair; and Mr.
Cruickshank and Mr. Thomas more recently in a case of considera-
ble complication, and where the affection was evidently not confin-
ed to the different branches of any single nerve.   This last case  is
given by Dr. Darwin, whom the patient had intermediately consult-
ed, in the second part of his Zoonomia, and is one of the most inte-
resting sections of the work.   The patient, a Mr.  Bosworth by
name, was between thirty and  forty years of age.  When he first
applied to Dr. Darwin he complained of much pain about the  left
cheek-bone.   Dr. Darwin suspected the antrum maxillare might be
diseased; and, as the second of the grinding teeth  had been lately
extracted, directed a perforation into the antrum, which was done,
and the wound kept open for two or three days without advantage.
Afterwards by friction about the head and neck with mercurial un-
guent,  he was for a few days copiously salivated, and had another
tooth extracted by his own desire, as also an incision  made in such
direction as to divide the ariery near the centre of the ear next the
cheek, which gave also a chance of dividing a branch of the affect-
 ed nerve; but without success.   Internally opiates were administer-
ed in large quantity when the pain was exceedingly  violent: bark
being used freely in the intervals, but  without effect.
   The pain spread  in various  directions from a point in the left
 cheek a little before the ear, sometimes to the nose, and forepart  of
 the lower jaw, and  sometimes  to the orbit of the eye on the same
 side ; the under part of the tongue being at times  so affected.   It
 returned on some days many times in an hour, and continued seve-
 ral minutes;  during which period it  is well worth  observing,  as
 showing the connection between an irregular sensitive and an irre- 
GE. VI.—SP.L]
NERVOUS FUNCTION.
197
gular irritative power in the same muscles, the  patient,  says  Dr.
Darwin, seemed to stretch  and exert his  arms, and appeared  to
have a tendency to epileptic actions, so that his life was rendered
miserable to himself to support and to his friends to witness.   The
complaint gradually grew worse, and Mr.  Bosworth removed  to
London for the purpose of again putting himself under Mr. Cruick-
shank's care, and of submitting to any operation he should recom-
mend. The pain was now intolerably acute, and  almost unremit-
ting ; and opiates afforded him little or no relief  though taken to
the quantity of six teaspoonfuls of laudanum at a  time.  The ope-
ration of dividing the diseased nerve was therefore determined
upon.
  " As the pain," says Mr. Thomas in his letter to Dr. Darwin,
after its completion, " was felt more acute  in the  left  ala of the
nose, and the upper  lip  of  the same side, we were induced to di-
vide the  second branch of the  fifth pair of nerves as it passes out at
the infra-orbital foramen.  He was instantly relieved in the  nose
and lip ;  but towards night the pain from the eye to the crown of
the head became more acute than ever.  Two days after we were
obliged to cut through the first branch passing out at the supra-or-
bital foramen: this afforded him the like relief with the first.   On
the same day the pain attacked, with great violence, the lower lip
on  the left side, and the chin ;  this circumstance induced the neces-
sity of dividing the third branch,  passing out at the foramen men-
tale.   During the whole period, from the first division of the nerves,
he  had frequent attacks of  pain on the side of the tongue ; these,
however, disappeared on the division of the last nerve.
  " The patient was evidently bettered by each operation ; still the
pain was very severe, passing from the ear under the zygoma  to-
wards the nose  and mouth, and upwards round the orbit. This route
proved pretty clearly that  the portio  dura of  the auditory nerve
was also affected, at least the  uppermost branch of the pes anseri-
na.  Before I proceeded, (continues Mr. Thomas,) to divide this—
(Mr. Cruickshank had operated hitherto)—I was  willing to try the
 effect of arsenic internally, and he took it in sufficient quantity to
 excite nausea and vertigo, but without perceiving any good effect,
 I could  now trust only  to the knife to alleviate his misery, as  the
pain round the  orbit was become most violent; and therefore inter-
 cepted the nerve by an incision across the side of the nose, and also
 made some smaller incisions  about the  ala nasi.  To divide  the
 great branch lying below the zygomatic process, I found it necessary
 to  pass the scalpel through the masseter muscle, till it came in con-
 tact  with the jaw-bone, and then  cut upwards ; this relieved him
 as usual. Then the lower branch was affected, and also  divided ;
 then the middle branch running under the parotid gland. In cutting
 this the gland was consequently divided into two equal parts, and heal-
 ed tolerably well after a copious discharge of saliva for several days.
    " I hoped and expected that this last operation would have termi-
 nated his sufferings, and my difficulties; but the pain still affected 
 198                     NEUROTICA.            [CL.IV.—OR.II.

 the lower lip and side of the nose, and upon coughing, or swallow-
 ing, his misery was dreadful.   This pain could only  arise from
 branches from the second of the fifth pair passing into the cheek,
 and lying between the pterygoideus internus muscle and the upper
 part of the lower jaw.   The situation of this  nerve  rendered the
 operation hazardous, but after some attempts it was accomplished."
 This finished the series of operations and restored the afflicted pa-
 tient to perfect health.
   I have dwelt the longer on this interesting case because it seems
 to show, first, that there is no certain cure but  in  the  use of the
 knife ; secondly, that a delay in performing the operation only af-
 fords time for the disease to spread from one part  of the  affected
 nerve to  another, and even to different branches of nerves in a state
 of contiguity : and thirdly, that  the disease betrays the spasmodic
 character of the diathesis when minutely watched, even in cases in
 which this character is most obscure.  Dr Darwin objects properly
 enough to arranging this  disease as a trismus, " since  no fixed
 spasm," says he," like the locked jaw exists in this malady."   He
 adds, indeed, that in the few cases he has witnessed,  there has not
 been any convulsion of  the muscles of the face : but in  i\lr. Bos-
 worth's case he has expressly noticed the morbid stretching of the
 arms, and the tendency to epileptic actions.



                         SPECIES II.

                 NEURALGIA PEDIS.

                 iierfce=aefte of tne iFoot.

RACKING AND LANCINATING PAINS  RANGING ABOUT THE HEEL ; AND
  TREMULOUSLY SHOOTING IN IRREGULAR DIRECTIONS TOWARDS THE
  ANCLE  AND BONES OF  THE TARSUS.

 This is the neuralgia filantaris of professor Chaussier : who men-
 tions a very decided case of it, to which Dr. Marino, a physician of
 Piedmont, had been long subject.   It commenced, he tells us, in
 early life ;  was relieved  by the mineral waters of Vivadio ; and still
 more by the pressure of a tight bandage.  With advancing years it
 became less severe, the  cause of which we have already explained
 in the preceding species, but never ceased altogether.  It alternat-
 ed with other nervous affections, and  was at length  complicated
 with convulsive asthma.
  In calling, as I believe for the first time, the  attention of the me-
 dical profession to this species, by introducing into  the volume of
 Nosology before the presentation of M. Chaussier's  book to the
 world, I had my eye directed to a very marked case which had then 
GE. VI—SP. II.]       NERVOUS TWCTION.                 199

lately occurred to me in a clergyman of this metro^plis, about for-
ty-five years of age, but otherwise in firm health and ^heerful spi-
rits.  He had  for many  years been a victim to it.  The paroxyms
were  short and of uncertain recurrence,  but  so acute as nearly to
make him faint, and at length compelled him  to relinquish the du-
ties of the pulpit, for which from his zeal and eloquence he was ad-
mirably qualified, but where he  had frequently  been obliged  to
break off with great abruptness from the  unexpected incursion ofa
fresh  paroxysm.    The pain usually extended up the calf of the leg
towards the knee, and ramified towards the  toes in an opposite
direction, and was usually compared by himself to that of scalding
verjuice poured over a naked wound.  The tibial branches of the
popliteal nerve, and particularly the plantar twigs, seem in this spe-
cies to have been the part chiefly affected, though  it is probable
that some of the  offsets from the peroneal branch associate in some
instance in the moibid action.
  Every therapeutic process that the art of medicine in the hands
of the most experienced physicians of this metropolis could devise,
was in this case tried  in a long and tedious succession in vain.
Sometimes external  and sometimes internal preparations, or a tight
ligature, appeared to afford a temporary alleviation, and to protract
the intervals: but never any thing more.   It was in  consequence
proposed by a surgeon of great eminence to amputate the leg, which
was at one time  on the point of being submitted to, though protest-
ed against by the present author, on two accounts.  First, the uncer-
tainty whether the morbid condition of the  nerve  might not  be
seated chiefly in the  origin instead of in the extremity of the nerve;
in which .case amputation  could be of no avail; and secondly, the
chance that in process  of time the keen sensibility of the affected
branches would  be worn out and obtunded by the violence of the
action.  Such was the  undecided and  miserable  condition of this
patient at the  time of noticing his case on the publication of the au-
thor's volume of Nosology.  Since this period, the prediction that
the aisease would gradually wear itself out,  has been completed:
the paroxysms are now slight and tolerable, and the intervals much
longer; and the patient has for nearly a twelvemonth been able to
resume the duties of his profession without any interruption. 
  200                     NKWRmCA.           L^L. IV.—OR. II


                          SPECIES III.

                 NEURALGIA  MAMMiE.

                 fierbe^aehe of the Breast.

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

  It is  about two years ago that I was requested by an eminent sur-
  geon  in this metropolis in dispensary practice, to examine a young
  woman thfln eighteen  years of age, who, for more than two years
  had been subject to a painful disorder of the breast that seemed
  equally to defy all parallel and all mode of treatment.  On examin-
  ing into the nature of the symptoms, I found them as described in
  the preceding definition.  The organ was  full-formed,  soft, and
  globular, without the slightest degree of inflammation, or hardness.
 When the paroxysm of pain was not present it would bear pressure
  wilhout inconvenience, but  during the pain the whole  breast was
 acutely sensible.   The paroxysms returned at first five or six times
 in the course of the day, and were short and transient: but as the
 disease became more fixed, it became also more severe and exten-
 sive :  for the agonizing fits  at length recurred as often as once an
 hour, and sometimes more frequently : and from being comparative-
 ly concentrated, the lancinating shoots darted both downward in the
 course of the circumjacent ribs, and upwards to the axilla, whence
 they afterwards descended to the elbow, below which I do not know
 that they proceeded at any time.   These fits  were at length so fre-
 quent  and vehement as to embitter her whole life, and incapacitate
 her from pursuing any employment, for it frequently happened
 that, if she attempted needle-work, her fingers abruptly dropped
 the needle a few minutes after taking hold of it, from a mixture of
 pungent pain and tremulus twitching.  The twitching or snatches
 in the  shoulder, for it at length reached to this height, were at one
 time so considerable as to give the patient an idea, to use her own
 words, that something was alive there ; while though the lancinat-
 ing pain did not descend below the elbow, a considerable degree of
 trepidation reached occasionally to her fingers' ends.  Her general
 health  was in the mean time unaffected, and she was regular in
 menstruation.
   I had no hesitation in regarding this a non-descript species of
 neuralgia; and as little in communicating my fears that no plan of
 medicine we could lay down would be more than palliative, even if
it should prove thus far beneficial, and that we must trust  to time
alone for a cure, and lhat obtuseness of sensibility which 1 have 
GE. VI.—SP.III.]     NERVOUS FUNCTION.
201
 already  noticed as a common consequence of high nervous irrita-
 tion, continued till the organ becomes exhausted and torpefied.
   Every remedial process was, nevertheless, tried in succession for
 the purpose of obtaining relief, if not full success. Bleeding, local
 and general, frequently and  profusely repeated ; purgatives of all
 kinds;  tonics and  antispasmodics of all kinds; the hot and  cold
 bath; electricity and galvanism in every form; rubefacients,  blis-
 ters, setons, issues, and whatever else could be suggested, were
 enlisted into service in succession.   But every thing was equally
 without  avail: nor  do I know that even a temporary relief was ob-
 tained by any of these.  Narcotics of all kinds proved  impotent:
 drowsiness, indeed, and a comatose stupor were  hereby in various
 instances obtained, but the interval of wakefulness  vjas as much as
 ever tormented  with the same racking paroxysms.'^From the pow-
 erful influence of nux vomica in  many cases of nervous affection,
 to some  of which we shall have occasion to advert  hereafter, I  had
 some hope of producing a slight impression on the nerves affect-
 ed : but the hope proved illusory: she took it in infusion as far as
 to about eight grains at a dose three or four times a-day, till  her
 head was intolerably confused and every other part become numb,
 but the paroxysms were intractable.
  The poor  sufferer, whose  relations were  incapable of affording
 the resources of private practice, tried one dispensary after another,
 and at length one of the largest hospitals of this metropolis, with-
 out the smallest benefit, and from  each was discharged as incurable.
 About six months ago, however, being nearly four years from  the
 commencement  of  the disease at home, and having utterly relin-
quished all medical means with the exception of a seton  under  the
breast, which was not dried up,  she began to think herself rather
better, and has continued to  improve ever since, till a week ago,
when her mother came to inform me  she was worse again.  This
intelligence greatly surprised me, till I learned that the seton  was
now quite healed.  It has since been opened  and there is a hope of
her again improving.
vol. m.—26 
CLASS  IV.
NEUROTICA.
                        ORDER III.


                      CINETICA.


             diseases affecting the f&usclea

rRREGULAR ACTION OF THE MUSCLES OR MUSCULAR FIBRES; COMMON-
                   LY DENOMINATED  SPASMS.

Having, in the Physiological Proem to the present class, glanced as
far as our space would allow, at the disputed question concerning
the nature of muscular irritability, and its affinity with sensorial or
nervous influence, it is now only necessary at present to take a very
brief view of the general character and mode of action of muscles
as they appear to the naked eye in a massy form, or in other words
as composed of an almost infinite variety of minute fibres.
  A muscle thrown into action, increases  in absolute weight, in
density, and in power of resistance.   It is also  said to increase in
absolute bulk: but the experiments upon this subject are contradic-
tory ;  the middle or belly of the muscle, indeed,  is at this time evi-
dently enlarged, but then its length appears to be proportionally di-
minished. Muscles constitute the cords, as bones do the levers of
the living frame; and in most cases the muscles grow tendinous as
the bones do cartilaginous towards  their extremities; by  which
means the fleshy and the osseous  parts of the organs of motion be-
come  assimilated and fitted  for that insertion of the one structure
into the other upon which their mutual action depends; the extent
and nature of the motion being  determined by the nature of the
articulation, which is varied with the  nicest skill to answer the
purpose intended.  Whether, however, the substance of tendons
consists of the same fibres as the belly of a muscle but only in a
state of closer approximation and possessed of finer vessels  which
do not admit the introduction of red bloody or whether they form a 
CL. IV.—OR. in.]      NERVOUS FUNCTION.
203
 distinct system of fibres, merely attached to those of the mucles, is
 at present undecided.  It is certain that tendons possess nothing of
 the peculiar structure of muscles, and seem to be more nearly al-
 lied to the simple solid.
    It appears singular, at first sight, that the tendinous fibres which
 thus seem to be compacted into a firmer and more substantial cord
 than those of the muscles, should be sometimes brokon by muscular
 exertion, while the muscular fibres remain uninjured ; yet this un-
 questionably depends upon their greater rigidity, and, consequently,
 inability of yielding to the force by which they are opposed.  And
 hence it is that the bones themselves are sometimes broken in the
 same manner as by a violent jerk, or  a sudden and spasmodic con-
 traction,  of which we shall presently meet with examples,  espe-
 cially in  the  patella, the ribs, and the arm.   The muscles  them-
 selves, however, are occasionally ruptured by a like  irregular vio-
 lence and excess of power, as the recti abdominis in tetanus, and
 the gastrocnemii in cramps.
   Muscular action then consists in a mutual attraction and concen-
 tration of the constituent fibres of muscles, in a manner peculiar to
 living matter, for we cannot imitate it by any combination or action
 of mechanical fibres.  It is not,  however, a contraction in every di-
 mension,  since  in this case the muscular volume would be  dimi-
 nished ; but in length only, attended with a proportional increase of
 bulk so as to preserve the absolute volume unchanged, or  nearly
 so.
   It is easy to conceive, from these few remarks,  that the force ex-
 erted by muscular contraction may be enormous ; but by  the me-
 chanical physicians it was calculated in the most extravagant man-
 ner from  premises in many instances wholly chimerical.  Thus
 Borelli estimated the force with which the heart contracts, in or-
 der to carry forward the circulation of the blood, to be equal to not
 less than 180,000lbs. at each contraction; while Pitcairn,applying
 the same speculation to the function of digestion, conceived that this
 process is accomplished by a muscular exertion divided equally be-
 tween the stomach  and the auxiliary muscles that  surround  it,
 amounting in the stomach  alone to the force  of  117,088 lbs. for
 which " had he assigned five ounces," says Professor Munro, "he
 would have been nearer the truth."*   Yet we do not want these
 visionary calculations to prove the wonderful power  possessed  by
 muscular fibres ; the facts we have already adverted to,  and others
 we shall have to notice in the course of the present order, are suf-
 ficient to establish their astonishing  energy,  without having re-
 course to unfounded hypotheses, or exaggerated statements.
   In general, says Dr. Parr, in  a  very excellent  article upon this
 subject,t it appears that the  force with which a muscle contracts is
in proportion to the number of its fleshy fibres, and  the extent  of

            • Monro, Comp. Anat. Pref. p. viii.
             f Med. Diet, in verb. Musculus. 
204
NEUROTICA.
[CL. IV.—OR. m.
the surface to which these fibres are attached; but  its degree  of
contraction or the  extent of its motion  is  in proportion to their
length.   The limits of contraction differ in the long  and in the cir-
cular muscles;  for the former do not contract more  than one third
of their length, but the circular  fibres of the stomach,  which  in
their utmost dilatation may be expanded  to a foot in circumference,
may after much fasting be reduced to the  circle of an inch.   It
must, however, be added that in circular  muscles no fibres pass
completely round ; bundles of fibres are collected and end at differ-
ent points, while some begin where others end.   Each may, there-
fore, admit of only a  limited contraction, while the dilatation just
mentioned may be the sum of the whole.
   The action of muscles is never intermitted, and only diminished
in the sleeping state ;  tfiough  where the sleep is profound  and le-
thargic the diminution amounts to almost a cessation, except in the
voluntary organs.   When muscles are not  exercised, the sensorial
or irritable fluid moves forward with an  easy flow ; or in the words
of Haller " the  vis insita is very slightly exerted;" but we can still
trace its  influence by  the position which the limbs assume and dis-
cover the relative strength of the antagonising muscles.  Thus we
find the flexors stronger than the extensors; for,  during sleep, the
head falls forward, and the body, legs, arms, and fingers are slightly
bent.  The cause of this additional strength is easily explained ; for
the flexors have stronger and more numerous fibres ; their insertion
is farther from the centre of their motions, and under a larger angle,
must increase  when  flexion has  begun.  This superiority of the
flexors bends the  fetus in the womb into a round ball.   The same
superiority of power continues, though in a less degree, after birth,
and hence frequent pandiculations are required  to give activity and
energy to the extensors,  which they again  lose in advanced age.
On awaking from a sound sleep the same yawnings and stretchings
occur from the same  cause : and Bethel fancifully refers the crow-
ing of the cock and the fluttering of his  wings to a similar purpose.
It is always useful in  diseases to examine the position of the limbs
during sleep, particularly the sleep of children.   If they deviate
from (the ordinary degree of flexure to a more straight position, there
is generally some irregularity in the state of tone, and of course in
the vital influx.
   The muscles of the body may  be divided into two grand classes,
voluntary or animal, and involuntary or  automatic.   In the former
we meet with some that are peculiarly remarkable for strength and
continuity of contraction, as the greater part of the round muscles ;
and others as remarkable for mobility and vacillation; among which
we may  place most of the  long  muscles.   These  properties are
strikingly exemplified in a state of disease,  and  call for particular
attention ;  the muscles characterised by mobility presenting exam-
ples of atonic or agitatory spasm;  while those that are conspicuous
for continuity of  action are chiefly subject to rigid or  entastic
spasm. 
(JL. IV.—OR. III.
NERVOUS FUNCTION.
205
   Continuity of exertion, however, is generally less evident in the
 voluntary than in the involuntary muscles, of which last some or-
 gans, as the heart, continue their efforts through life without inter-
 mission ; though all of them relax or remit occasionally or periodi-
 cally.  For this greater permanency and regularity of action  they
 are indebted  to the peculiar provision which has been made for
 their supply of nervous power; for while the voluntary muscles are
 furnished m a direct line from the sensorium, whence indeed the
 close connection they hold with it,  the control the will  exercises
 over them,  and  their catenation with the prevailing emotion of the
 moment: the involuntary muscles are dependent chiefly on the in-
 termediate or ganglionic system described in the proem to the pre-
 sent class, and are  more remotely connected with the sensorium :
 they are in consequence far less influenced by the variable impulses
 of the mental faculties, and are placed beyond  the jurisdiction  of
 the will.  And  hence the tenour of their action is more equable
 more permanent, more uninterrupted, and less subject to fatie-ue  m'
 weariness.                                              5
   But as  these  organs are by no  means free from the power of in-
 jury, or diseased action, they are  also subject at times, in common
 with  the voluntary organs, to those abnormal motions which are or-
 dinarily denominated spasms : and it is not a little curious to ob-
 serve the uniform tendency which different spasmodic affections
 manifest towards some organs or function rather than towards others
 Thus the vital function, in which  the heart and lungs are such  pro-
 minent  agents, is chiefly disturbed by palpitation and syncope ; the
 natural, or that in which  the abdominal organs so generally co-ope-
 rate, by hysterics; and the animal, extending through the range  of
 the voluntary organs, by  tetanus and epilepsy.   In the prosecution
 of the present order, indeed, we  shall  see that this does not hold
 universally; that epilepsy, for instance,  is often a disease rather  of
 the stomach or intestines, than of any other organ, and that the heart
 is sometimes affected with rigid instead of with clonic spasm: but
 the rule holds generally and is not essentially shaken by these casual
 exceptions.
  Dr. Cullen has contended that in all spasmodic affections the brain
 is the actual seat of disease, and that they  consist in some morbid
 modification of its energy.   « The scope and purpose of all that he
 has said/' he tells us, « is to establish the general proposition,  that
 spasmodic affections, whether they arise primarily in  the brain or
in particular parts, do consist chiefly, and always in part, in an affec-
 tion and particular state of  the energy  of the brain: and  that the
 operation  of antispasmodic medicines must consist in their correct-
 ing this morbid or preternatural state in the energy of the brain, by
their correcting  either the state of preternatural excitement or  col-
lapse, or by  obviating the too sudden alteration of these states.*
  This  proposition seems rather to follow from Dr. Cullen's singu-
* Vol. I. Ord. II. Gen. V. p. 388. 
206
NEUROTICA.
[CL. IV.—OR. III.
 lar doctrine concerning the mutable condition of the energy of the
 brain, and the immutable nature of the nervous power which is  pro-
 pagated from it by vibrations, than from the clear face of facts be-
 fore us.  Spasms, in many instances, are altogether local; they are
 confined to  particular muscles, or particular sets of associate mus-
 cles, and  have  no effect on the  brain whatever so as to disturb its
 energy; of which we have examples in hiccough, priapism, cho-
 rea, and often in palpitation.  They depend upon some  irritation
 existing not at  the origin, but at the extremity of the nerves:  and,
 where such is their source, even though the chain of morbid action
 should at length reach  the brain and effect its energy, as in convul-
 sions from teething, epilepsy from worms, or some palpitations from
 ossific or  polypous concretions, all the antispasmodics in the world
 will afford no relief so long as the local cause of irritation continues
 to operate ;  while the moment this is removed, where it is capable
 of removal,  as by the use of a gum-lancet or active anthelmintics,
 all the powers  of the brain become instantly tranquillized ;  its fa-
 culties are rendered clear, its energy is  re-invigorated, and its  mo-
 tive power or sensorial fluid flows forward in an uninterrupted ten-
 our.   The greater number of spasmodic  affections, therefore, do
 not so much depend upon  the state of  the brain as of the  living
 fibres  that issue from it, and maintain a correspondence with it;
 for the stream may be vitiated while the fountain is untouched.  We
 have seen, indeed, in the proem to the present class, from the con-
 current results of various physiological  experimenters, that al-
 though, while the organ of a brain exists, it exerts a certain influ-
 ence over the principle of muscular motion, this principle is far
 less dependent  upon the encephalon than that of general feeling or
 of the  local  senses: that it is found abundantly in animals totally
 destitute of a brain; and that, hence those possessing a brain may
be excited not  only into  abnormal and  spasmodic, but even into a
 continuation or reproduction of regular  and natural motions of va-
 rious muscular organs  after the brain has been separated  from the
 spinal  chain, by stimuli applied to this chain, or even by the artifi-
 cial breath of a  pair of bellows.
  The following are the  genera of diseases which will be found to
appertain  to the present order :
  I.  ENTASIA.
 II.  CLONUS.
III.  SYNCLONUS.
CONSTRICTIVE SPASM.
CLONIC  SPASM.
COMPLEX SPASM. 
GE. I.J
NERVOUS FUNCTION.
201
                       GENUS  I.

                       ENTASIA.

                   (Eonstrfctfoe Sjwrstn.

IRREGULAR MUSCULAR ACTION  PRODUCING CONTRACTION, RIGIDITY,
                          OR BOTH.

Entasia is derived from  the Greek tvrxo-n,  " intentio," " vehe-
mentia," " rigor," from tvTeiw, " intendo."  By many nosologists
the genus is called tonos, or tonus, which is here dropped in favour
of the present term, because tonus or tone is employed by physio-
logists and pathologists, in direct opposition to  irregular vehe-
mence or rigidity, to import a healthy and  perfect vigour or energy
of the muscles; and by therapeutists to signify medicines capable
of producing such or similar effects.
  The genus entasia includes the following species:
1.	entasia priapismus.	PRIAPISM.
2.	——— LOXIA.	WRY-NECK.
3.	———— ARTICULARIS.	MUSCULAR STIFF-JOINT.
4.	——— SYSTREMMA.	CRAMP.
5.	-------TRISMUS.	LOCKED JAW.
6.	-------TETANUS.	TETANUS.
7.	- LYSSA.	RABIES. CANINE MADN
8.	-------ACROTISMUS.	SUPPRESSED PULSE.
                        SPECIES I.

               ENTASIA PRIAPISMUS.

                        ftrfajnsm.

PERMANENT RIGIDITY AND ERECTION OF THE PENIS WITHOUT CONCU-
                          PISCENCE.

The specific term is derived from the name of Priapus, the son of
Venus and Bacchus,  who is usually thus represented in paintings
and sculptures, but with a concupiscent feeling.  Galen  applies the
term also to  females, as importing a rigid elongation of the clitoris
without concupiscence.
  Spasm is,  in all instances, a disease not of vigour but of debility
with a high degree of irritability : and there  is  no case in  which
this is more striking than in  the present species. It has been found 
208                     NEUROTICA.          [CL. fV.—OR. III.

occasionally in infancy; but it is far more frequently an attendant
upon advanced years.   It has sometimes also followed upon  cold,
and especially local cold, clap, dysury, and the use of cantharides as
a cure for seminal weakness.   It has at times been a result of free
living, and particularly hard  drinking.  The spasm consists in a
stiff and permanent contraction of the erectores penis,  unconnected
wilh any stimulus arising from a fulness of the vesicul* seminales.
  Dr. Darwin says, he had met with two cases where  the erection,
producing a horny hardness, continued two or three weeks without
any venereal desire, but not without pain. The easiest attitude was
lying upon the back with the knees bent upwards.   The  corpus
cavernosum urethrae at length became soft, and in a day or two the
whole rigidity subsided.  One of these  patients had been a free
drinker,  had a gutta rosacea  on his face, and died suddenly a few
months after his recovery from the present complaint.  It is sin-
gular that this spasm should  sometimes  continue after death: at
least we have accounts of  such cases  in  Marcellus  Donatus and
other writers.
  As the disease is a case of both local and general debility, its cure
is in most  instances difficult.  Antispasmodics  and tonics are the
only medicines that promise relief, as camphor, opium, bark, warm
aromatics,  warm bathing, cold bathing : but the whole are  often
tried without effect.
                        SPECIES II.

                   ENTASIA LOXIA.

                        fflarrs=neek.

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

The term loxia is derived from the Greek, >ofas, " obliquus, tor-
tus ;" whence loxarthrus in surgery, an obliquity of a joint of any
kind, without spasm or luxation.  By the Greeks, however, the term
was specially applied to the joints or muscles of the neck.
  This disease, in its genuine form, proceeds from an excess of
muscular action, particularly of the mastoid muscle on  the contract-
ed side.  But we frequently meet with a similar effect from two
other causes:  one in which there is a  disparity in the length of
the muscles opposed to each other, and consequently  a permanent
contraction on the side on which  they are shortest,  producing the
disease called wry neck ; and the other  in which  from cold or a
strain, there is great debility or atony  on the side affected, and, 
 GE. I.—SP. H.]         NERVOUS FUNCTION.                209

 consequently, an incurvation of the neck on the opposite side, not
 from a morbid excess, but an overbalance of action.
   This species, therefore, offers us the three following varieties:

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

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

              ENTASIA  ARTICULARIS.

                  fHuscttiar «Stiff=fomt.

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

The joints of the limbs are as subject to muscular contractions as
the neck: and, in many instances, from like causes : the following
are the varieties  of affection hereby produced:
x Irritata.                From excess of action in the muscles
  Spastic stiff-joint.          contracted.
£ Atonica.                 From  direct  atony in the  yielding
  Atonic stiff-joint.          muscles.
y Inusitata.                From long confinement or neglect of
  Chronic stiff-joint.         use.

  Bt  ides the ordinary causes of cold, inflammation, and strains, by
whicl« the first cx\d second variety are  produced, the former  has
sou   iraes. followed upon a sudden fright,* upon drying up a cuta-
neous eruption, or checked perspiration.t Friend, also, mentions a
case in which it  has been cured by a fright',%  and  Baldinger one in
which it disappeared on the revival of a suppressed eruption which
had given rise to it.§   Rheumatism has often produced it, and parti-
cularly the second variety, in the joint of the knee and thighbone.
  In  a  case of  the latter kind, it  was successfully attacked by
 Richter,||  with a cautery of a cylinder of cotton.   In this and the
third  variety much benefit is often derived from repeated and long
continued friction with a warm hand, and particularly if illined with
some stimulant baisam or liniment.  In an obstinate contraction of
the fingers  succeeding to a  fractured  arm,  Dr. Eason relates an
instance in which the rigidity suddenly gave  way to a pretty smart
stroke of electricity after every other mean had failed, and  the
patient had the use of his fingers from this time.U  Such exercise,
moreover, or exertion of  the limb  should be recommended as it
m^y bear without fatigue. The cold  bath, as an antispasmodic,  has
sometimes  been  serviceable in the  first variety, and more fre-
quently, as a tonic, in the second.
* Starke, Klin. Instit.  p. 32.
| Paullini. Cent. I. 39.
Jf Vit. Gabriel.
§ N. Magazin. Band. XI. 78.
|| Chir.Bibl  Band. X.  219.
H Edin. Med. Comment. V. p. 84. 
GE. I.—SP. III.]      NERVOUS FUNCTION.                  211

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

               ENTASIA  SYSTREMMA.

                          <£ramj).

SUDDEN AND RIGID CONTRACTION AND CONVOLUTION OF ONE OR MORE
  MUSCLES OF THE BODY :  MOSTLY OF THE STOMACH AND  EXTREMI-
  TIES, VEHEMENTLY PAINFUL, BUT OF  SHORT DURATION.

Systremma, literally " contortio, convolutio," " globus," is derived
from <Tv<J-T%t<pa, « contorqueo," convolvo in fascem."  Stremma the
primary known is an established technical term for " strain, twist,
wrench ;'' and the author has hence been induced to add the present
term to the medical vocabulary in the  sense now offered, for the
purpose of superseding and getting rid oicramfius which has hitherto
been commonly employed, though at the same time commonly re-
probated, as a term intolerably barbarous, derived from the German
krampf.  The proper Latin term  is, perhaps," raptus nervorum;"
whence opisthotonia  or opisthotonus is denominated by the Latin
writers, « raptus supinus."  But raptus is upon the whole  of too
general a meaning to be employed on the present occasion,  unless
with the inconvenience of another term combined wilh it.
  The parts chiefly attacked with cramp are the calves of the legs,
the neck and the stomach.   The  common causes are sudden ex-
posure to  cold, drinking cold liquids during great heat and perspi-
ration, eating cold cucurbitaceous fruits when the stomach is infirm 
2\%                    NEUROTICA.           [CL. IV.—OR. Ill

and incapable of digesting them, the excitement of transferred gout
and overstretching the muscles of the limbs, in which last case it
is an excess of  reaction produced by the stimulus of too great an
extension.   Hence many persons are subject to it, and especially
those of irritable habits, during the warmth and relaxation of a bed,
and particularly towards the morning when the relaxation is great-
est, the accumulation of muscular or irritable power most considera-
ble, and the extensor-muscles of  the legs are strained to their ut-
most length to balance the action which the  flexor-muscles  have
gained over them  during sleep.   Cold night-air is also a common
cause of cramp, and it is a still more frequent attendant upon swim-
ming, in which we have the two causes united of  cold  and great
muscular extension.  An  uneasy position  of the muscles is also in
many cases, a sufficient cause of irritation;  and hence we often meet
with very painful cases of cramp in pregnant women down the legs,
or about the sides, or the hypogastrium.
  Where the hollow or  membranous muscles are affected,  they
feel as  though they were puckered and drawn to a point;  the pain
Is agonizing, and generally produces a violent perspiration : and if
the stomach be  the affected organ the diaphragm associates in the
constriction, and the breathing is short and  distressing.  If the
cramp be seated in the more fleshy muscles, they seem to be writh-
ed and twisted into a hard knot, and a knotty induration is perceiv-
able to the touch accompanied with great soreness,  which continues
for a long time after the balance of power has been restored.
   In  common cases where  the  calves of the legs are affected, an
excitement of the  distressed muscles into their usual train of exer-
tion is found sufficient: and hence most people cure themselves by
suddenly rising into an erect position.  I  have often produced the
same effect and overcome the re-action  without rising, by forcibly
stretching out the affected leg by means of other  muscles, whose
united power  overmatches that of the  muscle that  is contracted.
Warm friction with the naked  hand, or, which is better,  with the
hand illined with camphorated oil or alcohol, will also generally be
found to succeed.  A forcible exertion  of some remote muscles,
which thus collects  and concentrates the irritable power in an-
other quarter, will also  frequently effect  a  cure : and it is to this
principle alone, I suppose, we are to  refer the benefit which is said
to arise from squeezing strenuously a roll of brimstone, which sud-
denly  snaps beneath  the  hold.  The brimstone  snaps from the
warmth of the hand applied to it; but its only remedial power con-
 sists in affording a something for the hand to grasp vehemently,
and thus excite a  sudden  change of action.
   Where  the stomach is affected, brandy, usquebaugh,  ether, or
laudanum afford the speediest means of cure; and it is often neces-
sary to combine the laudanum with one or the other of the preced-
ing stimulants.  Here also the external application of warmth, and
diffusible irritants as hot flannels moistened with the compound cam-
phor liniment, are found in most cases peculiarly beneficial.   Ex- 
GE. I.—SP. IV.]
NERVOUS FUNCTION.
213
citing a transfer of action to the extremities, as by bathing the feet
in hot water, or applying mustard sinapisms to them is frequently
of great advantage ; as in the use of hot, emollient and anodyne in-
jections, whose palliative power reaches the seat of spasm by sym-
pathetic diffusion, and often affords considerable quiet. Here, also,
the patient should be particularly attentive to his diet and regimen,
confining himself to such viands as are most easy of digestion, and
least disposed to rouse the stomach to a return of these morbid and
anomalous actions ; for a habit of recurrence is soon established,
which it is difficult  to break off.
  In pregnancy, where the crampy spasms are often migratory and
fugitive, the position should frequently be changed, so as to remove
the stimulus of uneasiness by throwing the pressure upon  some
other set of muscles : and if the stomach be  affected with  gout,
opium, rhubarb, chalk,  or aromatics should be taken on  going to
rest.
  The best preventives when the cause is constitutional, are warm
tonics, and habituating the affected muscles to as much exercise as
their strength will bear: and hence the same forcible extension used
in swimming which produces cramp the first or second time of trial,
will rarely do so afterwards.
  Cramp is also found, as a  symptom,  and as one of the severest
symptoms of the disease, in  various species of colic and  cholera;
in which cases it must be treated according to the methods already
pointed out under those respective heads.
                        SPECIES  V.

                 ENTASIA  TRISMUS.

                       3fcocke*=$ato.

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

This disease is  by the French writers called tic.   The technical
term is derived  from the Greek r^u, " to  gnash or grind the
teeth;"   which,  like the  French synonym,  is  supposed by the
lexicographers to  be an onomatopy, or a word formed from the
sound that takes place in the act of gnashing.
  In truth it was to a disease in which morbid gnashing formed a
symptom, that both the Greek and French term was originally ap-
plied ; for the trismus of the old writers consisted,  not of a rigid
but a convulsive or agitatory spasm of the lower jaw;  an affection
comparatively trifling, and rarely to be met with, and when it does
occur appertaining to the clonus of the present system of nosology,
the  clonic spasm of authors in general. And the use of trismus or 
214
NEUROTICA.
[CL. IV.—OR. in.
tic to import a state of muscle directly opposed to that which it first
indicated, is another striking  proof of the incongruous  change
which is perpetually occurring in the nomenclature of medicine, for
the want of established rules and principles to give fixation and a
definite sense to its respective terms.
   Dr. Akerman is the only writer of  reputation I am acquainted
within recent times, who has used trismus in its original intention ;
or rather who  has  united  its original with its modern meaning.
For he employs  the term generically; and  arranges  under it the
two species of trismus tonicv.i, being that now under consideration,
and trismus clonicus, or  the disease it  originally denoted.  But this
arrangement is uncalled for, and inconvenient, and has not been re-
ceived into general use : the term trismus being, with every writer
of the present day, limited  to the first of these two species alone,
notwithstanding  the  origin of the  word.  And hence,  as it  is so
generally and completely understood, there would be an affectation
in changing it  for  any other.  The Germans call it kinnbakkenz-
wange which is precisely parallel with the locked-jaw of our own
tongue.
   Dr. Cullen in the first edition  of his nosology, made trismus, and
tetanus, our next species, distinct genera, but he altered his opinion
before the publication of his First Lines, and regarded them as no-
thing more  than degrees  or varieties even  of the same species.
" From the history of the disease," says he,  " it  will  be  evident
that there is no room for distinguishing  the tetanus, opisthotonos,
and trismus or locked-jaw as different species of this disease :  since
they all arise from the same causes, and are almost constantly con-
joined in the same  person"* In consequence of which, in the later
editions of Dr. Cullen's Synopsis, in which  the supposed error  is
attempted to be corrected,  the disease is introduced with a very
singular departure from nosological method: for first, tetanus is em-
ployed as the term for a distinct genus, defined " a spastic  rigidity
of many muscles;" and next under this  generic division are  given
no species  whatever but two varieties of degree alone, to the first
of which is again applied the name of tetanus, defined " the half
or whole of the body affected with spasms;" and to the second that
of trismus ; defined  " spastic rigidity chiefly of the lower jaw."
   Passing by this  irregularity of method, the proper view of the
subject seems to lie in a middle course ; in contemplating trismus
and tetanus, not as distinct genera, or mere varieties of a single
disease, but as  distinct species of a common  genus; and under this
view it is contemplated in the present arrangement.  Trismus bears
the same relation to tetanus as  synochus does to typhus: the two
former, like the two latter, may proceed from a common cause and
require a similar treatment; and the  first  may terminate in the
last.   But trismus, like synochus,  may run its course  alone, and
conlinue limited to its specific symptoms.  And as Dr. Cullen has
* Pract. of Phys. Book. III. Sect. I. Chap. I. § MCCLXVII. 
CE. I.—SP. V.]        NERVOUS FUNCTION.
215
thought proper to make synochus and typhus distinct genera, he
ought at least to have ranked trismus and tetanus  as distinct spe-
cies.
  Trismus is found in all ages, sexes, temperaments, and climates.
In warm climates, however, it occurs far more frequently than in
cold; and chiefly  in the hottest of warm climates.  Dr. Cullen ob-
serves, that, the middle aged  are most susceptible of the disease,
men more  so than women, and the robust  and vigorous than the
weakly.  Other animals are subject to  this complaint as well  as
man, particularly  parrots ; and from many of the causes* that affect
the human race.
  These causes for the most part, are  chillness and damp operat-
ing upon the body when heated,  and hence  sudden viscissitudes of
heat and cold ; wounds, punctures, lacerations, or other irritations
of nerves in any  part of the body, whence it has not unfrequently
followed on  venesection when  unskilfully  performed,! and still
more frequently on amputation,  worms or other acrimony  in the
stomach and especially in those of infants.  We have thus the three
following varieties  offered to us, which, however, chiefly differ in
symptoms peculiar to the period of life in which the disease is most
disposed to show itself, or in the interval between the casual ex-
citement and the spastic action :
ot  Nascentium.                  Attacking infants during the first
   Locked jaw of infancy.          fortnight after birth.
C  Algidus.                     Occurring at all  ages, after ex-
   Catarrhal locked jaw.           posure  to cold and damp, es-
                                  pecially the  dew of the even-
                                  ing, the symptoms usually ap-
                                  pearing within two or  three
                                  days.
y  Traumaticus.                 Occurring  as  the consequence
   Traumatic locked-jaw          of a wound, puncture or ulcer:
                                  chiefly in hot climates; and rare-
                                  ly  appearing till nearly  a fort-
                                  night after local  affection.
   The pathology is highly difficult, if not mysterious, and has hence
been purposely avoided by most preceding writers.  Dr. Cullen
expressly avows that  he " cannot  in any  measure attempt it."}.
There is one principle, however, to which I have frequently had
occasion to direct the reader's attention which will help us in a con-
 siderable degree to develop something of its obscurity, and to ac-
 count more especially  for so remote a separation between the seat
 of primary irritation and that of spasmodic excitement, which con-
 stitutes, perhaps, its most embarrassing teature.  The principle I

   * Bajon. Abhandlungen Von Krankheit auf der Insol Cayenne, Sec.
   f Delaroche, Journ.de Med. Tom. XV. p. 213. Forestus. Lib. X. Obs. 111.
 Schenck, Obs. L. I. N. 250.
   % Pract. of Phys. Rook. III. Sect. I.  Chap. I. § MCCLXIX 
  216                     NEUROTICA.           [CL. IV.—OK. III.

  allude to is the sympathy that prevails throughout the whole of any
  chain of organs whether continuous or distinct, engaged in a com-
  mon function, and which is particularly manifest at its extremities ;
  so that let a morbid action commence in whatever part of the chain
  it may, the extremities, in many instances, become the chief seat of
  distress, and even of danger.  We had occasion to notice  this law
  of the animal economy when treating of parapsis  illusoria, or
  that imaginary sense of feeling and of acute pain in a limb  that has
  been amputated and is no longer a part of the body, which we re-
  ferred to the principle before us : and farther noticed by way of
  illustration, the pain often suffered  at the glans penis from  the
  mechanical irritation of the neck of the bladder by a calculus.  So,
  irritating the fauces with a feather excites  the stomach, and even
  the diaphragm, to a spasmodic action, and the contents of the organ
  are rejected.  Irritating the ileum, as in ileac passion, produces the
  same effect upon the stomach and oesophagus;  at the  same time
  that the other extremity of the canal  is attacked with rigid spasm,
  and consequently with obstinate costiveness : while in cholera both
  extremities are affected  in a like way,  and we have hence both
  purging and vomiting.  It is to the  same principle we are to as-
  cribe it that when  the  surface of the body is  suddenly  chilled, as
  on plunging into a cold bath, the sphincter of the bladder becomes
  irritated, and evacuates the contained urine:  and, in treating of
  marasmus, we had occasion to show that while, in one of its species,
 the disease seems to commence in the digestive, and in  another in
 the assimilating organs, constituting  the  extreme ends of a very
 long and complicated chain of action, it very generally happens that
 at which end soever the decay commences the  opposite end is very
 soon affected equally.
   In a  coniinued chain of nervous fibres, however, this principle of
 sympathy which induces remote parts, and particularly remote ex-
 tremities, to associate in the same morbid action, is peculiarly con-
 spicuous.   Hence, if a long muscle be lacerated in any  part of its
 belly the tendinous terminations are often the chief seat of suffering.
 As the ulnar nerve sends off twiggs from the elbow to  supply the
 fore-arm and fingers, a blow on the internal condyle of the humerus
 gives a tremulous sensation through the fore-arm and hand: and as
 the ulnar nerve itself is only an offset from a plexus or commissure
 of the cervical nerves which also give a large branch to the  scapu-
 la, a paralysis of the ring or little  finger has sometimes been  re-
 moved by stimulating the scapular extremity by a caustic applied
 at the internal angle of the scapula.  In inflammation of the liver, a
 severe pain  is often felt at the top of the shoulder, and in palpita-
 tion of the heart, at the left orifice of the stomach.   Both  these are
 to be accounted for by recollecting that the radiations of the phre-
nic nerve extend in an upper line to the shoulder, and in a lower
to the diaphragm, which constitute its extreme points; and that one
of its branches passes over the apex of the heart.  Now as the un-
der surface of the diaphragm participates, from its contiguity, in an 
OE. I.—SP. V.]        NERVOUS FUNCTION.
217
  inflammation of the liver, the top of the shoulder suffers, as form-
  ing the extreme point of the phrenic chain  by which these organs
  are connected; and as the  upper surface of  the diaphragm is in di-
  rect contact with the left and very sensible  orifice of the stomach,
  an uneasiness at the apex of the heart becomes the cause of irrita-
  tion to this orifice in consequence of its connexion with  the  dia-
  phragm, and  hence, of necessity, with the lower  branch of the
  phrenic nerve at its extreme distribution.
    These remarks apply with particular force to the disease before
  us, and many others of the same class with which it has a close ana-
  logy, as tetanus, neuralgia, lyssa, and hemicrania.  And, although
  from the intricacy of the intersections and decussations with which
  various nerves  pursue their radiating courses, it is  impossible for
  "s, in many instances, to determine why one line of connexion suf-
  lers while another  remains unaffected, yet  in  most instances we
  may be able, by an accurate survey, to  trace the  catenation, and
  hence to obtain some insight into the physiology of these exquisite-
  ly curious, and complicated disorders.
   In mapping the nervous ramifications which give rise to trismus
 or locked-jaw, we must regard the ganglionic system consisting of
 the various branches of the intercostal  trunk, and the  numerous
 branches which unite with it from the whole line of the spinal mar-
 row, as constituting the centre; and as, from this centre,  we per-
 ceive ramifications  radiating in every direction to the face, the  en-
 tire length of the back, the upper and lower limbs,  and the thora-
 cic and abdominal viscera, we see a foundation laid even by a con-
 tinuous chain, for an association of remote parts and even extreme
 points in  morbid changes, even though  we may not be able,  satis-
 factorily perhaps, in any instance, to trace out the  individual  line
 by which the diseased action is carried forward, and to separate it
 from other  lines with which it is inextricably interwoven.   Thus,
 in the case of trismus nascentium, forming the first variety under the
 present species, the irritation of the nerves of the stomach, which
 is very clearly the primary  seat of disease in  most cases, is propa-
 gated directly to the central branches of the ganglionic system, by
 the  tributary offsets which the stomach receives from it.   But we
 have already observed, that the  chief contribution to this grand
 junction-canal is derived from the  intercostal nerve itself, in the
 first instance an arm from the trigemini or fifth pair of nerves, two
 branches of which radiate upwards, constitute the maxillaries supe-
 rior and maxillaries  inferior, and are lost in the muscles of the jaws.
 So that the upper extremity of the nervous line distributed over the
 stomach is the nerves of the jaws themselves ;  and hence, agree-
 ably to the law of the animal economy we have just pointed out, the
 muscles of the jaws, forming this extremity in the chain of morbid
 action, are the organs in which we may expect an irritation of the
 nerves of the stomach in  various instances to manifest itself most
strikingly.
   In like manner we may account for the second and third varieties
  vol. in.—28 
i\S
NEUROTICA.          [CL.IV.  OR. IH
of trismus, or that produced by a chilly dampness, or irritative vio-
lence applied to the upper or lower extremities: for as these are
all supplied by nerves from the vertebral source, which, as we have
already remarked, gives off branches from every aperture in the
spine to the ganglionic system,and as this system, at its upper end,
terminates in the maxillary branches of the  fifth pair of nerves, the
muscles into which these nerves are distributed constitute one ex-
treme point of a long chain of  nervous action, while those of the
upper and lower limbs constitute the other.  And hence the same
law which produces a spastic fixation of these muscles in certain ir-
ritations of the  stomach, may reasonably be expected to operate
with a  like effect in certain irritations  of the upper and  lower
limbs.  And as the intercostal nerve, at its first rise from the com-
mon source of itself and the maxillary branches,  receives also, in
its progress, offsets from the sixth, seventh, eighth, and ninth pairs
of cerebral nerves, as well as from all the vertebral, and as all these,
in consequence  of such  an interunion and decussation, are  sending
forth branches over the  muscles of the back, the chest, and the tho-
rax, there is no difficulty in conceiving that when a rigid spasm has
once commenced in the  lower jaw, it should be propagated through
any of the muscles appertaining to these  parts of the system, or
even originate in them from any of the causes that excite  locked-
jaw, and hence lay a foundation  for tetanus as well as trismus, both
as a primary and a  secondary disease. And I  have touched upon
this subject now that we may not have to  repeat the present expla-
nation when treating of  tetanus in  its proper place.
   In the simplest state of  trismus, indeed, there is some degree of
stiffness found at the back of the neck, and even in  the sternum.
The disease, in some cases, shows itself with sudden violence, but
more usually advances gradually : till at length the  muscles that
pull up the jaw become  so  rigid, and set the teeth so closely toge-
ther, that they do not admit of the  smallest  opening.
   In tropical climates, for  Dr. Cullen's remark that it is most com-
mon to the middle-aged only applies to the temperate regions of
Europe, children are peculiarly subject to this complaint, and with
a few peculiarities which, though producing no specific difference*
are sufficient to establish a variety. The disease in this case is vul- «£. "'
garly known by the absurd name of falling of  the jaw. It occurs
chiefly between the  ninth and fourteenth day  from birth; seldom
after the latter period.  Without any febrile accession, and  often
without any perceptible cause whatever, the infant sinks into an un-     **
natural weariness, and drowsiness, attended with frequent yawnings,
and with a difficulty, at first slight, of moving the lower jaw; which
last symptom takes place in some instances sooner, in oihers later.
Even while the infant is yet able to open its mouth there is, occa-
sionally, an inability to suck or swallow.  By degrees the lower jaw
becomes rigid, and totally resists the introduction of food.   There
is no painful sensation;  but the  skin assumes  a yellow hue, the 
GE. I.—SP. V.]
NERVOUS FUNCTION.
219
 eyes appear dull, the spasms often extend over the body, and  in
 two or three days the disease proves mortal.
   The ordinary cause is irritation  in the intestinal canal.  Hence
 viscid and acrimonious meconium frequently produces it; as worms
 are said also to do, some months after birth.  It seems moreover in
 some instances to have followed from irritation in tying the  naval
 string, or its not being properly attended to afterwards :  in which
 case, though the stomach may be affected by contiguous sympathy,
 the disease makes a near approach to the third or traumatic varie-
 ty.  Yet the appearance of the spastic action is as early as where
 the stomach is primarily affected.
   In cold and even mountainous countries this variety is also some-
 times found.  " I am informed," says Dr. Culien, "• of its frequently
 occurring in the Highlands of Scotland ;  but I never met with any
 instance of it m  the low country."*   Whether according to the con-
 jecture of this celebrated writer,  it is more common to some dis-
 tricts than to others,  has not been sufficiently determined.   " It
 seems," says he, " to be more frequent in Switzerland  than  in
 France."  Hot climates, however, constitute its principal domain ;
 and hence it is not very surprising that  Bajon  should place one  of
 its chief residences at Cayenne ;f or that Akerman should assert it
 to be endemic in Guinea.
   In the second variety of the disease or that proceeding from cold
 or night dew, the symptoms often  appear within a day or two after
 exposure to the exciting cause.  It is not common that the spasm
 extends to the muscles of the chest or back so as to produce  .teta-
 nus,  though there is often an uneasy sensation at the root of the
 tongue  with some difficulty of swallowing liquids after their intro-
 duction into the mouth, the disease thus making an approach towards
 lyssa or canine madness in its symptoms, as we have just endeavour-
 ed to show that it docs in its physiology.   According to the  observa-
 tions of Baron Larrey,  indeed, this approach is in many instances
 very considerable; for he informs us that on post-obituary examina-
 tions  he  has often found the pharynx and oesophagus much contract-
 ed, and their internal membranes red, inflamed, and covered with a
 viscid reddish mucus.   Dr. Hennen, however, does not place much
 dependence upon any such appearances ;  he admits,  nevertheless,
 that they are to be traced occasionally, though he  ascribes them
 more to an increased flow of blood consequent on increased action
 than to any other cause.|
  In this variety, from the  slighter nature of its attack, the patient
 not unfrequently recovers by skilful medical treatment, and there are
 unquestionably instances of spontaneous  recovery,§  though cases
of this kind  are very rare.  The intellect remains unaffected, there
* Loc. citat. § MCCLXXXI.
| Bajon, Abhandlung. von Kranheit. auf derlnsel Cayenne, &c. Eta). 1781.
$ Principles of Military Surgery, 246.                        «
5; Briot, Hist, de la Chirurgie Militaire en France, &c. 8vo. Begansoriyl8ir,. 
220                      NEUROTICA.          [CL. IV—OR. III.

is little qoickness of the pulse, sometimes none whatever, and little
or no disorder of any kind, though the bowels are usually very cos-
tive.  If the patient pass the fourth or fifth day we may begin to
have hopes of him ; for the spasmodic constriction will  then fre-
quently remit  or intermit; but, as even in  the last case, it is apt to
return at uncertain intervals, there is  still a considerable  danger
for many days longer.
  When, as in the third variety, the disease proceeds from a nerve
irritated by a wound or sore of any kind, the spasmodic symptoms
are much later in showing themselves  ; and sometimes do not make
iheir appearance till eight or nine days afterwards, occasionally, in-
deed, not at all, till the wound is healed.  The disease is more dan-
gerous in proportion to the delay : the adjoining muscles of the face
become more  affected, and, as is already observed, the spasms often
shoot downward into the back or chest, and trismus ft complicated
with tetanus.  The breathing is nasal and abrupt, the accentsare in-
terrupted and  slow, and uttered by the same avenue ; the muscles of
the nose, lips, mouth, and the whole of the face are violently drag-
ged and distorted, and the patient sinks from nervous exhaustion
and want of nutriment,  the jaw-bone  being  set so fast  that it will
often break rather than give  way to mechanical force.
  The disease, from this cause,  is generally fatal : and we are in-
debted to the ingenuousness of Sir James M'Grigor and Dr, Hennen
for a confession that, whatever remedies were employed in the Bri-
tish army, whether in India or in Spain, the mortality was nearly the
same.  But as the treatment of the present variety and the ensuing
species should be founded on a like principle, we shall reserve this
subject till we have entered  upon a distinct history of the latter.
                        SPECIES  VI.

                 ENTASIA TETANUS.

                         STetamts.

Permanent and rigid fixation of many or all the voluntary
   muscles ; with incurvation of  the  body and dyspnoea.

Tetanus is derived from nrxttu, which itself is  a derivative from
Tuva, " tendo, extendo."  Like trismus, it  is a term common to the
early Greek writers, among whom it was  u-ed synonymously with
opisthotonus and emprosthotonus, though the two latter were after-
wards employed to express two distinct modifications of the disease.
  From peculiarities in the seat or  mode  of its attack this species
offers us the three following varieties : 
OE. 1.—SP. VI.]       NERVOUS FUNCTION.                  221

» Anticus.                      Tetanus of the flexor-muscles.
  Tetanic procurvation.             The  body  rigidly  bent for-
                                   wards.
C Dorsalis.                      Tetanus of the extensor-muscles.
  Tetanic recurvation.              The  body rigidly bent back-
                                   wards.
y Lateralis.                     Tetanus of the lateral muscles.
  Tetanic Iranscurvation.           The  body rigidly bent  later-
                                   ally.
£ Erectus.                      Tetanus of  both  the posterior
  Tetanic inflexibility of the        and  anterior muscles.   The
     body.                         body rigidly erect.
  The first of these varieties is the emprosthotonus  of early wri-
 ters ; the second the opisthotonus ;  the third the pleurosthotonus of
 authors of a later date ; the fourth the proper tetanus of Dr. Lionel
Clarke and'a few others.   To  these  varieties it has been usual to
 add the singular disease called catochus ;  which by Sauvages, Cul-
 len, and various other authorities, is regarded as  closely connected
 with this species.  It has a near affinity  to it unquestionably, and
 hence out of difference to concurrent opinions,  it was suffered to
 stand as a variety of tetanus in the  first edition of the author's No-
 sology, but with  a note intimating that it seems rather to belong to
 the genus carus of the fourth order of the present class, and to be
 a modification of the species kc stasis under that genus : and as this
 appears to be its proper place it will now be found arranged there
 accordingly.
   The general physiology, so  far  as it seems capable of elucida-
 tion, has been already given under  the preceding species.   The
 exciting  causes are also for the most part those of trismus ; though
 it appears in infancy  far less frequently, unless as a concomitant of
 that disease.   Damp and cold, therefore, and nervous irritation from
 wounds or sores in hot climates and crowded hospitals, are the chief
 sources of its production ; and where these accessories exist, terror
 seems to be a powerful auxiliary, and has alone, in some instances,
 been sufficient for its production.   " Passion, or terror " says Dr.
 Hennen, ''after  wounds and operations, has been known to produce
 the disease in some : and sympathy, though a rare cause,'inothers."
 It  is said also to have been produced by insolation or exposure to
 the direct rays of the sun.*
    Lateral tetanus is very  rarely to be met with, and seems to
 be rather a chronic than an acute malady. Fernelius, who first de-
 scribed it,f  gives a case in which it occurred annually, but only in
 the winter, during which season the patient had two or three par-
 oxysms daily, the head was first attacked with a peculiar vibratory
 feeling which gradually descended to the neck with a sensation of
« Pathol. Lib. V. p. 372.
f Medical Observations and Inquiries, Vol. VI. 
 222                     NEUROTICA.           [CL. IV.—OR. Ill

 cold, and by the time it reached the scapula, was immediately sue
 ceeded by symptoms of opisthotonus, and afterwards of lateral con-
 traction, during which the mind and external senses were unaffect-
 ed, but the flexor muscles were so firmly fixed that no antagonist
 force of the by standers was able to overpower the contortion
   Nor are either of the other varieties, in  any  degree so frequent
 as trismus, except where they form a subsequent part of the general
 chain of morbid action.  My observant friend Dr. Hennen, confesses
 that during the whole period of his superintending the British hos-
 pitals in Spain he never met with but one case  of emprosthotonus,
 and even this he describes as an incurvation that rather approached
 it than constituted the disease itself.  " It was observed," says he,
 " at the  same time and in the same hospital, with the various de-
 grees of trismus : rigid spasms of almost every  muscle of the body
 and violent periodical convulsions, all from similar injuries to that
 in which it was produced."*
  From the complicated manner, indeed, in which tetanus shows it-
 self, and its anomalous attack upon different sets of muscles at the
 same time, it seems in many instances to put all the subordinate di-
 visions of classification at defiance. It is, in truth, for the most part
 a mixed disease, affecting various and opposite sets of muscles ; and
 this in many cases so equally that the spastic action of the flexors
 just  balancing  that of the extensors, « the patient,"  to adopt the
 language of Dr. Lionel Clarke, "seems often to be braced between
 opposite contractions."  It is to this form, indeed, that this last very
 intelligent writer has  limited the name of tetanus as that to which
 it applies most emphatically.  Like Dr. Hennen, he asserts that he
 had never seen a  single case of genuine emprosthotonus ; and that
 of the other two varieties, of which he treats the opisthotonus and
 proper tetanus, the former occurs most frequently.
  In episthotonus or tetanic recurvation the symptoms some-
 times show themselves suddenly, but more commonly advance slow-
 ly and imperceptibly :  the patient  mistaking the unusual stiffness
 which he feels about the shoulders and cervical region for a crick in
 the neck, produced by cold and rheumatism. The stiffness, however,
 increases, he finds it impossible to turn his  head on either side
 without, turning his body : he cannot open his jaws without pain,
 and he has some  difficulty in swallowing.  A spastic and aching
 traction now suddenly darts at limes towards the ensiform cartilage,
and thence strikes through to the back, augmenting all the previous
 symptoms to such a  degree that  the patient is  no longer able to
 support himself, and is compelled to take to his bed.   The pathog-
nomic symptom in this variety is the spasm under the sternum which
is perpetually increasing in vehemence ; and instead of returning,
 as at first, once in two or three hours, returns now every ten or fif-
 teen minutes; immediately after which all the host of concomitant
 contractions renew their violence and with additional  severity :
* Military Surgery, p. 247. 
HE. I.—SP. VI.]        NERVOUS FUNCTION.
223
the head  is forcibly retracted,  and the jaws snap with a fixation
that rarely allows them  to be afterwards opened wide enough to
admit the little finger.   This vehemence of paroxysms  may  not,
perhaps, last longer than for a few minutes or even seconds : but
the spastic action prevails so considerably, even through  the inter-
vals, that it is difficult for an attendant to bend the contorted limbs
into any thing like an easy or reclined  position.  The breathing is
quick and laborious, and  the puhe, though calmer and less hurried,
small and irregular.  The face is sometimes pale but oftener flush-
ed, the tongue stiff and  torpid but  not much  furred; the  whole
countenance evinces  the most marked signs  of deep distress,  and
swallowing  is pertinaciously abstained from, as accompanied with
great difficulty and often producing a  sudden renewal of the par-
oxysms.  The last stage  of the disease is truly pitiable. The spasms
return every  minute  and scarcely allow a moment's remission.
The anterior muscles join in the  spastic action, but the  power of
the posterior is still superior; and hence while every organ is lite-
rally on the rack from the severity of the antagonism, the spine is
more strongly recurvated than ever, and forms an arch  over the
bed, so that the patient rests only on the back part of the  head  and
on the heels.   During the exacerbation of the spasms the lower
extremities, even while they  continue rigid, are so violently jerk-
ed that the utmost attention is necessary to prevent the patient from
being projected from his bed : and Desportes gives a case in which
both the thigh  bones were broken from  the violent contraction of
the flexor-muscles  during a momentary remission of the exten-
sors ;* similar results  to which we shall  have  occasion  to notice
hereafter.
  The tongue is in like  manner  darted spasmodically out of  the
mouth,  and the teeth  snapped suddenly and with  great force ; so
that unless a spoon covered with soft rags, or some other interven-
ing substance, is introduced between the teeth at such periods,  the
tongue must be miserably bitten and lacerated.  The exertion is so
laborious  that the patient sweats  as in a hot-bath ;  the pulse is at
this time quick, small, and irregular; the heart  throbs so  violently
that its palpitations may be seen ; the eyes are sometimes watery  and
languid; but more commonly rigid and immoveable in their sock-
ets : the nostrils  are drawn  upward, and the cheeks backward to-
wards the ears, so that the whole countenance assumes the air of a
cynic spasm or sardonic  grin, while a limpid or bloody froth bub-
bles from the lips.   There is sometimes delirium, but this is  not
common; the  patient is worn out under this laborious agony in a
few hours ; though  more  usually a general convulsion comes to his
relief and he sinks  suddenly under its assault.
  In the erect tetanus, in which there is a balance of spastic action
between the anterior and  posterior sets of muscles, the progress of
the  disease is not essentially different.   The march of the spastic
• Hist, des Maladies de St. Domingue, 11. p. 171. 
224                      NEUROTICA.    •       [CL.IV.-OK. Ill

action, however,  varies in some degree,  as  we have already ob-
served, in almost every instance from trismus to tetanus, and from
one modification of tetanus to another : yet the course we have now
described is that  which chiefly takes place where the disease ad-
vances in something of a regular and uninterrupted progress.  Its
danger and duration are commonly to be estimated from the degree
of violence of ihe incursion.   Where  this is very  severe the pa-
tient rarely survives the third day, and is sometimes cut off on the
second, or even in six  and thirty or  four and twenty hours.   But,
where the attack is less acute, the patient may continue to  suffer
for a  week before he reaches  his tragic termination.   If he have
strength  enough  to survive  the ninth day he commonly  recovers,
for the paroxysms diminish in violence, the intervals of remission
arc longer, and the muscles being generally more relaxed he is
able to take a little nourishment.  Through the whole period there
is an obstinate costiveness, partly from want of food in the stomach,
but chiefly from an association of the mouths of the intestinal  ex-
cernents in the spasmodic constriction.
  The general principle of cure is far more easily expressed than
carried into execution.  It is that of taking off the local irritation,
wherever such exists, and ol tranquillizing the nervous erethism of
the entire system.  The first of these two objects is of  great im-
portance in the locked-jaw or  trismus of infants; for by removing
the viscid and acrimonious meconium, or  whatever other irritant is?
lodged in the stomach or bowels, we  can sometimes  effect a speedy
cure without any other medicine.   Castor oil  is by far  the best
aperient  on  this occasion, and it may be given both by the mouth
and in injections.  But if this do not succeed we should have re-
course to powerful anodynes ;  and of these the best by far is opium,
which should be administered from  three to five drops in a dose,
according to the age of the patient.  Musk  and the host of anti-
spasmodics have been tried so often with so little success, that it u
not worth while to put the smallest dependence upon them : not
has the warm  or  cold bath produced effects sufficiently general or
decisive, to allow us to lose any time in  trusting to their operation.
They may be  employed, however, as auxiliaries; but our  sheet-
anchor must be  opium, which, if the  spastic  action have  made
much advance when  we first  see the patient, should  instantly be
employed in conjunction with the prescribed  aperient.   By taking
off the constriction from the intestinal canal, and thus restoring and
quickening the peristaltic motion, it may even expedite the dejec-
tions.
   In  trismus or tetanus from  wounds or sores, the  local irritation
is not so easily subdued : nor is its removal of so much importance,
though in no case of small moment.  But, generally speaking, the
spactic action is, in these  instances,  as much  dependent upon con-
stitutional, as upon topical irritability,  and when it has been once
excited it will run through its career, whether the local  cause con-
tinue or not.   It is owing  chiefly to this fact that the best and most 
   GE. I.—SP. VI.]       NERVOUS FUNCTION.                  225

   active plan of cure so often fails of success : and the most cautious
   practitioners hesitate in their  prognostications,  whatever be  the
   march  of symptoms,  for  the  first four or five days.  " From the
   state of the pulse," says Dr. Hennen, « I have derived no clue to
   either the proper treatment or the probable event :  it has, in  the
   cases I have  met with,  been  astonishingly unaffected.  From  the
   state of the skin I  have  been left equally in the dark.  Sweating
   which  some have  imagined critical, I have seen during the whole
  course of the disease, and attended with a most pungent and pecu-
  liar smell, while in others it has never appeared at all: and suppu-
  ration,  which is generally interrupted, I have seen  continue unaf-
  fected by the  spasms.   Even the process of healing, which, it would
  be reasonable to conclude, should be altogether put a stop  to, has
  gone on apparently uninfluenced by the disease: and in the most
  severe  case I ever  saw, which occurred after a shoulder-joint ampu-
  tation, sent into Elvas from before the lines of Badajos, the life of
  the patient and the perfect healing of the wound  were terminated
  on the same day."  So powerfully does the constitutional irritability
  operate  in many cases  after  the disease has once  displayed  its
  hideous features, and  render the local  treatment of subordinate
  importance.
    In numerous instances, however, a change in the condition of the
  wound has produced a beneficial result; and hence various means
  have been resorted to for the purpose of effecting such a change, as
 local bleeding, anodyne applications to allay the morbid sensibility-
 resinous, terebinthinale, or mercurial stimulants to excite a new'
 action :  and amputation of the diseased  limb.   The first of these
 three plans is  the ordinary mode of practice, and in full plethoric
 habits it has sometimes proved favourable; the second plan seems
 to have been very generally employed by Baron Larrey, who occa-
 sionally used stimulants of a far higher power, as pencilling the
 wound with lunar caustic, or an application of  the actual cautery.
 Amputation seems to have answered in a few cases, if we may give'
 full credit to those who have chiefly tried and recommended it :*
 but it is at best a clumsy and desperate kind of remedy ; and, for
 reasons already assigned, must be often altogether inefficient if it
 do not add to the constitutional erethism.
   The  general treatment has consisted in a  free use of opium ;
 salivation ; the  hot or cold bath ; and wine or ardent spirits, in some
 instances so far as to produce intoxication.  Dr. Cross gives a case
 in which, after other medicines had been used in vain, and every
hope seemed to fail, the  patient  was inebriated  with spirits, and
kept in this state for ten days, with the result of a perfect recovery.f
A generous use of wine appears to be almost indispensable, and,
considering the ordinary constitution in which the disease occurs,

         * Silvester, Med. Obs. and  Inquir. I.  Art. I.
           White, Med. Obs. and lnq. II. Art. XXXIV.
         f Thomson's Annals of Philosophy.
  VOL. ill.—29 
226
NEUROTICA.          LCL. IV.—OR. III.
the difficulty of supporting the system by  common means, and the
great sensorial exhaustion which is perpetually taking  place, it is
far from difficult to explain in what manner it operates beneficially ;
but intoxication is a desperate experiment, and, where it succeeds
once,  we  have reason to apprehend it  would kill  in a hundred
instances.
   The warm  and the cold bath  have each of  them a much better
 claim to attention ; and their votaries are  so equally divided that it
is no easy  matter to say which is the most strongly recommended.
The latter demands more general strength in the system than the
former : but neither of them are to be depended upon except as an
 auxiliary.   The cold  bath has  the  authority  of Dr. Lind  in  its
favour,* and  has, in some  instances been tried  with  success in
 America.!
   Mercury, in various forms, has been had recourse  to from a very
 early  period: and, on the authority of Dr. Stoll, has occasionally
been used for the  purpose of exciting salivation.  On what ground
it has been carried to  this extent I do not know, except it be that a
pretty free How of saliva from  the  mouth spontaneously, has,  by
 many persons, been regarded as a favourable  sign.   The  disease,
 however, does not seem to be accompanied with any  symptom that
 can be called critical; and it is hence probable that this spontaneous
 flow of saliva is nothing more than a result of the violent action and
 alternating relaxation  of all the parts about  the fauces.   Never-
 theless, salivation where it has  been accomplished, is said by many
 writers to have been serviceable, though  I know of no  practitioner
 who has relied on it alone. And, in reality, such is the rapidity with
 which both trismus and tetanus usually march forward where they
 have once taken a hold on the system that we  have seldom  time to
 avail ourselves of this mode  of cure, were its pretensions still more
 decisive than they seem to be.
    Opium, then, in every stage  and every variety of both  tetanus
 and iocked-jaw, is the remedy on which  we are  to place our chief
 if not our only dependence.   But to give it a full chance of success
 it should be administered in very free doses, and it  is  not easy for
 us to be too  free  in its use.  In the Edinburgh Medical  Commen-
 taries^ we have a case in which five hundred grains  were adminis-
 tered  within seventeen days, which is about thirty grains a-day.
 But in the West Indies the  quantity is often  carried with the most
 beneficial effects very considerably beyond this. Thus Dr. Gloster
 of St. John's, Antigua, gave to a negro, labouring under tetanus
 from an exposure to the night air, not less than twenty grains every
 three hours,in conjunction with musk, cinnabar and other medicines;
 and continued it with  but little abatement for a term of  seventeen
* Essay on Diseases in Hoi Climates, p. 257.
f Tallman. Amer. Phil. Trans. I. XXI.
  Cochran, Edin. Med. Com. Vol. HI. p. 183.
* Vol. 1. p. 88. 
»,E. 1.—SP. Tl]        NERVOUS FUNCTION.
227
 days, in the course of which the patient took five hundred grains
 of this narcotic.  For the first six days little benefit seemed to be
 effected, but after this period the symptoms gradually declined un-
 der the same perseverance in the medicine; and  in thirteen days
 more they were so much diminished that no further assistance was
 thought necessary.
   If there be any thing which adds to the sedative pouer of opium
 in this disease  it is sudorifics, and particularly ipecacuun.  And
 upon this  subject Dr Latham has given a valuable pape:  in ihe
 Medical Transactions, in which he offers examples of failure in the
 use of James's powder, when used either alone or in alternation with
 opium ; but of  full  success by uniting the two powers of the nar-
 cotic and the  sudorific, though he afterwards  preferred ipecacuan
 to James's powder,  and prescribed in  the form of the  compound
 powder of this name.  He gives cases in which he employed this
 compound in very severe attack", and sometimes in what seemed to
 be its last stage of the disease,  with  an immediate arrest of its
 symptoms,  and  progressively a perfect restoration to health.   His
 doses consisted  of ten grains  repeated every three or four hours.
 In no instance was there any unusual inclination  to sleep, how long
 soever this treatment was continued, which in one case was for  a
 fortnight:  nor was  there any degree  of sickness, nor any other
 inconvenience, except that of a perspiration troublesome from its
 excess.*
   It is only necessary to observe further that during the treatment,
 either of trismus or tetanus,  a very particular attention  should be
 paid  to ventilate the chamber with pure air:  and especially to
 purify the air  of close and crowded hospitals, without which no
 plan of treatment in the world can be of any avail.  We should also
 remove, if possible, the  costiveness to which the bowels are so
 peculiarly subject,by some gentle aperient: for  it  sometimes hap-
 pens, not  only  in infantile trismus or tetanus, but in  that from
 obstructed perspiration,  or cold and dampness, that the  primary
 cause of irritation is seated in the bowels; while, whatever accumu-
lation takes place in  this  quarter, during the course of the  disease,
may add to and exacerbate the general erethism.  At the same time
nothing can be more mischievous than the drastic purges which
practitioners are apt to give at the commencement of this  disease,
consisting of jalap, scammony, and aloes.   We  have already seen
that the general excitement is so extreme that the slightest occa-
sional irritation,  even that of changing the position of the head, is
sometimes sufficient to produce a  return of the spasms : and hence
there  can be nothing more likely to do it than the griping effects of
such acrimonious medicines.  And it will be far safer to pass by the
constipation altogether, than  to attempt to remove  it by  such dan-
gerous  means.  The best medicine is castor oil, which may be
given either by the mouth or in the form of injections: and if this
* Med. Transact. Vol. IV. Art. IV. 
228
NEUROTICA.
[CL. IV.—OR. HI
do not succeed, we may employ calomel.  But  the  action of the
bowels must only be solicited, and by no means violently excited.
                       SPECIES VII.

                  ENTASIA LYSSA.

                          Ifcaiucs.

spasmodic constriction of the muscles of  the chest ;  SUPER-
  VENING TO THE BITE OF A RABID ANIMAL ; PRECEDED BY A RETURN
  OF PAIN AND INFLAMMATION IN THE BITTEN PART : GREAT REST-
  LESSNESS,  HORROR, AND*HURRY OF MIND.

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

              -------H.£ZTt£>i Si t AT22A Jetwav*
              So with a furious Lyssa was he stung.

  The author  has ventured to  restore  the Greek term, not only as
being more classical, but as being far more correct than the techni-
cal  term of the present day, which is hydrophobia, or water-dread ;
since this is by no means a pathognomic  symptom ; being sometimes
found in other diseases; occasionally ceasing in the present towards
the close of the career ; and, though almost always observable among
mankind, in numerous instances wanting, even from the commence-
ment, in rabid dogs and  wolves.  "Constat  repetita," says Sauva-
ges, " apud Gallo-provinciales experientia, canes luposque rabidos
bibisse, manducasse,  flumen  transasse, ut olim Marologii,  et bis
Forolivii observatum,  adeoque nee cibum nee potum aversari."
The same fact is affirmed of  rabid wolves in  a case given by Tre-
court in his Chirurgical Memoirs and Observations. Dr. James in
like manner relates  the  case  of a  mad-dog that both drank milk
and swam through a piece of water ;f  and one or two similar cases
are said to have occurred  among mankind :\  though even here a
spasmodic constriction of the muscles of the chest, and sometimes of
  * Iliad IX. 237.
 . | On Canine Madness, p. 10.
  + Fehr. Nachricht von einer todslichen Krankheit nach dem tollen Hunds-
bisse Govt. 1790, 8vo. 
GE. I__SP. VII.]       NERVOUS FUNCTION.
229
the throat, seems to  have been present.  Dr. Vaughan, indeed,
gives the case of a patient who called for drink through the whole
course of the disease, and only ceased to  ask for it a short time
before his death.
  I have occasionally met, on the contrary,  with a few obstinate
cases of  hydrophobia, or water-dread,  without any connexion with
rabies : one especially in a young  lady of nineteen years of age, of
a highly nervous temperament which was preceded by a very severe
tooth-ache and catarrh.  The muscles of the throat had no constric-
tion, except on  the approach of liquids, and the patient through  the
whole of the disease,  which lasted a  week, was able to  swallow
solids without  difficulty;  but the  moment any kind of liquid was
brought  to her a  strong spastic action took place, and all the mus-
cles about the throat were violently convulsed if she attempted to
swallow.
   Similar examples are to be found in the medical records, and par-
ticularly one of great obstinacy in the Edinburgh Medical Essays,
which was chiefly relieved by  repeated  venesections,* as the pre-
ceding case was by large doses of opium   Hydrophobia is there-
fore too  general and indefinite a term to  characterize  the  genus
before us, unless we mean to include under it diseases to  which it
is by no means commonly applied, and which, in truth, have little
connexion with rabies.  Hunauld has, indeed, employed it in this
extensive signification, and has hence made it embrace no less than
seven distinct species, of which two only are irremediable.!
   There is, even in the  present day, so  little satisfactorily known,
and so few opportunities of acquiring any practical knowledge con-
cerning  the  general  nature and pathology of rabies that it might',
perhaps, be most prudent to imitate the modesty which Dr. Cullen
has set us upon this subject, and to let it pass without a single re-
mark.   Yet the few following hints,  derived  from the only three
cases in which the author has ever  been consulted, together with
the reflections to which they have  given rise in his own mind, may
afford a little glimmering light into the principle of the disease,
and give an opportunity to succeeding pathologists of describing it'
more perspicuously.
   The symptoms enumerated  in  the definition, and especially  the
constrictive spasm that oppresses the muscles of deglutition andof
the chest generally,  sufficiently show that the  present species of
disease bears a very close analogy to the two preceding, in the mis-
chief which it excites; and, as by far the most frequent cause of
the two  preceding species is the irritation of a wound or puncture
on the surface of the  body, it bears quite as close an analogy to them
in  the nature of  its cause as in that of its effects.
   We  have seen it  to be a law operating  throughout the  animal
  * Inflammation of the Stomach with Hydrophobia, &c. by Or J. Innes. Ed
Med. Ess. I. p. 227.
  f Discours sur la Rage, et ses Remedes.  C'hatcaus Gontier, 1714, 12mo. 
230
NEUROTICA.
[CL. IV.—OU. 111.
 system, that if a morbid action commence in any part whatever of
 a continuous chain of functions, or of fibres, it  often produces a
 peculiar impression upon  its exiremities; so that the extremities
 themselves form, in many instances, the chief seat of distress and
 even of danger: and this more especially where the one extremity
 of the chain becomes affected in consequence of the primary affec-
 tion of the other.   And we  have also  endeavoured  to show, from
 the general course and intermediate connexions of the nerves which
 supply the surface of the body, and particularly the extremities, that
 they constitute a direct  fibrous chain, of which those that are in all
 common cases primarily  irritated by wounds or punctures in the
 spastic diseases before us  form the one extremity, and those which
 enter into the muscles  of the upper regions of  the chest and the
 cheeks the other.* It is  not necessary, therefore, to travel over
 the same ground  again ; the reader may turn to it at his leisure :
 and  he will find that we have hence endeavoured  to trace out some-
 thing of  the means by which trismus and tetanus are produced by
 simple wounds or  punctures in the limbs, and especially in an irri-
table habit.
  Now if the reasoning  be sound, as applied to trismus and tetanus,
it must be equally good  as applied to lyssa;  and  will induce us to
expect a more complicated disease and a still more severe and des-
perate result; as  we have, in the present instance,  not  merely an
ordinary  and mechanical, but a specific and chemical source of irri-
tation to  encounter, and  so indecomposible in its nature that it is
capable of lurking in the system, and apparently  in the part where
it may chance to be deposited, for weeks or even months without
losing its activity:  of continuing dormant if there be no sufficient
irritability of constitution or nervous fibre for it to operate upon,
and of operating as soon as  such a condition may arrive :  for that
some exciting cause is usually necessary to rouse  it into action, will
sufficiently appear  in the sequel of this inquiry.   Sir Lucas Pepys,
however, Dr. Bradsley, and various other writers, have made it a
question  whether the virus of rabies is ever originated, or produced
spontaneously, or  in any  other way  maintained  than by a direct
communication from one animal to another; while M. Girard,  of
Lyons, has denied  that there is any such thing at all, and contended
that rabies consists in  nothing more than  an acute degree of local
irritation, and its effects  on a highly mobile and excitable constitu-
tipn.  We have long, however, had various examples on record,
and have lately been  furnished  with another by Mr. Gillman,  in
which a dog chained up  in a yard, and cut off from all medium  of
contamination by other animals, has occasionally been attacked with
genuine lyssa, and exhibited its most decisive characters.
  Nevertheless, whilst we are thus establishing that the symptoms
of rabies  are dependent upon a specific virus, it may not be foreign
to remark that most animals, when roused to a high degree of rage,
♦ See Vol. III. p. 216. 
GE. I.—SP. VII.]
NERVOUS FUNCTION.
231
inflict a wound of a much more irritable kind than when in a state
of tranquillity: and we  have numerous examples  in which such
wound has been very difficult of cure, and not a few in which it has
proved fatal, as though at all times under such a state of excitement,
some peculiar acrimony was secreted with the saliva.   In the Ephe-
mera of Natural Curiosities, is an example of symptoms of hydro-
phobia or water-dread, produced by the bite of a man worked  up
into fury ;* and  in the Leipsic Acta Eruditorum is another instance
of the same kind,f though neither of them seem to have been fatal.
Meekren,| however, Wolff,§ and Zacutus Lusitanus|| have each an
instance of such a bite terminating in death, yet without hydropho-
bia.  Le Cat gives a case of death produced by the bite of an en-
raged duck:l and in a German miscellany of deserved repute we
have another of the same kind.**  The instances, indeed, are innu-
merable, but it may be sufficient to observe further that Thiermay-
er gives us two cases, one in which the bite of a hen, and another
in which that of a goose proved fatal on  or about the  third day,tt
without hydrophobia : and that Camerarius has an instance of epi-
lepsy produced by the bite of a horscft
   Marvellous as these facts may appear, it is  more consistent with
reason to accredit them than to impugn the host of authorities to
whose testimony they appeal.   And it hence  seems to follow, that
the passion of rage, whose influence is always considerable on the
salivary  glands, has often a power of stimulating them, among most
animals, to  the secretion of an  acrimonious and malignant virus
with which the saliva becomes tainted.
   Rabies, however, has sufficiently shown itself to be dependent
upon a peculiar virus, and capable of producing specific effects; to
be sometimes originated, and sometimes received by communica-
tion. Now the only animals which have hitherto been ascertained to
have a power of originating it are several species of the genus canis,
as the dog, fox and wolf, and one species of the genus feiis, which is
the domestic cat;  it is probable, however, there are others belong-
ing to different classes endowed with a like power ; and some wri-
ters have attempted to bring instances from the horse, mule, ass, ox
and hog, yet they are not instances to be depended  upon.   In like
 manner, Plater, Doppert, and even Sauvages himself have asserted
the same of mankind, and have brought forward a few casual cases
* Ann. IX, X. app. p. 249.
f Ann. 1702. p. 147.
t Observ. Cap. LXVII.
§ Observ. Med. Chir. Lib. II. N. 5.
|| Prax. Admir. Lib. III. Obs. 84. 88.
•I Recueil Periodique. II. p. 90.
 ** Samml. Med. Wahrnehm. B. II. p. 98.
 ■j-j- In Goekelu Consil. et Obs. N. 19,
n Diss, de Epileps. freq. p. 15. 
>*0
NEUROTICA.
[CL. IV.—OR. III.
 in support of such  assertion.  These,  however, are in  every in-
 stance, modifications of empathema, and especially of rage or fright,
 grafted on a highly irritable temperament,  and hence associated
 with hysterical, or some other spasmodic motions.
    Of the remote or predisposing causes of this disease we know no-
 thing. The excitement of vehement rage, putrid food, long continu-
 ed thirst from a want  of water to quench it, severe and pinching
 hunger, a hot and sultry state, or some other intemperament of the
 atmosphere, have been, in turn,  appealed to as probable  prcdispo-
 nents, but the appeal in no instance rests on  any authcrity.   That
 the stimulus of vehement rage will often produce a peculiar influ-
 ence on the saliva, and  render  it capable, by a bite, of exciting
 the most alarming symptoms of nervous  irritation we  have  just
 shown ; but these symptoms are not those  of lyssa ; and the virus,
 whatever it consists  in, appears to be of a different kind.  Putridity
 is, perhaps, the ordinary state in which dogs and cats obtain the offal,
 on which, for the most part, they feed :  they show no disgust to it,
 and it offers a cause far too  general for the purpose.   In long voy-
 ages, again, when a crew has been without water, and reduced to
 short provisions, dogs  have  been, in innumerable instances, known
 to die both of thirst and hunger without betraying any signs of ge-
 nuine rabies. That  a  peculiar intemperament of the atmosphere
 may at times be a cause, it is impossible to deny ; but the disease,
 even when of spontaneous  origin,  has  appeared under, perhaps,
 every variety of meteorological change, and seems to be far less com-
 mon in hot and sultry regions than in those of a more moderate tem-
 perature :  for it  is not  known, except by report,  in South America
 or the West Indies,  as I have been repeatedly informed by intelli-
 gent residents in those quarters ;  while  M. Volney tells us that it
 is equally uncommon in Egypt and Syria, and Mr. Barrow, at the
 Cape of Good Hope and in the interior of the country, where the
 Caffres feed their dogs on nothing but putrid  meat, and this often
 in the highest degree of offensiveness.
   It is not improbable that several of these may occasionally be-
 come exciting causes ; but  it is  hence  obvious that they are  not
 competent of themselves to produce the disease.  Some of them in-
 deed have been put to a direct test, and have explicitly proved their
 incompetency. Thus in the wards of  the Veterinary School at Al-
 Alfort, three dogs were shut up and made the subjects of express
 experiments.  One was fed with salted meats, and totally restrain-
 ed from  drinking: the second  was  allowed  nothing but water;
 and the third allowed neither food nor drink of  any kind.   The first
 died on the forty-first  day of the experiment,  the second on the
 thirty-third day ; and the third  on  the twenty-fifth; not one  of
 them evincing the slightest symptom of rabies.
  That the specific virus of rabies is less volatile and active than
many other kinds of morbid poisons is clear from the fact that it is
never found diffused in  the atmosphere,  so as to produce an epi-
demy; that it never operates on those who are most susceptible of 
oE. I.—SP. VII.]
NERVOUS FUNCTION.
233
  its influence except when accompanied with  a wound or inserted
  into the cutis;  and that,  even in this case, it usually requires in
  mankind, and probably also in other animals, some auxiliary cxcite-
  ment to enable it to carry forward the process of assimilation : for
  it rarely happens that all the men or quadrupeds that are bitten by
  a rabid dog suffer from the inoculation.   Mr. Hunter,indeed, gives
  an instance in which out of twenty persons who were bitten by the
  same dog only one received the disease.   This is a happy circum
  stance, as it affords an important interval for medical treatment, if
  we should ever be so fortunate as to hit upon any curative process
  that may be depended upon.   At the same time I cannot avoid again
  to observe that as  this  virus is less volatile than most others, it is
  perhaps less indecomposible than any of them, and hence is capable
  of remaining in a dormant and unaffected state, in any part of the
  system, into which it has been received by insertion, for a  far longer
  period than any other known contagion whatever.
    When the disease has once  fixed itself among a large establish-
  ment of hounds, it has been said that the acrimony of the poison be-
  comes more concentrated and active; operates through an unbroken
  skin, and even taints the atmosphere.   There is, however, no solid
 foundation for such an opinion; and though the disease runs rapidly
 from one dog to another, and it may be difficult in many cases to
 trace the marks of a bite, yet considering that the smallest and most
 imperceptible scratch of a tooth may be a sufficient medium of in-
 fection,  and  that every  inoculated  dog adds to the  sources from
 which it may de derived, there is  no difficulty in accounting for
 such rapidity of spread without ascribing anomalies to the laws by
 which it is regulated.   Heister, indeed, has given a case of lyssa,
 in one of the foreign collections, produced in a man  by his having
 merely put into his mouth the cord by which the mad dog had been
 confined: but as in this instance there was probably some ulceration
 in the mouth at the time, there is nothing marvellous in its produc-
 tion. Palmarius, in like manner, relates the case of a peasant who, in
 the last stage of the disease, communicaied it to his children in kiss-
 ing them and taking leave of them.* Yet unless we could be certain
 that there were no cracks or other sores on the lips, and no eruption
 on the cheeks of these children, the example affords  no proof.
   I can distinctly stale that I have seen  the same intercommunica-
tion successively  repeated between a rabid young man and a young
woman to whom he was betrothed, and who could not be restrained
from such a token of affection, without any evil consequences ; not-
withstanding  that the patient was labouring at that  time under hy-
drophobia and all the severest marks of the disease which destroy-
ed him in a few  hours afterwards, and had also a perpetual desire
to spit his saliva about  the  room.
   It has, on the other hand, been doubted whether the virus is ca-
pable of propagation from the human subject to any animal even by
          * De Mort. Contagios. p. 266.  Paris, 4to. 151S
VOL. ill.—30 
234
NEUROTICA
[CL* IV.—OR.- Ill
 inoculation : but a bold experiment of M. Magendie and M. Breschet
 has completely settled this question ; for on June 19, 1813, having
 collected  upon a piece  of linen a  portion of the saliva of a rabid
 man in the last stage of the disease, they inserted it under the skin
 of two dogs  that were in waiting, both of them in good health; of
 which one became rabid on  the  27th of July, and bit two others,
 one of which also fell a victim to the disease just a month afterwards.
   The general aggregate of the symptoms point forcibly to the ner-
 vous system as the immediate quarter  of disturbance.   Such was the
 opinion of Morgagni, Cullen, and Percival ; and such indeed is the
 common opinion of the  present day.   By many writers, however,
 the  effects have been rather referred to the sanguiferous system,
 and regarded as a fever; Mangor describes it as a continued fever ;*
 and Rush  and many others as an inflammatory affection ; Bader as a
 fever siu gencris.-f  Nor is the difficulty in the least degree removed
 by dissection, for nothing can be more at variance than the appear-
 ances in different cases.  Generally speaking the fauces and parts ad-
 joining exhibit redness and inflammatory characters.   But  while in
 some instances these are  so considerable as to be on the point of gan-
 grene, in others there  is no inflammatory appearance  whatever.
 Morgagni has examined and described bodies in both these states.
 Rolfine gives one or two decided cases of the latter sort :\ while
 Ferriar notices examples in which the inflammation of the fauces had
 spread over the whole oesophagus and even the stomach ;§ and an-
 other writer had recorded an instance in which it has descended to
 the ileus, which was in a state ofgangrene.fi   In some cases the en-
 cephalon  has  appeared to be as much diseased as the fauces; the
 vessels turgid ; the plexus choroides blackish ; the ventricles loaded
 with water.  Sometimes the  lungs have been inflamed,  sometimes
 the  liver,  sometimes the vagina;  while the  blood, according to
 Sauvages, has been also found in a dissolved state, and according to
 Morgagni  in a state highly tenacious and coagulable.   From all
 which  we can only conclude, that owing to the violence of the dis-
 ease, every organ is  greatly disturbed, and those  the most so that in
 particular cases are most severely  affected.   Riedel asserts  that
 among dogs a highly offensive fetor of a peculiar character is thrown
 forth from every  part of  the body :1f but I have not found this re-
 mark confirmed by the veterinary  practitioners of our  own country ;
 and it certainly does not apply to mankind, with an exception or two
that seem to depend upon some accidental circumstances ; for Wolf
* Act. Havn. II.
f Vf rsuch einer neuen Theorie, &c.
t Dissert. Anat. Lib. I. cap. xii.
§ Medic. Facts and Observations. Vol. I,
II N. Act. Nat. Cur. Vol. IV. Obs. 20.
1 Act. Acad. Mogunt. Erf. 1757. 
GE. I— SP.  VII.]
NERVOUS FUNCTION.
235
informs us, that in one of his patients, and a patient that ultimately
recovered, the blood stunk intolerably as it was drawn from a vein ;
and a patient of Dr. Vaughan's complained of a most offensive smell
that  issued from the original wound, but of which no one was sen-
sible except himself.
  Desault, in his treatise on rabies, tells  us that he has often met
with numerous minute worms in the heads of those who have died
of this disease ; and he hence regards such animalcules as its cause.
But this  writer was a slave to the Linnean hypothesis of invermi-
naiion, and applied the same cause  to syphilis, which he also sup-
posed to be maintained by a transfer of vermicules from one indi-
vidual to another : and hence proposed to treat syphilis, lyssa, and
itch, as diseases of a like origin, with the  common antidote of mer-
cury, and gives instances of a success which  no one has met with
out of his own practice.  The cases, however, which he describes
had not advanced to the stage of water-dread ; and in all  of them he
thought it prudent to  combine  with his mercurial inunction cold
bathing, and Palmarius's antilyssic powder.
  Vander Brock, and after him, Rahn, maintain that the return o£
pain  and  inflammation in the bitten part, on the onset of the disease,
does not occur from any virus which has  hitherto been lying dor-
mant there, but from the universal excitement  alone.  It may be
observed, however, in opposition to  such an opinion, that this local
affection is in most instances a prelude to the general disease, and
forms the punctum saliens from  which it issues; as though the con-
tagious ferment  had remained  dormant there, and was at length
called into action by some exciting  cause.
  There seems, nevertheless, to  be a slight departure from the
general character of the disease in a few  cases, and particularly in
those that are produced by the bite of a rabid  cat, whether the
latter have originated it, or received it from a rabid dog, as though
by a  passage through the domestic cat the  virus undergoes a similar
change to that which takes place in the  virus of small-pox, when
passing through the system of an individual  which has previously
submitted to  the influence of cow-pox: for, upon  the  whole, the
disease appears to evince somewhat less malignity, to be more dis-
posed to intermit, and  its spastic symptoms, and especially that of
water-dread,  to be  both less frequent and less violent:  so that in
respect to symptoms we may perhaps mark out the two following
varieties:
* Felina.                 The spastic symptoms less acute and
  Feline Rabies.             frequently intermitting  ; produced
                             by the bite of a rabid cat.
b Canina.                 The spastic constriction, for the most
  Canine Rabies.             part, extending to  the muscles of
                             deglutition, which are violently con-
                             vulsed at the appearance or idea of
                             liqaids : produced by the bite of  a
                             rabid dog. 
33b
NEUROTICA
[CL. IV.-OR. III.
   There is a case of feline rabies, if it be rabies, in Morgagni, and
which is copied from him into Sauvages' Nosology, in which the
above distinction is so strongly marked, that the author in the first
edition of his own Nosology, was induced to follow M. de Sauvages'
mode of classifying it, and made it, after him, a distinct species,
though  he  deviated from the name under which it occurs  in this
justly celebrated writer, which is that of Anxietas a Morsu.* The
history of the enraged cat  is not given, nor is it certain that the
rage was that of rabies.  The  master of the animal was attacked
and wounded  both by its teeth and  claws.  The symptoms took
place four  days after the bite, and  were confined to spasms of the
chest without hydrophobia; nor do these seem to have been of great
violence, for they are described as « magna praccordiorum anxietas."
Local and general bleedings were useless : a frequent repetition of
the warm bath afforded relief; but it only yielded to an ephemera
with copious sweat.   The  intervals were  lunar: for it  returned
with the full moon for two years :  the bitten part,  as usual, first
becoming highly irritable, and  the spasms or vehement anxiety of
the praecordia supervening, which were now relieved by bleeding
After this  period it returned with every fourth full moon for two
years more, and then appears to have ceased.
   A few instances  of intermission, with a return of periodical pa-
roxysms, produced by the bite of a rapid dog, are also to be found
in the medical collections : of which Dr. Peter's case, recorded in
the Philosophical Transactions! affords a striking example,  the pa-
roxysm returning for many months afterwards, severely once a fort-
night, or at every new and full moon, and slightly at the quarters,
or in the intervening weeks.  Selle, indeed, asserts that he has met
with an  instance of the same  kind of intermission  among dogs ;
and hence  where the individual recovers, both varieties seem occa-
sionally to  subside in this manner.
   Dr. Fothergill has given two cases of unquestionable  affection
from  feline rabies  produced by the same animal.   The cat first bit
the maid-servant, and afterwards the master of the house about the
middle of February.   The wound inflicted on the maid-servant re-
mained open and irritable from the first, and continued to resist eve-
ry application for many months; it healed, however, at length, and
no constitutional symptoms supervened.  The wound inflicted on the
master healed easily and in a short time, but in the middle of the
ensuing June, being four months afterwards, the usual symptoms of
lyssa  appeared, yet with comparatively  slight and occasional wa-
ter-dread;  insomuch that the patient, far more resisting the use of
the warm-bath, sometimes called for it,  expressed a high sense of
the comfort it afforded him, and was able at times to dash the wa-
ter over his head  with his own hands.   It terminated,  however,
* Classis. VII. Order I. v. 6.
| Phil. Trans. 1745. No. 475. 
GE. I—SP. VII.]
NERVOUS FUNCTION
237
fatally, and with the general symptoms of distress which we shall
give presently*
   In the Transactions of the Medical Society of London,f we have
a highly interesting case of the same kind, which proved equally
fatal, in seventy-four clays from the  time  of receiving the injury,
and fifty-eight hours from the  commencement of the disease ; all
the symptoms moreover exhibiting less violence than usually occurs
in canine madness, with little or no water-dread, and consequently
an ability to drink fluids to the close of the disease, though the mus-
cles of  deglutition, as well as those of the  chest, evinced always
some degree of constriction, with occasional exacerbations.!   The
patient was a young lady of eighteen years of age;  the attack was
made in the month of January, with both  claws and teeth, by a do-
mestic cat that was lurking under the bed, and which,  though not
known to be ill, had for some time before been observed to be wild
and had been roving in the woods.   The fate of the animal  is not
mentioned.  The lacerated parts were incised and purposely inflam-
ed by the application of spirit of turpentine.  The wounds healed
and the general  health of the patient continued perfect till the
beginning ofthe ensuing April, when she was suddenly frightened by
looking out of a window, and seeing  a mad-dog pursued by a crowd-
ing populace.  This proved an exciting  cause.  She instantly ex-
pressed alarm, anxiety, and dejection of mind.   In the afternoon
she complained of an unusual stiffness in  moving her left arm, and
its sense of feeling was impaired; she discovered an  aversion to
company; the irritations of noise, heat, and light were offensive to
her; she avoided the fire, and  forbade a candle to be brought near
her.  The rigidity and insensibility of the affected arm seemed to
shoot in a line from  the middle finger which had been lacerated,
and was accompanied with an acute pain  which terminated in the
glands of the axilla, where she complained of a considerable swell-
ing.  Yet neither of the  hands  (for both had been injured) were
affected with discoloration, tension,  tumefaction, or any other mark
of local injury, though a degree of lividity had been observed upon
the lacerated part of the finger a  short  time before the disease
made its appearance.  She had a  painful  constrictive sensation  in
her chest, and the respiration was interrupted by frequent sighings.
The spasmodic symptoms increased, and  at length the  whole sys-
tem, but especially the lungs, was affected  with violent convulsions :
the breathing was exquisitely laborious, but the paroxysm subsided
in about two minutes.  Frequent  sickness and vomiting followed :
the convulsive spasms about the throat obliged her  to  gulp what
she swallowed, and she showed a slight  reluctance,  but nothing
more, to handling a glass goblet.   The pulse  was  132 strokes
in a minute ;  the skin  was cool, the  tongue moist, the bowels
* Neue Betragezur Natur und Arzney-wissenchaft. B.  III. 118.
f Med. Obs. and Inquir. Vol. V.
* Vol. I. Art. IV. p. 78. 8vo. 1810. 
238
NEUROTICA.
I'CL. IV.—1>R. III.
 open, the thirst urgent, without any tendency  to delirium.   She
 was worn out, however, by sensorial exhaustion and  distress, and
 at last expired calmly at the distance of time from the attack already
 stated.
   In the general progress of c anine rabies, all the above indica-
 tions are greatly aggravated, and the mind often participates in the
 disease and becomes incoherent.  Whatever be the exciting cause,
 the  wounded part almost always takes the lead in the train of symp-
 toms and becomes uneasy, the cicatrix looking  red or livid,  often
 opening afresh, and oozing forth a little coloured serum, while the
 limb feels stiff and numb.  The patient is next oppressed with anxiety
 and  depression, and sometimes sinks into a melancholy from which
 nothing can rouse him.  The pulse and general temperature of the
 skin do not at this time vary much from their natural state. A stiff-
 ness and painful constriction are, however,  felt about the chest and
 throat; the. breathing becomes difficult, and is interrupted by sobs
 and  deep  sighs, as the sleep  is, if any  be  obtained, by starts  and
 frightful dreams.  Bright colours, a strong light, acute sounds, par-
 ticularly the sound  of water  poured from bason to bason, even a
 simple agitation ofthe air by a movement ofthe bed  curtains, is a
 source of great disturbance, and will often bring on a  paroxysm of
 general convulsions, or aggravate  the  tetanic  constriction.   The
 patient  is tormented with thirst, but dares not drink ;  the sight or
 even idea of liquids making him shudder : his eye is haggard, fixed
 and  turgid with blood from the violence of the struggle : his mouth
 filled with a  tenacious saliva, in  which, we have already shown,
 lurks the secreted and poisonous miasm, and he is perpetually en-
 deavouring to  hauk  it up and spit it away from him in  every direc-
 tion  ; often desiring those around him  to stand  aside as conscious
 that  he might hereby injure them.  The sound which is thus made,
 from the great oppression he labours under and his vehement effort
 to excrete the tough and adhesive phlegm, is often of a very singu-
 lar kind ;  and, being sometimes more acute than at others, as well
 as quick and sudden, and also  frequently repeated, like every other
 motion of the body,  has  occasionally, to a warm and prepossessed
 imagination, seemed to be a kind of barking  or  yelping.  And
 hence, probably, the vulgar idea that a barking  like that of a dog
 is a common symptom of the disease.  The restlessness is extreme,
 and if the patient attempt to lie  down and compose himself, he in-
 stantly starts up again, and  looks wildly round him in unutterable an-
 guish. "On going into the room," says Dr. Munckley, describing the
 case of a patient to whom he had been called, and the  author can
 bear witness to the accuracy of his very forcible delineation, " we
 found him sitting up in his bed, with an attendant on each side  of
 him  : he was in  violent agitation of  body ; moving himself about
 with great vehemence as he  sat in the bed, and tossing his arms
from side to side. On seeing us he bared one of his arms, and strik-
 ing it with all his force, he cried out to  us with the greatest eager-
ness  to order him to be let blood.  His eves were redder than the 
GE. I.—SP. VII.]      NERVOUS FUNCTION.
239
  day before; and  there was added to the whole look an appearance
  of horror and despair greatly beyond what I had ever  seen  either
  m madness or in any other kind of delirium."   The patient was,
  nevertheless, « perfectly in  his senses at this time; and there was
  not the least appearance of danger of his  biting any person near
  him ; nor, among the variety of motions which he made, was there
  any which looked like attempting to snap or bite at any thing with-
  in his reach: and they who  were about him had no  apprehension
  of his doing this."* The patient had at this time reached the third
  day of the disease, and expired about two hours after Dr. Munck-
 ley had left him.
   There  is, however, a considerable  difference in  many  of the
 symptoms which characterize  the progress of this malady derived
 from difference of age, idiosyncrasy, or some other casualty, so that
 it is possible no two cases precisely parallel each other.  The vo-
 lume of the Medical Transactions  from which I have just quoted,
 contains three instances of lyssa communicated by different practi-
 tioners.  In the first, which is Dr Munckley's, no notice whatever
 is taken of the original bite,  which was both in the hand and cheek,
 from a favourite lap-dog, and the  patient does not seem to have had
 any return  of pain or irritation  in these organs.   In the second
 case, which is that of a lad of  fifteen years of age, the bite, which
 was in the leg, was so small that it was scarcely perceptible at the
 time,  and  from first to last  never gave the least uneasiness.f  In
 the third case, which is  that of an adult woman, the disease was
 preceded by the ordinary prelude of torpor, stiffness,  and tingling
 in the bitten part,  shooting upwards to the trunk.f In the first case,
 the patient's mind never wandered to the last moment of life, which
 is a common character ofthe disease ; in the second and third, both
 were furiously mad, bit themselves, the bed-clothes, and whatever
 else fell in their way. In all of them, however, there was a severe
 hydrophobia, and in  all of them the pulse did not essentially vary
 from its common standard.   The first died on the third day ; the
 two last recovered ; the one under a treatment which  consisted
 principally of opium, and  the other under that of salivation ;  leav-
ing it therefore doubtful how far  the recovery may be ascribed to
 the natural powers ofthe constitution, and  how far to remedies so
 widely different in their nature.
  There is, also, in  these three cases, an equal and most singular
discrepancy  in the interval   between the infliction  of the  wound
and the incursion of  the disease.  The first interval was about six
weeks,  which may be regarded as the ordinary term : the second
was only five days: the third is not set down with  any degree of
precision :  the patient is  only  stated to have been seized " about
the time that the second horse died" that had been bitten by the

           * Medical Transactions, Vol. II. Art. V. p. 53.
           t Id. Art. XII.  p. 192.
           * Id. Art. XV. p. 222. 
240
NEUROTICA.
[«L. IV.—OR. Hi.
 same rabid dog : and hence this interval consisted probably of about
 a fortnight.
   This discrepancy seems to depend entirely upon the nature  or
 presence of the prcdisponent or exciting cause that gives energy
 to the virus, and without  which it may lie, as we have already ob-
 served, for  an  almost indeterminable period dormant, but unde-
 composed, and  still therefore as malignant as when first generated.
 In the lad who was soonest affected, there seems to have been a strong
 predisposition to the disease from the first moment, and which  alone
 became an  exciting cause; in  the woman,  who suffered about a
 fortnight afterwards, there was probabiy some degree of predispo-
 sition, but the immediate exciting cause appears to have been  over-
 exertion in  walking, for we are told that " she was seized as she
 was going on an errand on foot, and had walked about two miles."
   There is  a like uncertainty among quadrupeds.   We have just
 taken the interval of ten or twelve days as  the common term ; but
 in the instance  just referred to it may have been considerably lon-
 ger.  According to Meynall, the disease among dogs appears from
 ten  days to eight  months after the bite.  In  Earl Fitzwilliam's
 hounds which were bitten, June 8, 1791, the interval varied  from
 six  weeks  to more than six  months :  and not much less in Mr.
 Floyer's hounds as described by Dr. James.  It is not therefore  to
 be wondered at, that there should be a great uncertainty among
 mankind.   And hence we find it has occurred a week or fortnight
 after the bite, three weeks, a month, and sometimes six weeks, and
 even three  months ; after which  last  period, however, notwith-
 standing occasional instances to the contrary, the patient is generally
 considered safe.  There are two  cases published  by Dr. Tracher
 in the American Medical and Philosophical Register,* in which the
 injury inflicted  by the same dog, August 16, 1810, did not produce
 hydrophobia in  either instance till  nearly three months afterwards,
 namely, November 3, and November  14, ensuing:  and it is the
 more remarkable that the  first case was  that  of a child under four
 years of age: ihe second, that of an old man of seventy-three.
 Both terminated fatally: in the former case in six days, in the lat-
 ter,  in seven from the onset of the disease.
  The academical journals, and monographic  writers, nevertheless,
have numerous instances of the malady appearing after a bite of
 many years standing;  sometimes  twelve, eighteen, twenty, and
 even thirty years: but the  cases want authority in most instances.
 I shall presently, however, have occasion to notice one in which  it
 occurred and proved fatal more than nine months afterwards:  and
 there is another communicated by Dr. Bardsley,to the Manchester
 Society, strongly entitled to credit, however difficult it may be to
 account for the  fact, in which  the attack did not  commence till
twelve years after the bite of a dog  supposed  to be mad.  The pa-
* Vol. 1. p. 457 
GE. I.—SP.II.]
NERVOUS FUNCTION.
241
tient died in the Manchester  Infirmary with decided symptoms of
the disease.  He had been for some time  antecedently labouring
under great nervous agitation and considerable depression of spi-
rits : and Dr. Bardsley inclined to ascribe it to this  cause  rather
than to any specific poison lurking in the system.  But this is to
suppose that lyssa is capable, under particular circumstances, of
being generated  spontaneously  in  the human  frame, while  Dr.
Bardsley, as we  have  already observed,  contends that it  cannot
exist, even among dogs, except by contact.
  The mode of treatment  is a field still perfectly open for trial;
for at this moment we  have no specific remedy nor any plan that
can be  depended  upon,  after  the disease shows itself.
  Antecedently, indeed, to this period  our course is obvious, and
particularly if we should be so fortunate as to be consulted at the
time of the bite : and should consist in endeavouring, by the prompt-
est and most efficacious means,  to prevent the spread of the dis-
ease by cutting out  the virus before absorption has taken place.
This has been clone in various ways : for the lacerated part has
been sometimes amputated or dissected ; and at other times totally
destroyed by the actual  or potential cautery.   The actual cautery,
by the  means of irons  heated to  whiteness, was first adopted and
recommended  by Dioscorides,*  and afterwards  by Van Helmont,
Morgagni,! and Stahl : the potential cautery seems to have  been
proposed as a less terrific mode of operation, and has usually been
accomplished by the means of lapis infernalis or decarbonated soda.
It is recommended by Schenck, Pouteau, and Dr. Mosely.  A no-
tion, however, has obtained from very  early period that the irrita-
tion produced by a  cautery,  whether actual or potential, only in-
creases the tendency to absorption : and Trampel has endeavoured
to prove this :\ on which account Hildanus and Morgagni have ad-
vised excision  in combination with the cautery: the former pro-
posing to cut the eschar as soon as it is formed, without letting it
remain for a spontaneous separation; and the latter, far more effec-
tually, recommending that inustion should follow the application
of the  knife instead of preceding it.
  Of these three modes of operating, the potential cautery is least
entitled to be depended upon,  for it is not sufficiently rapid in its ac-
tion.   Of the other two it is,  perhaps,  of little consequence  which
is selected, and either of them will generally prove sufficiently effi-
cacious alone,  if employed early enough to anticipate absorption,
and extensively enough to make sure of extirpating or destroying
every portion of  the bitten part.  There is reason to believe that
in many instances this has not been done, so that Camerarius places
as little confidence in the actual  cautery as in the potential; and
Dr. Hamilton almost as little in excision.  And hence, another rea-
     * Lib. VI.
     t De Sed. et Caus. Morb. Ep. VIII. Art. 26.
     $ Beobachtungen und Erfahrungen, &c. Band, 11. passim.
,OL. 111—31 
242
NEUROTICA.
[CL. IV.—OR. Ill
son for employing both means in the manner recommended by
Morgagni; in which case we shall find it unnecessary to superadd
any of those irritant, exulcerant, or suppurative applications which
have been employed  by many practitioners with a  view of intro-
ducing a fresh local action, and maintaining a fresh local discharge,
and  which have  chiefly consisted of cantharides, camphor, allia-
ceous cataplasms, resins, turpentine, or as Celsus recommends, cu-
linary  salt.*   It  may likewise be advisable, as proposed by Sir
Kenelm Digby, and since his time by Dr. Haygarth,  to wash  the
wound thoroughly with tepid water,  or tepid wine and water, be-
fore the excision is commenced.
  There is also another, and a very easy, and perhaps a very sa-
lutary operation, which I would strenuously recommend from the
first, even before the process of ablution.   I mean that of applying
a tight ligature to the affected part wherever it will admit of such
an application, at a short distance above the laceration.  I have
never had an opportunity of trying the benefit of such a measure
in my own practice ; but analogy  is altogether in its favour, for it
is well known to be one of the most important steps  we can take in
confining the poisonous effects of the rattle-snake,and other venom-
ous animals, and of mitigating its violence by the torpor which fol-
lows ; and it has the sanction of many authorities of deserved cre-
dit as Hacquet, Percival,  Vater,  and Wedel.
  If, however, the local plan should prove ineffectual, our curative
practice, as already observed, is still unfortunately all afloat, and we
have neither helm  to steer by, nor compass to  direct our course.
There is, indeed,  no  disease  for  which   so many remedies have
been devised, and none in which the mortifying character of vanity
of vanities has been  so strikingly written on all  of  them.   In the
loose and heterogeneous manner in which they have descended to
us,  they seem indeed to have followed upon one another without
rational aim or intention of any kind.   Yet, if we  nicely criticise
and arrange them,  we shall  find that  this is not  the  case.
  There are  four principles by which physicians appear to have
been guided in their respective attentions to this disease.   That of
stimulating and supporting the vital power so as to  enable it to ob-
tain a triumph in the severe conflict to which it is exposed.  That
of suddenly exhausting the system by severe bleedings and purga-
tives, as believing the disease to be of a highly  inflammatory cha-
racter.  That of opposing  the  poison by the usual antidotes and
specifics to which other animal poisons were supposed to yield.
And that of  regarding  the disease as  a nervous or  spasmodic, in-
stead of an inflammatory, affection, and, consequently, as most suc-
cessfully to be attacked by an antispasmodic course of medicines and
regimen.
  The very popular use of volatile alkali and camphor,  may, by
some, be  ascribed to  the  first of these views, as being powerful
* De Medicina, Lib. V. Cap. xxvii. § 1. 
GE. I.—SP. VII.]
NERVOUS FUNCTION.
243
 stimulants; yet, in fact, they were rather employed from different
 motives, and fall within one or two ofthe principles of action which
 yet remain to be considered.   But to this class of medicines, design-
 ed expressly to support the vital power, and enable nature  herself
 to triumph in so severe a struggle, belong expressly the warm and
 cordial confections and theriacas that  were at one time in almost
 universal estimation; as also vaiious kinds of pepper given in great
 abundance, oil of cajeput, different preparations of tin, copper and
 iron, and, in later periods, bark.
   In direct opposition to this stimulating and tonic plan, was that
 of suddenly debilitating and  exhausting the system  upon the hy-
 pothesis that the symptoms of canine rabies were those of  violent
 and rapid inflammation.  The practice of submersion in cold water,
 belongs mostly to this view of the subject, as  used a century ago,
 though in the time of Celsus, it  was employed in  a much slighter
 degree to take off the spasm of hydrophobia, and to  quench the
 thirst that accompanied it.   " Miserrimum genus morbi;  in quo
 simul aeger et siti  et aqua: metu cruciatur : quo oppressis in angusto
 spes  est."*   In this almost hopeless state, the only remedy (unicum
 remedium)  Celsus continues, is to throw the patient instantly and
 without warning, into a fish pond, alternately, if he has no knowledge
 of swimming, plunging him under the water  that he may drink, then
 raising his head, or forcing him  under it if he can swim, and keep-
 ing him below till he is filled with the water; so that the thirst and
 water-dread may be extinguished at the same  time.  But there is
 here, continues our  author, another  danger, lest the body of the
 patient, exhausted  and worn out by the submersion as well as by the
 disease, be thrown into convulsions : to prevent which, as soon as
 he is  taken out of the pond he is to be  put into warm oil.f
   The  bolder practitioners  of subsequent times, in  pursuing the
 refrigerating plan, were regardless of convulsions, and persevered
 at all hazards in reducing the living power to its last ebb ; believing
 that the nearer they suffocated the patient without actually  killing
 him, the greater their chance of success.  Hence Van Helmont
 kept the wretched  sufferer under water  till the Psalm u Miserere"
 was sung throughout, which under some choristers occupied a much
 longer time than under others; and in the experiments ofthe Mem-
 bers ofthe Academie Royale, we meet with instances of a still more
 dangerous pertinacity ; though success is said to have accompanied
 one or two of them.   Thus, M. Morin  relates the case of a  young
 woman, twenty years old, who, labouring under  symptoms of hydro-
 phobia,  was  plunged into a tub of water with a bushel of salt  dis-
 solved in it, and was harassed with repeated dippings till she became
insensible and was at the point of death, when  she was still left in
the tub sitting against its sides.  In this state, we are told, she was
 at length fortunate enough to recover her senses ; when, much to
• De Medicina, Lib. V. Cap. XXVII. % 2.
f Cels. loco citato. 
241
NEUROTICA
|GL. IV.—OR. Ill
her own astonishment, as well as to that of the by-standers, she
found herself capable of looking at the water, and even of drinking
it without choking.*
  With respect to the warm oil-bath which Celsus recommends in
succession to that of cold water, the present author can say that, in
a single instance to which he was a witness when a young man, it
produced no benefit whatever.   It was prescribed by a physician in
consequence of the recommendation of Celsus, but who certainly
had not read him attentively, nor was acquainted with the scope of
his reasoning.  For in this case cold bathing had not been tried
antecedently, and consequently there was no danger of those con-
vulsions for which  alone the Roman physician enjoins the use of
the oil.  The experiment, however, was so far perfect, that the tub
was full of oil and deep enough to  reach the patient's chin.
  In connexion with the cold bath thus persevered in to suffocation,
the reducent or antiphlogistic plan was still farther forwarded, at
one time, by the use of strong drastic purgatives, of which colocynth
was, for a long  period the favourite ;t and at other times by a very
bold and perilous use  ofthe lancet.
   Bleeding has lately been revived  and carried to the extent of
deliquium by large and rapid depletions, and the operation has been
repeated  almost as long as the powers of life would allow.  Dr.
Shoolbred, of Calcutta, had two patients who recovered under this
process :  but he employed mercury at the same time, and it is by no
means  certain  either  by the history of the patients, or ofthe dog
by which they were bitten, that the disease was a genuine lyssa.
   Yet, whatever benefit this practice may possess, it has no pre-
tensions to  novelty: for there is not a single course of treatment
ever invented for this intractable disease that has been for upwards
of a century more  extensively tried and retried,  both moderately
and profusely,  or excited  a warmer controversy upon its merits.
Poupart,  in  1699, espoused the  practice, and gives the case of a
woman, who perfectly recovered by bleeding her to deliquium, and
afterwards confining her for a year to bread and water.f
   Berger, in the same year, recommended bleeding, but advised
that the blood should be taken from the forehead    In the Breslavv
Collections  for 1719, is the case of a cow supposed to be rabid and
said to be cured by  profuse bleeding. And the Philosophical Trans-
actions abound with similar histories, some of them purporting to
have been attended with similar success, derived from human sub-
jects : but most of them  too loosely given or too indecided in their
symptoms to be in  any measure entitled to reliance.  That  of Dr.
Hartley and Mr. Sandys was, at one time, appealed  to as demonstra-
tive.   It is  the case of a groom who was bitten by  a dog, supposed
to be mad, towards the end of November, and who sickened about
* Hist, de PAcademie Royale, Ann. 1709.
f Hellol. An. de morsis a rabido Colocynthis?  Paris, 1676.
t Hist, de PAcademie des Sciences. Ann. 1709. 
GE. 1.—SP. VII.]
NERVOUS FUNCTION.
245
the middle of January ensuing ;  he had an aversion to drink, and
was  conjectured to be labouring under rabies.  Venesection was
here trusted to almost entirely,  and every repetition of the lancet
seemed serviceable : in consequence of which he lost a hundred and
twenty ounces of blood in the course of a* week, by different deple-
tions, which consisted of sixteen or twenty ounces at each time.
The man recovered : but few readers will believe him to have been
really rabid, when  they learn, that although he  had  an aversion  to
drink, he swallowed liquids: that his chief symptoms were sickness,
trepidation, a faultering speech and memory ; and that, through the
whole course of the  disease,  he attended, though with some diffi-
culty, to his duty in the stable.*
  The Edinburgh Medical Commentaries are equally replete with
cases in which the same plan of evacuation had been tried, but they
are also equally unsatisfactory.   Thus, Dr. Tilton informs us that,
having heard of the recovery of a patient from the  disease before
us, who had bled profusely  and almost to death, by an accidental fall
from an high place, and a division of the temporal artery,  he em-
ployed venesection freely in a case of his own, drawing off from
twenty  to  thirty ounces at a time, and occasionally bleeding  to
deliquium.f   But  the symptoms are here also so doubtful that the
result is of no importance.
  The practice, therefore,  has been not uncommon for at  least a
century and a half; and had it proved as  specific as some late
reports would induce  us to believe, it must have descended to  us
with a wider and more  confirmed reputation, and formed the only
course to be relied on.   But the misfortune is, that however salu-
tary at times, it has often completely failed in the hands of unpre-
judiced and judicious practitioners; and where it has succeeded it
has  generally been combined with other means that have been
resorted to at the same time.  There is a case of failure related  by
Dr.  Plummet- in the Edinburgh Medical Essays :| but it is not much
to be relied on, as not more than twenty ounces of blood were lost
at a second  and accidental bleeding, and only ten a day  or two
before by a  prescribed venesection.   Mr. Peters,  however, who
employed profuse  and repeated bleedings, sometimes even to deli-
quium, had, in his day, so little dependence on  them alone, that  he
uniformly  combined this remedy with opium  and  mithridate,  or
other cordials, and in the  case which he has introduced into the
Philosophical Transactions, he ascribes the success which accom-
panied  his plan to this  combined mode of  treatment.§   In like
manner, Mauchart, as quoted by Buhlmeier, while he advises bleed-
ing, and to an extent proportioned to the  length of the  interval
between the infliction of the wound and the attack of the paroxysm,
* Phil. Trans. Year 1737-8.
f Vol. VI. p. 432.
t Vol. V. Part II.
«, Phil. Trans. 1745. No. 475. 
246
NEUROTICA.
[CL. IV.—OR. Ill-
 (and where the patient is of a melancholy temperament, even to
 deliquium,) advises, at the same time, that the bitten part be scari-
 fied; and when this also has bled till  nothing  but serum escapes,
 that the wound be dressed with milhridate, theriaca, or rue, and a
 defensive plaster put ovfcr it, and that the patient take pills, com-
 pounded of mithridate and other materials, to the number of nine
 every day for nine months, keeping himself in a free perspiration,
 and cautiously changing his linen.
   In the case of dogs, venesection, how liberally soever made use
 of, does not  seem to be of much benefit.   It has lately been the
 subject of a series of  experiments at Paris, under the superinten-
 dence of MM. Magendie, Dupuytren, and Breschet, who have car-
 ried it to deliquium, but without any success whatever.  And hence,
 though it has unquestionably been serviceable, in many cases, the
 practice cannot be regarded as a specific.
   The poison of rabies has, by a numerous body of  pathologists,
 been contemplated as of a nature akin  to the poison of other vene-
 mous animals, and particularly serpents ; and consequently, best to
 be opposed by the usual remedies and  specifics to which these are
 found most effectually to yield.   And hence, in the first place,the
 use ofthe radix Mungo of Koempfer, (ophiorrhiza Mungos, Linn.)
 still supposed  to be a specific for the bite of the cobra di capello
 and the ratlle-snake.   In India and Ceylon it is used to the present
 day  as an antidote against the bite of the mad dog :  Koempfer
 highly extols  it, and Gremmius, who practised with great reputa-
 tion  at Columbo, employed it  very largely.
   Acids and alkalies belong to the same class of antilyssics.  Of
 the former Agricola, who was hostile to the depleting system, pre-
 ferred the muriatic acid, and regarded this as a specific* even when
 restrained to  a topical application.  Poppius  preferred the sul-
 phuric ;  but by far the greater number of practitioners the acetous
 was held in most esteem.  Many combined this last with butter and
 used it both internally and externally : Wedel, with other materials;
" as a cure,"  says he,  u for the bite of  a mad dog, let  the  patient
drink vinegar, theriaca, and rue."f
   The general suffrage, however,  was far more considerable in
favour of the alkalies, and especially of ammonia  or volatile  alkali.
There is some reason for this  preference.  It is  well  known that
ammonia is a valuable medicine, whether applied externally or
internally, in a variety of animal poisons.  I have successfully used
it more  or less diluted in various instances, as a lotion against the
sting of gnats, wasps, bees  and vipers; and I have seen it of great
service in checking the poison of the rattle-snake, and restraining
the extent of the  inflammation.  On the Continent, and especially
in France, the  usual form in which ammonia was formerly employed
in cases of lyssa, was that of the eau de luce, a  caustic spirit of
• Chirurg. p. 391.
t Exerc. Semiot. Pathol. Cap. 8. 
GE. L—SP. VII.]
NERVOUS FUNCTION.
24*i
ammonia prepared with quick-lime combined with rectified  oil of
amber, rendered more easily miscible by being rubbed into half its
weight of soap.  This was in general employed both externally and
internally,* though in the Journal de  Medicine, we  have several
reports of a successful use of it when confined to  an internal trial
alone: especially one related by M. Hervet,t  and  another  by M.
Rubiere.J
  Mercury, from its proving a specific in syphilis, and more  espe-
cially from its specific action on the salivary glands, the immediate
outlet of the poison of  rabies,  has had a strong claim to general
attention ; and has been very extensively tried in various forms,
and acquired  a high degree of reputation.   It  was first recom-
mended  by Desault of Bordeaux in  1736, and  afterwards  very
confidently by Dr. James in  our own country, as a certain cure for
man and other animals.   He used it both as a prophylactic  at the
time of the bite, and an antidote at the commencement of the disease.
He employed it as well externally as internally ;  but his'favourite
form was that of the turbeth mineral, in the shape of pills.  He has
published in the Philosophical Transactions, a full account of his
success with this medicine on Mr Floyer's hounds, after they had
made a  trial of every  other favourite  and  fashionable remedy in
vain.  These dogs, as we have already observed, were affected with
a severe hydrophobia, which has been denied by some writers to be
a symptom of the disease as appertaining to quadrupeds.   All the
hounds, we are told that were salivated with the mercury, in what-
ever stage ofthe malady, recovered, and the rest died.§  His expe-
riments on mankind are  less complete : for they amount to not more
than three, and in each  of these  the  medicine was employed as a
preventive, shortly after the, infliction  of the bite;  and  hence, as
the patients never  became rabid, we cannot be sure that they had
received the contagion, or  would have had the disease, had the
mercury never been employed.  The muriate of the metal was
another favourite form, which  by Loisy, was  used together with
inunction.
  The grand object was to excite a speedy salivation, and maintain
it so long as there was supposed to be any danger ; and especially
where the administration had been delayed till the paroxysm had
shown itself.  Frank, Girtanner, De Moneta, Raymond and a host of
writers upon the subject, deny, not only that mercury is a specific,
but that it has never produced a cure, in whatever way it  may have
been employed.  Kaltschmid, on the contrary, with an unjustifiable
  * Sage, Erfahrungen, &c. p. 49.
   Guettard, Memoires sur differentes parties des Sciences et Arts. Paris,
1768. p. 122.
  f Journ. de Medicine. Tom. LXII.
  * Id. Tom. LX1V.
  $ Phil. Trans. Vol. XXXIX.  Year 1735-6. 
348
NEUROTICA.
[CL. IV— OR. Hi
 confidence, calls it re medium indubium ;* and De Choiseul a methode
 sure et facile.^   In the fortieth volume of the Journal de Medicine
 there  is  a  relation in which  mercurial inunction  seems to have
 been successful in  a genuine case, and 1 have heard of one or two
 other instances, that have occurred in our own  country.
   As diuretics were supposed to possess a strong  alexipharmic
 power, or that of expurgating the system from animal  poisons in
 general, these have also had their votaries, and been in high repu-
 tation, as a remedy for lyssa.   Cantharides were  at  one time the
 favourite medicine  under this head, or some other stimulant insect
 of the coleopterous order, as the meloe,  lytta, or one or two species
 of scarabaeus ; which,  like mercury, and ammonia, were sometimes
 taken internally alone, and sometimes applied topically also, to keep
 up  a perpetual irritation.   Bohadsch tells us gravely, that the dis-
 ease will always yield  to ten cantharides powdered and introduced
 into the stomach :\  Monconys, that the powder should be continued
 from the bite to the time in  which we may reasonably expect
 the symptom  of hydrophobia ; and adds  that this medicine, which
 was regarded  as an arcanum in his day, was a remedy of publicity
 over all Greece.§   He might have extended his theatre ;  for Egypt
 was as well acquainted with the general principle of this practice as
 Greece or Hungary ; and it is a positive exhortation  of Avicenna,
 that whatever  diuretic  was employed  should be carried to its utmost
 acrimony, even to the  discharge of bloody urine.||
  The ash-coloured liverwort (lichen terrestris  cinereus Raii,) was
 another diuretic of great popularity, and which  seems at length to
 have triumphed over the stimulant insects, and to have superseded
 their use ; on  which account Linneus changed its trivial name from
 cinereus to caninus.  In our own country, this medicine was atone
 time peculiarly in vogue.  It was given  in powder,  with an equal
 quantity of black pepper, a drachm and a half of the  two forming
 the dose for an adult, which was taken for four mornings fasting, in
 half a pint of warm cow's milk ; th<  patient, however, was first to
 lose nine  or ten  ounces of blood, and  afterwards to be dipt in cold
 water for a month together, early in the morning.   And  such was
the  general confidence in this plan, or rather in the antilyssic power
of which the lichen was supposed to be the  most active  principle,
 that its virtues formed  one of the most common  subjects  of eulogy
in the Philosophical Transactions at the  time when Mr. Dampier
 introduced it to public notice at an early period of the  history of
the  Royal Society ;1T while, at the earnest solicitation of Dr. Mead,
  *  Dissertatio de Salivatione mercuriali, ceu indubio prsservationis et cura-
lionis remedio adversus rebiem caninam.  Jan. 1760.
  ■J- Nouvelle Methode, sure et facile, pour le traitement de spersonnes atta-
qu£es de la Rage.  Paris, 1756.
  $  Posit. Zoolog. in Klinkosch. Diss. Select.
  § Voyages, I. p. 406.
  ||  Lib. IV. Fen. VI. Tr. iv.
  1  Mechanical Account of Poisons. Art. 3. 
GE. I.—SP.  VII.]
NERVOUS FUNCTION,
249
  the powder was admitted in  the year 1721 into the London Phar-
  macopoeia, under the title of Pulvis antilyssus ; who declares,  that
  "When united with the previous venesection, and subsequent cold
  bathing, he had never known it fail of a cure,* though he had used
  it a thousand times in the course of thirty years' practice."
    How far emetics may be  serviceable general trial has not, per-
  haps, been sufficient  to determine.   They have often been found
  capable of relieving spasms of the throat, and enabling the patient
  to swallow liquids when every other plan  has failed.  They were
  hence recommended by Agricola,  but only, perhaps on account of
  their violence upon a weakened frame, as a  sort of forlorn hope,
  for he does not advise them till after the third day.   Dr. Satterley,
  however, has given a case in the Medical Transactions, which he
  regarded as rabies, in which vomiting was employed from  an early
  period of the disease, and with very decided advantage.!  But there
  seems to be a doubt whether the patient here referred to, laboured
  under genuine lyssa.   He had been bitten three months before by
  a dog, but the fate of the dog was not known : the cicatrix betray-
  ed no uneasiness or irritation precursive to the disease,  or during
  its course: the hydrophobia was remittent, or intermittent, so that
 the patient drank liquids at times with  tolerable ease; the spastic
 action ran to a greater extent over the muscular system than usual,
 so as at or.«e time to produce emprosthotonus,  and the patient  did
 not expire till at least a week after the  attack: all which are very
 unusual symptoms in lyssa, and have seldom, if ever, been com-
 bined in the same individual.
   In lyssa, however, the nervous system appears to be that which
 is by far the most severely tried,  and to which the  disease may be
 most distinctly referred.  And hence it is not to be wondered at
 that  antispasmodics and sedatives  should  also have been  had  re-
 course to very extensively, and obtained a very general suffrage.
 In effect, whatever benefit in this disease has  at any time been de-
 rived from ammonia, camphor, or cold bathing, it is more easv to
 resolve their  palliative  or  remedial  power into the principle of
 their being active antispasmodics, than to any other mode of action.
 The  more direct antispasmodics and sedatives, however, employed
 in tiiis malady were musk, opium, bella donna, nux vomica,  and
 stramonium. The last has chiefly been  tried in India, where three
 drachms and a half of the leaves infused in a very large portion of
 water or other common drink, and swallowed  daily for three days
 in succession after the bite, was, at  one  time, a very approved and
 popular remedy.
   Musk  and opium, however, are the antispasmodics which have
been  chiefly depended  upon  in Europe.  They  have sometimes
been  given in very large doses alone, but more generally in union
 vith  other medicines.   Cullen seems  doubtful of the powers of
—.-------------------------------------------------------------------•-------------■—~r
             * Chirurg. parv. Nurub. &c. 8vo. 1643.
            t Vol. IV. p. 348.
  vol.. in.—32 
250
NELK0 11CA
XL.  IV.—OK. Ill
 either,  apparently from  not  having had sufficient opportunities of
 witnessing the disease, and their effects upon it, and hence refers
 us, in both instances, without venturing upon any decisive opinion
 of his own, " to the labours of the learned and industrious Societe
 Royalc of Paris, who have taken  much pains,  and employed the
 most proper means  for ascertaining the practice in this disease."*
 With respect to musk he admits,  however, that Dr. Johnston has
 given us  two facts that are very much in favour of its power :  and
 " I have," says he,  " been informed of an instance in this country,
 of some large doses of musk having proved a cure after symptom.-.
 of hydrophobia had come on."t   Hilary says,  " In these cases  it
 acts as  a sudorific ;" and Gmelin regarded it as a specific antidote.^
   Opium, in like manner, when employed alone, was given in large
 doses, and we have numerous cases on record in which this, like the
 preceding medicines, is said to have operated a cure.§  But unfor-
 tunately neither musk nor  opium, in whatever quantity employed,
 have  been found successful in general  practice.   Tode more espe-
 cially has pointed out the inefficiency of the former, in  the largest
 doses referred to;||  and Raymond  has confirmed his remarks.il
 But a late experiment of Professor Dupuytren of  the Hotel-Dieu,
 has given  a still more striking and incontrovertible prool of its utter
 inefficacy, if not in all cases of the disease,, in certain states  and
 circumstances. Surlu, a  man aged twenty-four, had been  bitten by
 a dog sufficiently proved to be mad, had been cauterized immediate-
 ly afterwards, and been discharged as  supposed to be cured.  In
 about a month from the time of the  bite, he was attacked  with
 rabies in  its  severest symptoms,  and conveyed  to the  hospital.
 Opium  was the medicine determined upon, and  as the constriction
 ofthe throat  prevented it from being given by the mouth, a gum-
 my solution was injected into the veins, for which the sapluena and
 cephalic were alternately made use of.   Two grains of the extract
 were  in this manner  thrown in, and the patient was in some degree
tranquillized  foran hour  or two: the dose was doubled towards the
evening of the same day.  It was repeated at intervals, and  at  length
increased  to eight  grains at a dose.   The  relief it afforded, how-
ever,  was  never more than  temporary:  and he expired on the  fifth
day from the  incursion.**
   From this  inefficiency  of opium  and musk separately, they have
often  been united to  strengthen their effect; or either of them  has
been combined with  camphor, oil of amber,  inunction  with olive
 * Materia Medica, Vol. II. p. 252. 380.             -J- Id.
 t Diss, de specifico antidoto novo adversus effectus morsus canis rabidi.
lub. 1750.
 § Dantic, Gazette de Sante, 1777. p. 51.
 I!  Annalen, IX. p. 33.
 \ Med. Observ. and Inquiries, Vol. V
 r' Orfila, Traite sur les Poisons,  &c. 
■ E. I.—SP.  VII.]      NERVOUS FUNCTION.
>5l
oil,* or bleeding.   Musk was also at one time very generally com-
bined with cinnabar, and in this form supposed to be peculiarly
efficacious.  The famous powder employed by the  natives of Ton-
quin, and introduced into this country by  Mr. Cobb, on which ac-
count it was called pulvis Cobbii or Tunguinensis, consisted of six-
teen grain i of musk with forty-eight grains of cinnabar, mixed in a
gill of arrack.  This taken at a dose is said to have thrown the pa-
tient in a sound  sleep and perspiration in  the  course of two or
three hours ;  and  where it did not, the dose  was repeated till  such
effect was produced.   And this medicine also was regarded as a
specific during the short  career of its  triumph, and a cure was
commonly supposed to follow the administration ofthe medicine.
  The sedative  power of  several of the  preparations of arsenic,
however, had perhaps a  fairer pretension than  any of these, and
especially as, like mercury, it has for ages been employed with de-
cided benefit in Asia, in the case of syphilis.   Agricola mentions
its use in his day,t but  the forms in which  it was then employed
were rude and incommodious, and they  do not appear to have  been
followed with much success.  It is  to be  regretted, however, that
even in the elegant and manageable  form of  Dr. Fowler's solution,
it  has  not been found to be more efficacious.   It has of late  years
been tried in various  cases, and particularly with  great skill, and
in full doses, by Dr. Marcet, but in every trial it has disappointed
our hopes.
   Under this head I may also observe that the Prussic acid has oc-
casionally been had recourse to, but without any apparent benefit.
In the form  of the distilled water of the prunos  lauro-cerasus, it
was  not  long since made a subject  of experiment at Paris by  M.
Dupuytren, who injected this fluid  into the  veins  of various  dogs,
and  appears to have done  so in one instance into  those of a  man:
but in every  case without effecting  a cure.
   There are two or three other remedies  which it is difficult to
arrange, but  which have also acquired  a  considerable celebrity in
the cure of lyssa; and hence it is necessary to notice them.
   The first is the Ormskirk medicine,  so called from its preparer
Mr. Hill of Ormskirk, supposed, for the inventor could not be pre-
vailed upon to publish his secret,  to consist of the following ma-
terials :  powder  of  chalk, half an  ounce ;  armenian  bole,  three
drachms ;  alum,  ten grains;  powder of elecampane-root, one
drachm ; oil of anise, six drops.   The single  dose thus compounded,
is to be taken every morning for six times in a glass of water with
a small proportion of fresh milk.   If this be the real formula, and
the  analysis of Dr. Black  concurred with that of  Dr. Heysham in
determining  it to be  so, the inventor seems to have contemplated
the  specific virus to be an acid, for the basis of this preparation is
  •  Vater, Pr. de Olei Olivarum efficacia contra morsum canis rabiosi expe
rimento Cresdae facto, adstructa, Viteb. 1950,
  f  Comment, in Popp. p. 54. 
252                       NEUROTICA.          [CL. IV.—OR. HI.

unquestionably an alkaline earth.   And with regard to its occasion-
al efficacy, the latter writer,  following the general current of opi-
nion of the day, informs us that this has been so thoroughly estab-
lished by experience, that there can be  no room to doubt it.  Dr.
Heysham himself, however,  admits of  various cases in which  it
failed,  while in many instances his successful  ones do not afford
proofs of an existence ofthe genuine disease.*
   The  second of the  anomalous  remedies  I have just referred,
might  possibly have been introduced under the head ofthe common
antidotes for the bites of venomous animals ;  but as it has reputed
powers in some degree peculiar to itself, it is best to notice  it sepa-
rately.  This  is the  alyssum, or alysma Plantago  (madwort plan-
tain,) of established reputation in America  as a specific  for tht
bite of the rattle-snake, where it seems to rival the imprescriptible
claims ofthe  ophiorrhiza  Afungos, though  its juice  is  generally
given in combination with that  of the common horehound—an ad-
dition that certainly does not promise much accession to its strength.
   This species of alyssum has for some ages been a popular remedy
for canine  madness, especially  in  the north  of Europe: and in a
late  communication to Sir Walter  Farquhar in the Russian tongue,
translated and published in Mr. Brande's Journal,} we are told that
it still  retains its popular sway  and reputation over a great part of
the  Russian empire: and that  in  the government of  Isola it has
never failed of effecting a cure in  a single instance for  the last five
and twenty years.  The  preparation is simple : the root is reduced
to a powder, and  the powder is to be eaten by being spread over
bread and butter.  Two or three  doses are  said to be sufficient in
the worst cases:  and will be  found to cure mad dogs themselves.
   The next remedy I have to notice is also of extensive use in the
present day, and comes before us with no mean authority.   Whilst
the medical practitioners of the East, are pursuing their plan of ab-
stracting rabid blood from the system, as the surest means of curing
canine madness,  the physicians of Finland have undertaken to ac-
complish the same effect by introducing  rabid blood into the morbid
frame.  In the second number  ofthe Hamburgh Medical Reposi-
tory, Dr. W. Rithmeister of Powlowskin Finland, has given an ar-
ticle in which he has collected  a multiplicity of striking cases and
various authorities in proof that the blood of a rabid  animal, whert
drunk, is  a specific  against the canine  hydrophobia, even where
the symptoms are most strongly marked.  The rabid wolf-dog,  or
other quadruped, is, for this purpose, killed, and its blood  drawn
oft' and collected as  an antilyssic ptisan.  Dr. Rithmcister's com-
munication contains a letter to himself from  Dr.  Stockmann  of
White Russia, confirming this account, and  stating the practice to
be equally  common and successful in his own country.
* Diss. Med. Rabie Canina, 8vo.
f Journal of Sciences and the Arts, No. IX. p. 142. 
GE. 1.—SP. VII.]
NERVOUS FUNCTION.
253
   I will only add, that a discussion  has lately taken place between
two Italian physicians of distinguished  reputation, Professor Brug-
natelliof Pavia, and Professor Valetta of Milan, upon the virtues of
chlorine as an antidote for the disease in question. The former has
strongly recommended it;* and the latter has denied that it is of
any use :f in answer, however, to which denial,  Professor Brugna-
telli has adduced various authenticated  facts,  by which what he
calls the specific powers ofthe chlorine have been established and
verified.J
  I have thus endeavoured, upon a subject of so much interest and
importance,  to put the  reader into possession of the general  his-
tory of tae  practice  that  has hitherto prevailed ;  and  he  will at
least allow that if the result  be highly  unsatisfactory—as most un-
satisfactory it is—such conclusion does not result from idleness on
the part of the medical profession.
  But how are we to reconcile the clashing and  contradictory state-
ments which  the present analysis unfolds to us?  This is  a question
of easy solution.   Yet there  are  many circumstances which ought
to be borne in memory, and  that will, in a certain degree, account
for  such opposite views and ^decisions  without  rudely impeaching
the  veracity of any of the experimenters
  In the first  place, it is possible that the  morbid poison  itself, like
 that of plague or intermitting fever, may vary in its degree of viru-
lence, in certain idiosyncrasies,  certain countries,  or certain sea-
sons ofthe year: and hence that  a medicine which has proved use-
less in general practice, may succeed in  particular persons, parti-
cular places, or at particular periods :  or, if inactive in itself, may
be employed in so much milder a degree of the disease that the
constitution may be able,  in most or many instances, to triumph
over it by its own powers alone.
  It is a just  remark of Celsus that omnis feremorsus habet quod-
dam virus ;§ and we have  already given proof that this  is particu-
larly the case when the animal that bites is labouring under the in-
fluence of violent rage or other sensorial excitement:  the symptoms
incident upon which produce a severe effect upon the nervous sys-
tem, and often simulate those of  genuine  lyssa.   And hence, there
can be little  doubt that these symptoms have often been mistaken
for  lyssa, and have given a celebrity to  the medicines employed for
their cure to which  they were never entitled.   In various cases,
as  we have  already  seen, the  disease commences almost  coeta-
neously with the external injury, or inoculation: in others, not till
months or even years afterwards. In some instances the first symp-
toms ofthe disease show themselves in tne  bitten  part, and even
this in  a very different manner, for there  may be  a troublesome

           *  Giornale de Fisica, &c. Pavia, Dec.  1816.
           \  Biblioteca ltaliana, Gennaj. 1817.
           %  Gironnale di Fisica, &c. Pavia,  Febbraj. 1817.
           §  De Medicina, Lib. v  x. 
254
M'.l'IIOTlOA.
;t;L. iv.~or.iii.
 sense of numbness, or of irritation ;  and this irritation may be con-
 fined to the cicatrix, or travel up the limb, and produce acute pain
 or spastic action:  while in  other instances there is no local affec-
 tion whatever through the entire progress ofthe malady.  Ordina-
 rily speaking, hydrophobia, or water-dread, is one of the most com-
 mon, as well as one ofthe severest symptoms of the disease; yet
 there are  instances, even where the rabies has terminated fatally,
 in which water-dread  has not been once  complained of.  Most com-
 monly again, on an early examination  after death, the fauces  and
 parts adjoining are found red and inflamed : but we have already
 observed that Morgagni  dissected patients in which there  was no
 such  appearance  whatever.   And  in two bodies examined after
 death by Dr. Vaughan,the fauces, oesophagus, stomach, diaphragm,
 and intestines, were all in a natural  state.
   There can be little or no doubt, moreover, where many persons
 arc bitten in quick succession by the same rabid animal, that the
 poison is not equally introduced into all of them. In some cases it
 may be expended entirely upon the earlier victims,  and hence the
 rest, though bitten, may be free  from the virus; while  in others
 where the teeth have  to  pass through various foldings of clothes, it
 is possible that the virus which still remains may be wiped off in
 its passage,  and the laceration be nothing more than a clean wound
 from the first.  And  in ail such cases  a  sanguine  experimenter,
 without allowing for these circumstances, will be apt to persuade
 himself, whatever medicine he makes use of, that the absence of
 the disease,  is owing  to the  efficacy of the plan or the medicine he
 has prescribed, and which he is hence tempted to  hold up to the
 world as an  antidote or specific.
  Some of these remarks will best explain the very different results
 of the same  mode of treatment, in the eleven patients entrusted in
 1775 to  the care of M. Blaise of Cluny, after having been dreadfully
 bitten and  torn by a mad wolf. The principal remedy was mercurial
 inunction, though  combined  with antispasmodics.  The mercurv
 was carried  on in all of them to salivation, and the treatment con-
 tinued for above a month, in those that  lived long enough for this
 purpose.  One died with great horror and water-dread about the
 twelfth day from the injury, and after the mercury  had began to act.
 A second perished under hydrophobia, furious, and at length coma-
 tose, just at the close of a month, his mouth and gums being slightly
 affected by the mercury.  A third died  nearly six weeks after the
 commencement of the mercurial plan, having been  taken away by
 his friends on the eighteenth day apparently in  a state of doing-
well.   The remaining eight, after having exhibited greater or less
 symptoms of spasmodic affection, but never amounting to hydropho-
bia, are  said to have recovered, and were discharged accordingly :"
but in a subsequent work M. Blaise  informs us, that even one ol
*  Methode gprouvee pour la traitementde la Rage 
GE. I.- -SP.VH.]
NERVOUS FUNCTION.
2bd
these died in a paroxysm of hydrophobia six weeks after his dis-
 charge, and supposed restoration to health.*
   In all these cases the success is ascribed to the action ofthe mer-
cury, and the want of success to some irregularity or other commit-
 ted  by the patient while  under medical care.  The enormities,
however, are in general  rather far fetched, and not very convincing.
Thus', in the last of the above cases, it is ingeniously observed that
the man  who had  been so long  discharged as well, four days only
before the symptoms of hydrophobia appeared on him,  had thrust
his arm  down the throat of an oax  which was said to be  mad;
though no proof was offered that the ox was really mad, nor is it pre-
tended that even  this reputed mad  ox inflicted any bite upon the
arm whatever.  Who does not see, that in all these cases the mer-
cury may have been guiltless of exercising any control? that those
who died may  have died in consequence of an effective lodgement
of the virus in the wound inflicted, and that those who survived,
may have survived because it obtained no admission  to the bitten
part ?
   It is, moreover,  highly probable that a spontaneous cure is occa-
sionally effected by the strength ofthe constitution, or the remedial
power of nature alone.   The fact appears to be,  that the  disease
requires about six or seven days to run  through its course, at the
expiration of which period the system seems to be exonerated by
the outlet of the salivary glands, of the poison with which it is in-
fested.   And hence, if by any means it be able to sustain and carry
itself through this period, without being totally exhausted of ner-
vous power in  the course of so protracted and prostrating a conflict,
it will obtain a  triumph over the disease: and any prescribed medi-
cine made use of on  the  occasion will seem to have effected the
cure, and will run away with the credit of having done so, till subse-
quent instances dissolve the charm, and prove beyond contradiction
the utter fatality of its pretensions.
  I have already had to observe  that the contagion of lyssa, though
highly malignant,  is neither  very  volatile nor very active, and in
every instance, perhaps, requires some  exciting or predisponent
cause to  enable it to take effect: but, as it seems to be more inde-
composible than any other contagion  we are acquainted with, it is
capable of lying latent and undissolved for months, if not years, till
it meets with a cause of this kind.  And hence the very long and un-
certain interval which sometimes occurs between the  attack ofthe
rabid animal and the appearance of rapid symptoms, has often proved
another source of deception ;  of which we have a singular example
in Mr. Nourse's case, related in an early volume ofthe Philosophical
Transactions ;f which states that a lad, who had been  bitten in the
thumb by a mad dog, took morning  and  evening for forty days a
dram of the pulvis antilyssus already  described, and bathed in the
* Hist, dela Societe de Medicine, Tom. II.
f No. 445. 
256
NEUROTICA.
[CL. IV. OR.  111.
 sea for ten days in succession.   He was in due time reported to be
 well, and the cure was altogether ascribed to the specific virtues of
 the antilyssic powder.  He was shortly afterwards cut for the stone,
 from which also he recovered : nineteen months after which ope-
 ration, however, he was attacked with hydrophobia and the other
 symptoms of canine  madness, and fell a victim to  their violence.
 Had this patient died under the operation of lithotomy, or from any
 other  circumstance in the interval,  the virtues of the antilyssic
 powder would have obtained a complete, and indeed a rational tri-
 umph in this instance : and even now  there may be a question whe-
 ther the appearance of the disease was not retarded  by the plan
 pursued: though  its specific power can no longer be maintained
 for  a moment.  The occasional exciting  cause which, in this  in-
 stance, at length gave activity to the dormant virus, is not pointed
 out to us.  But it is difficult, if not impossible,  to account, without
 such a cause, for the quickening of the lurking  seminium  of the
 poison at this time rather  than  at any other.   And the following
 valuable remarks of Dr. Perceval, occurring in his manuscript com-
 ment on the author'b volume of Nosology in relation to  this subject,
 are in  full illustration ofthe same opinion.
   "  A wine porter was attended, in Dispensary practice, for a low
 fever : after a time appeared  symptoms of lyssa; and much inquiry
 elicited the recollection of his having  been  slightly bitten by  a dog
 six weeks before.   In the interval he  was convicted of some frau-
 dulent practice in the cellar of his master, to whom he owed great
 obligation, and was dismissed with disgrace. Anxiety on this event
 seemed to produce the fever which terminated in lyssa.
   -•Lately an officer  in our  bai racks  was  bitten by a  dog,  whose
 madness being recognized, the bitten part was excised immediately ;
 after an undisturbed interval of two months he was advised to go  to
 England to dissipate the recollection of the accident: there he  exer-
 cised himself violently in hewing wood ; felt pain in the  hand  which
 had been bitten ; emoarked for Ireland ; had symtoms of hydropho-
 bia on board the packet, and died soon after his  arrival.
   "  I have lately seen a case of hydrophobia treated ineffectually
 by most profuse bleeding and large doses of opium.   Here too the
 bitten  part was extirpated by caustic  within an hour.   He  was  a
 man of steady mind, nor could any occasional cause be assigned for
 bringing the poison into action, except that a bilious diarrhoea was
 suddenly checked.
   " From the varying period of attack  we might infer  that the in-
 fluence of occasional causes is very considerable. In  the last patient
 hydrophobia supervened exactly five  weeks from the  time  ofthe
 bite : he lost a hundred and eight ounces of blood in twelve  hours
 which sunk him much; violent perspiration, and at length delirium,
 attended the  water-dread;  during the last twenty-four hours he
 swallowed, and recovered  his senses ;  and died slightly convulsed
 whilst cutting an egg.  These cases seem to point out  agitation ol
mind and feverish excitation as powerful occasional causes." 
GE. I.—SP. VII.]
NERVOUS FUNCTION.
25-7
  In a disease so intricate as lyssa a very complex treatment is by
no means unpardonable ; but it may fairly, I think, be  questioned
whether the complexity and the energy ofthe means employed to
produce a cure may not, rather, in some instances, have had an op-
posite effect, and have hastened and  confirmed a fatal issue.  A
patient bitten by a mad dog, having in vain tried and persevered in
the use of the Ormskirk medicine, was next  put under the joint
care of Dr. Watson and Dr. Fothergill.  Having been bled standing,
as long  as he could stand, he was next immersed in a warm bath,
where he was ordered to remain till  he again became faint: a
clyster of milk and water with a drachm of Dover's powder dissolved
in it was injected as soon as he was removed from the bath: half
an ounce of mercurial  ointment was at the same time rubbed into
the legs and thighs, and three grains of thebaic extract given in the
form of pills : two grains being ordered to be continued every hour
till he became sleepy.
  To stand the brunt of a treatment thus vigorous would demand no
ordinary constitution, even without the co-operation of any disease.
But that the wretched  sufferer should sink (as  he did, in a few
hours) under the assault of such a malady and such a mode of cure,
cannot be matter of surprize to any one.
  The whole subject is afflictive, as well in respect to its treatment
as its progress.   But how, after all, is a young practitioner to pro-
ceed when he meets with a case of rabies ? This is  a most im-
portant question ; and  the following remarks, submitted with great
deference as the result of some little personal experience, and no
small degree of reflection, are meant to meet it, and to point out the
path, which, in the  present unsettled state of the subject it may,
perhaps, be  most expedient to adopt.
  From the whole of the  preceding survey it is sufficiently clear
that we  have no direct specific for the cure ofthe disease ; and hence,
whatever plan we employ must be palliative only.  It appears also
that the disease  consists in a poison of a peculiar kind capable  of
assimilating some of the animal secretions  to its own nature, and
that the new matter, or contagion, hereby produced continues to be
eliminated for five or six days principally, if not entirely, from the
excretories of the salivary glands, as the inflammation of gout un-
loads itself on the extremities, and the specific matter of exanthems
on the surface generally; and that at the expiration of this period,
or  as soon as such depuration has been effected, the disease abates,
and the patient is restored.  It appears, also, that the disease is one
of the most dangerous in the whole catalogue of nosology, and that
few patients recover from it under any plan  of medicine that  has
ever been devised :  but  that nevertheless  some patients have re-
covered under almost  every mode of treatment however incongru-
ous and contradictory  to other modes; and hence, that many cases
of  restoration must be rather referred to a natural, or spontaneous
 cure, than to the virtue of medicines.
   In this state of things it seems reasonable that our first intention
   vol. in—33 
358
NEUROTICA.
CL. l\.-oli. HI
should consist, as in various other kinds of animal poisons communi-
cated in the same manner, in supporting the system generally, and
the nervous part of it  more particularly, so that  it may not sink
under the violent excitement and augmented secretion which the
ov^an of the nerves has to encounter during so perilous a struggle.
And it is to this principle we have to resolve all the benefit which
has at any time been found to result from the use of the stimulant
theiiacas and other cordials of the old practitioners.  On this ac-
count ether, ammonia,  and camphor, have a strong claim upon our
attention, and especially  the two last, as they may be given in a
solid form.  All the pungent spices belong to  the  same class, as
cardamum-seeds, and capsicum, and may be adverted to as auxilia-
ries ; nor should wine or even ardent spirits be refrained from, if the
patient can be induced to swallow them ; moderately through the
entire course of the disease,  but  liberally  and profusely as his
strength declines.   Our grand object must be to keep him alive,
and prevent a fatal torpitude in  the sensorium for a certain number
of days, at any expense of stimulants, or of subsequent debility.
Wine is profusely given with great success in the bite of the most
venomous serpents of the East,  and analogy justifies us in proposing
it in the present instance.
   Our next intention should be to diminish, as much as possible, the
spastic action ofthe chest and fauces, and to prevent a return ofthe
exacerbations.   And to this end as much quiet and composure as
we can possibly procure, under so restless a slate  of  body, seems
imperatively called for, and is far more  likely to  be serviceable
than the fatigue of taking the patient  repeatedly out of bed for the
purpose of plunging him either into a hot or a cold bath. And though
opium has never of itself, perhaps, produced a cure, it seems ad-
visable to try it in liberal doses :  and  the more  so as several ofthe
cases already adverted to afford a direct proof that it is capable, oc-
casionally, of producing some degree of tranquillity for a short pe-
riod.  In employing it, however, it seems  most reasonable, from
analogy to combine it with some diaphoretic, and particularly with
ipecacuan in the form of Dover's powder, since, at all  times, the
animal frame is most disposed to be quiet and  free from irregular
actions when there is  a  general  moisture upon  the  surface.  In
many cases of rabies such a state of body has been found unques-
tionably favourable  ; and in one  of the  instances already quoted from
the Medical Transactions, the benefit was so striking that the prac-
titioner could not avoid regarding it as critical.  It is possible,*also,
though no great stress can be laid upon  this remark, that a part of
the virus itself may be hereby eliminated, as in various other cases
of animal  poisons.
  To obtain and encourage  such elimination should indeed be our
first object, if we had any means of  accomplishing  it upon which
we could fully depend.  This,  however, we have not; but, as the
quarter to which the virus  is directed is the salivatory glands,  of
which, indeed we have full proof in consequence of the saliva be- 
GE. I.—SP. VII.]     NERVOUS FUNCTION.
259
  mg the fomes of the poison apparently as soon as it becomes elabo-
  rated; and as we have a medicine which possesses a specific influ-
  ence on this organ, and is capable of augmenting its secretion to al-
  most any extent, it seems of the utmost importance that, while we
  endeavour to support  the system, and to  allay the nervous irrita-
  tion, we should endeavour at the same  time to quicken the elimi-
  nation of  the morbid matter, by exciting the salivary emunctories,
  and thus probably also  carrying it off in a diluterand less irritant
  form.  It is  difficult to withhold  one's assent to all the  numerous
  instances of cure which are so confidently asserted to have follow-
  ed upon the use of mercury carried to the point of free  salivation
  And hence, without allowing this medicine  to be a specific more
  than any other, we may indulge a reasonable hope of its forming a
  good auxiliary, and should employ it freely, either externally, in-
 ternally, or m both modes simultaneously; but with as little disturb-
  ance  to the patient as possible,  till a copious ptyalism  is  the re-
  sult.
   Fever, or inflammatory action, does not necessarily belong to lyssa
 in any stage :  and the  present mode of  treatment is altogether
 grounded  upon this principle.   Either, however, may become inci-
 dentally connected with it  from the  peculiar state of the  habit or
 some other cause.  Hence, as a preventive, the bowels should be
 kept moderately open ;  and wherever there  is any just  apprehen-
 sion of plethora, or a turgid state  of the vessels, and  particularly
 of the brain, blood should be drawn freely from the arm, and, if ne-
 cessary, be repeated.  We have  already seen that such a state of
 congestion is sometimes produced  even at  the onset of the disease,
 and is so forcibly  felt by the patient himself, that he  earnestly in-
 treats the medical attendant to bleed him.   Such intreaty should,
 perhaps, never be  urged in vain: but the  bleedings to deliquium^
 which have of late years been so strongly recommended,  are a rash
 and dangerous practice, unfounded on analogy,  and by no means
 rest on any sufficient assurance.
   Such, in the doubt and darkness that at present beset us concern-
 ing  the real physiology of  lyssa, seems  to be the safest and most
 promising path we can pursue, when called upon for aid in so afflic-
 tive a malady.  Our best time for action, however, and almost  the
 only time we  can improve,  is immediately on the infliction of  the
 wound: a tight ligature above  which, with the double precaution
 of excision and cauterization, may in general be regarded as an ef-
 fectual preventive.  I do not know, indeed,  that the profession is
 acquainted with  any other.  It has, however, been  proposed in
 France, to  fight off the poison of lyssa by pre-occupying the ground
 with the poison of a viper, upon the principle of combatting vario-
lous with vaccine matter: and for this purpose it has been suggest-
ed that the  part bitten by a mad dog should be again bitten a little
below the wound, as soon as may be, by a venomous serpent whose
virus, from its greater activity, will, in most cases, be certain of
taking the  lead, and mav, it is presumed,  guard the constitution 
260                      NEUROTICA.         [CL.'lV.—OK. 111.

against any subsequent effects from the wound of the mad dog.  I
have not, however, heard that this proposal has ever been carried
into effect, and the claim of ingenuity is most probably the whole
it will ever have to receive.
  I ought not, however, to conclude without noticing one very ex-
traordinary fact in the economy of morbid  poisons, and especially
of that before us, which I have had confirmed by the testimony of
several veterinary practitioners entitled to credit.  It is, that no
dog who has ever had the distemper, as it is  called, which is the
canine catarrh or influenza, has been known to become rabid spon-
taneously, though he is capable of receiving the disease by the bite
of another dog.  If this be true, for which, however,  I cannot fully
vouch, we have  certainly another instance of morbid poisons mor-
tally conflicting with each other; and it might  be worth trying how
far inoculation with the matter of canine catarrh might succeed in
protecting  a  human subject after the infliction of  a  rabid bite;
though in the dog, perhaps, from  a  stronger predisposition to ra-
bies, it seems to be impotent.  In South America, rabies, as al-
ready observed, is altogether unknown, and  1 have hence been anx-
ious to learn whether the distemper be unknown there also:  and,
in answer to this inquiry, it has been told me, by several intelligent
residents in that quarter,  that this last disorder is so common and
so fatal, that two-thirds of the dogs littered there perish of it while
pups: a remark which still further confirm the home-report con-
cerning  its influence on  rabies, and  sufficiently explains the non-
existence of the latter on the shores of the  Plata.
                       SPECIES  VIII.

              ENTASIA  ACROTISMUS.

                      pulselessness

FAILURE, OR  CESSATION OF THE PULSE, OITKX ACCOMPANIED WITH
  PAIN IN THE EPIGASTRIUM; THE PERCEPTION AND THE VOLUNTARY
  MUSCLES REMAINING UNDISTURBED.

Acrotismus is literally "defect of pulse," from x^ros, "pulsus "
with a privitive x prefixed: whence  the technical term crotophus
or crotofihium, importing " painful pulsation or throbbing in  the
temple."  Asphyxia is  the  term employed for this disease by
Ploucquet, and would have been used in the present arrangement
but that it has been long appropriated to import suspended anima-
tion or apparent death;  a total cessation, not of the pulse only,  bm
of sense and voluntary motion. 
GE. I.—SP. VIII.]      NERVOUS FUNCTION.
261
  This failure or cessation of pulsation sometimes extends over the
whole  system, and is  sometimes confined to particular parts.   In
every case it imports an irregularity in the action of the heart, or of
the vessels that issue from it, and in most cases, an irregularity pro-
ceeding from local or general weakness, and dependent upon a spas-
modic disposition hereby produced in the muscular tunic of the ves-
sels.   Of this last cause we have a clear proof in the universal chill
and paleness that spread over the entire surface in the act of faint-
ing or of death, to which fainting bears so striking a resemblance.
Except, however, in the agony of dying the spasmodic constriction
for the most part soon  subsides, and the arteries recover their proper
freedom and diameter. Yet this is by no means the case always, for
in violent hemorrhages, and  especially hemorrhages of the womb,
the rigidity has sometimes continued for several days, during the
whole of which time the heart has seemed merely to palpitate, and
there has  been no pulse whatever.   Morgagni relates  a case of this
kind which extended  to a much longer period, but at length termi-
nated fatally ;* and examples are by no means uncommon in which
it has existed for three,! four, or even five days{ before death.
  Other irritations, besides that of weakness, have occasionally  led
to a like spastic state of the arteries.  The stimulus of an aneurism
of the aorta has produced it  in the brachial arteries,  so that there
has been no pulse in the wrists: and gout or some acrimony in the
stomach has operated in  like manner on the arterial system to a
much  greater extent.  The  cause, however, is not  always to be
traced, and hence Marcellus Donatus has given an instance which he
telis us was unaccompanied with any disease whatever ;§ the irrita-
tion  prrobably having subsided.   Berryatt, in the  History  of the
Academy of Sciences, has furnished us wilh a very singular exam-
ple of this disease which was  general as well as chronic, and con-
tinued through the whole term of life.   In all which cases, how-
ever, though the heart itself should seem to participate in the pulse-
lessness, we are not to suppose that it is entirely without any alter-
nation of syncope and diastole, but only that its action is indistinct
from weakness or irregularity.   In treating of the nature ofthe
pulse in  the Physiological Proem to  the third class,  we observed
that it is  in some  persons unusually  slow and has been found, as
measured by the finger, not more than ten  strokes in a minute :|j
and that in many of these cases the cause of retardation seems to be
a spasticity or want of pliancy in the muscular fibres of the heart or
arteries, or both, rather than  an actual torpor which is also an  oc-
casional cause.  I have never met with  any case in which the  or-
dinary standard of the pulse  was not mor.e  than ten strokes in a
* Ue Sedibus etCausis Morb. Ep. XLVI11. Lugd. Hat.4to. 1767.
| Pathology, p. 25.
t lJeiargus, Med. Jahngange, Band. V. p 23
§ Lib. VI. cap. II. p. 620.
J Vol. IT. p. 16. 
262
NEUROTICA.
[CL. 1V.—OR. HI.
minute ; but I have at this time a patient of about thirty-six years
of age, whose pulse has not exceeded  twenty-four or twenty-six
strokes, and has often been below these  numbers.  He is a captain
in the Royal Navy, of a sallow complexion and bilious temperament:
till of late  he enjoyed good health, but about three years since was
attacked with  a fit of atonic apoplexy from which he recovered
with difficulty.  At an interval of a few weeks from each other, he
had several other fits ; on recovering from the last of which he in-
stantly married a young lady to whom he had  for some time been
engaged.
  He has  now been married about fifteen months, has a healthy in-
fant just born, and has had no fit whatever.  His spirits are good,
and he is  residing by the sea-side, which situation he finds agree
with him best.  Dr. Latham gives a similar example in a merchant
whose pulse, though never intermissive, seldom, for ten or twelve
years that he  had known him, exceeded thirty-two beats in a mi-
nute ; occasionally was as slow as twenty-two, and at one time only
seventeen. "  I once,"  says  Dr. Latham  " attended him through a
regular fever, when his pulse was  not  more than sixty, notwith-
standing the disease  ran on  for at least  a fortnight with a hot and
dry skin, white and furred and parched tongue, and occasional de-
lirium."*
  In many of these anomalies there is not only no perceptible pulse
or a very retarded one, but often intermissions more or less regular,
and occasionally a want of harmony between the stroke in  some of
the arteries compared  with  that in  others.  Reil gives a case in
which the heart, the carotids,  and the radial arteries all  pulsated
differently :f and Beggi  another, in which the acrotism, or want of
pulsation,  extended over the entire frame with the exception ofthe
heart, which pulsated violently.!
  This species is strikingly  exemplified in the biographical sketch
of Mr. J. Hunter, drawn up and prefixed to his volume on Blood and
Inflammation by Sir Everard Home.   Mr. Hunter for the four pre-
ceding years had annually suffered  from a  fit of the gout in  the
spring.   In the year 1773, this did not return, and having, on a par-
ticular occasion, been greatly affected in his mind, " he was attack-
ed," says  Sir Everard Home, "at ten o'clock in the forenoon, with
a pain in the stomach, about the  pylorus : it was the sensation pe-
culiar to those parts, and became so  violent that he tried change of
position to procure ease ; he sat down, then walked, laid  himself
clown on the carpet, then upon chairs, but could find no relief: he
took a spoonful of tincture of rhubarb, with thirty drops of lauda-
num but without the smallest benefit.   While he was walking about
the room he cast his eyes on the looking glass, and  observed his
countenance to be pale,  and his lips  white,  giving the appearance
* Med. Trans. Vol. IV. Art. XX.
f Memorabilia clinica. Vol. II. Fasc. I. 6. Hall. 1792.
- Opp.Pacehioni. Rom. 4to. 1741. 
GE. I.—SP. VIII.]
NERVOUS FUNCTION.
263
of a dead man. This alarmed him and led him to feel for his pulse,
but he found none in either arm.  He now thought  his complaint
serious.  Several physicians of his acquaintance : Dr. William Hun-
ter, Sir George Baker, Dr. Huck  Saunders, and Sir  William For-
dyce, all came but could find no pulse : the pain still continued, and
he found himself, at times, not  breathing.  Being afraid of death
soon  taking place if he did not breathe, he  produced the voluntary-
act of breathing: his working his  lungs by the power of the will,
the sensitive principle  with all its effects on the machine, not being
in the least affected by the complaint.  In this state he continued
for three  quarters of an hour, in which time frequent attempts were
made to feel the pulse but in vain.   However, at last the pain les-
sened, and the pulse returned, although at first but faintly, and the
involuntary breathing began to take place.  While in this state he
took Madeira, brandy,  ginger, &c.  but did not believe them of any
service, as the return of health  was  very gradual.   In  two hours
he was perfectly recovered."*
   This is one ofthe most extraordinary cases on record, consider-
ing the extensive group of important functions that were jointly af-
fected, and  the total freedom of the rest:  and nothing can  more
strikingly prove how close is the sympathy that in many instances
prevails between discontinuous organs.  The chief  disease seems
to have prevailed in the  heart,  the chief pain  in  the stomach  on
its upper side; and for this we may, perhaps, account, from a law
of the animal economy we have so  often of late  had occasion to
keep in view, by which a morbid action affecting one extremity of
a  nervous fibre, or bundle of fibres, is, under particular circum-
stances, most severely felt at the other extremity : for as one of the
branches of the phrenic nerve  passes over the apex of the heart,
and is afterwards continued to  the diaphragm which maintains so
intimate an association with the stomach, it serves as a direct line
of communication between each of these organs;  and the painful
impression imparted to the  end of the nervous twig that rests on
the heart may, by this  law,  be  transferred to its  other extremity
that lies  so contiguous to the upper part of the stomach.
   The nature of the pain and the  collateral  symptoms seem suffi-
ciently to show that this disease was of a spasmodic  kind:  for the
deficiency of pulse was subsequent to, and consequent upon the pain,
and ceased upon its removal, while the deadly paleness of the face
gave proof of  a constriction of  the capillaries.
   So far as my own experience  has extended, such failures of the
pulse, whether consisting in a total suspension, or a preterna-
tural retardation, and attended with  acute or with very little pain,
are dependent upon a  diseased  state  of the larger arteries, or the
larger viscera  of the  thorax or abdomen, and generally  lead to
sudden death.   The case of the captain of the navy which I have
  * Sir E. Home's life of Mr. Hunter prefixed to the Treatise on Blood, &c.
p. xlvi. 
264                     NEUROTICA.          fCL. IV.—OR. 111.

just related and which was drawn up something more than a twelve-
month ago, I may now apply to, while the present text is printing,
in illustration of this remark: for  I have just been informed by his
sister  that while at Swansea,  apparently in as  good  health as he
had ordinarily enjoyed for several years, he  was attacked with a fit
of apoplexy which carried him off in less than an hour.  Such, too,
was the  fate of Dr. Latham's patient, for we are told that " one
day, when in complete health, as he then considered  himself, he
dropped down in the street, and expired." And so sudden was the
decease of Mr. J. Hunter, that feeling himself unwell while in the
course cf his professional attendance at St. George's Hospital he
went into an adjoining room, gave a deep groan, and dropped down
dead.
   In all cases of this kind, therefore, the mode of treatment must
depend upon the nature of the exciting or predisponent cause as
far as we are able to  ascertain it.   Where  the cause  is constitu-
tional, a sober, quiet and regular habit of life, with a due attention
to the ingesta and egesta,  and particularly to a tranquillized state
of mind, will often enable the valetudinarian  to reach his three-
score  and tenth year, with cheerfulness and  comfort:  but he must
content himself with

             ----the cool sequestered vale of life, *

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


                         CLONUS.


                       <Elom'c Sjwsm.

 FORCIBLE  AGITATION OF ONE MORE  OR MUSCLES IN SUDDEN AND
                      IRREGULAR SNATCHES.

 The Greek terms, xAovos and *Aovjjs-<s, import agitation, commotion,
 concussion.   The clonic, or agitatory spasms form two distinct or-
 ders in Sauvages, and a single genus in Parr.  The first is unneces-
 sarily diffuse  : the second is too  restricted.  The  two orders of
 Sauvages are  in the present arrangement  reduced to two genera,
 and constitute that immediately before us, and synclonus, or that
 which immediately follows.  Dr. Cullen seems at one time to have
 had a desire of distinguishing the diseases of both these genera by
 the name of convulsions ; and of limiting the name of spasms to the
 permanent contractions or rigidities of the muscular fibres produced
 by spastic action, constituting the different species of the preceding
 genus.  « I think it  convenient,"  says he, in his First Lines, " to
 distinguish the terms  of spasm and  convulsion, by applying the
 former strictly to  what has been called the tonic, and the latter to
 what has been called  the clonic spasm."   Yet  the whole are treat-
 ed of in his nosological arrangement under  the  common  name of
 spasmi, and even in his First Lines, notwithstanding this distinction,
 under that of spasmodic affections without  fever."  These spas-
 modic affections are,  indeed, subsequently divided into  a  new ar-
 rangement of" spasmodic affections of the animal functions;—of the
 vital;—and of the natural:" throughout which an attempt isstill made
 to separate the term convulsion from that of spasm, and apply it to
 all clonic or agitatory motions ofthe muscles, while convulsio is,
 nevertheless,  retained in the synopsis, as the technical name of that
 single species of disease which is colloquially called convulsion-fit,
 and not extended to any others. There is doubtless a difficulty in
 drawing a line between entastic and clonic  spasm in many cases,
 from the mixed nature of the symptoms ; but if it be felt of impor-
 tance to take terms out of their general meaning, and tie them down
 to  a stricter  interpretation, such interpretation should be  rigidly
 adhered to, or some degree of confusion  must necessarily ensue.
   To understand the  real nature ot the spasms we are  now enter-
 ing upon, it may be expedient to recollect that the nervous power
 or fluid appears  to flow naturally, as indeed we  have already ob-
 served in the  Physiological Proem to the present class, by minute
jets, or in an undulatory course, like the vibrations of a  musical
chord.  But the movement is so uniform, and the supply so regular,
  vol. in.—34
GE. II] 
266
NEUROTICA.
[CL. IV—OR. HI.
in a state of healih, and where there is no fatigue, that we are not
conscious of any discontinuity of tenour, andean grasp as rigidly and
as permanently with a muscle as if there was  no relaxation in its
flow of power.   To prove the nature  of  the influx, however, no-
thing more is necessary than to reduce the muscle from a state of
healthy tone to a state  of languor, or to wear  it down by fatigue ;
for in this condition all the muscles tremble, and the stoutest man is
incapable of extending his arm with a small weight in his hand, or
even of raising a glass of wine slowly to his mouth, without a mani-
fest, and even a painful oscillation.
   The flow of the nervous power, in a.statc of health, is augmented
by the application of various stimulants both mental and corporeal.
The ordinary mental  stimulus is the will, but any other mental
faculty when violently excited will  answer  the same purpose,
though the action which takes place in consequence hereof, will, in
some  degree be irregular, as proceeding  from an irregular source,
and wiil  in  consequence  make  an  approach  to the  character of
spasms ; of which  a violent excitement of almost any of the pas-
sions  afford examples  sufficiently evident, and especially the pas-
sions  of fear and anger, under the influence of which it is sometimes
found impossible to keep a single limb still.
  The ordinary corporeal stimulants are  the fluids which are natu-
rally applied to the motory organs themselves   Thus  the air we
breathe becomes a sufficient exciiement to the action of the lungs,
the flow of the blood from the  veins a sufficient excitement to that
ofthe heart, while the  descent ofthe feces maintains the peristal-
tic motion of the intestinal canal.
   Where these stimulants are regularly administered, and the or-
gans to which they  are applied are in a state of health, the alterna-
tions of jets and  pauses in the flow of the  nervous  power, as wc
have already remarked, are uniform.  But in  a  state of diseased
action, whether from a morbid secretion  of the  fluid, or a morbid
condition of the  fibres that are to be influenced by it, this uniformity
is destroyed, and in two very different ways :  for first, the nervous
energy may rush forward with a force that prohibits all pause  or
relaxation whatever, and this too in spite of all the power of the
will;  and we have then a production of rigid or entastic spasms, or
those abnormal contractions in different parts of the body of which
the preceding genus furnishes  us with abundant examples : and,
next the pauses  or relaxations may be too protracted; and in this
case every movement will be performed  with  a manifest  tremor.
Where this last is the  case, moreover, the succeeding jet, from the
accumulation of nervous power that necessarily follows upon  such
a retardation, must at length take place  with  an inordinate  force
and hurry ; and  the movement in the voluntary muscles, when at-
tempted to be controlled by the will, must be  irregular and often
strongly  marked with  agilation, giving us examples of convulsive
or clonic spasm.   And as, moreover, in such a state of the nervous
system or of any part of it, there will often be  found a contest be- 
GE. II.]
NERVOUS FUNCTION.
267
 tween the retarding and the impelling powers; the spasm will not
 unfrequently partake of the nature of the two, the nervous energy,
 after having been irregularly restrained in its course, will rush for-
 ward too impetuously, and for a few moments without any pause;
 and we shall have either a succession of constrictive and clonic
 spasms  in the same muscle or sets of muscles, or a constrictive
 spasm in some parts, while we have a clonic spasm in others: and
 hence those violent and ramifying convulsions which we shall have
 more particularly to notice under the ensuing genus.
   A sudden and incidental application of any irritant power what-
 ever, to any ofthe muscular  fibres, will throw them into an irre-
 gular action not only in a morbid state, when they are most prone
 to such  irregularities, but even  in a state of health.  Hence  the
 involuntary jerk that takes place in all the limbs when a boat, in
 which we are  sailing at full speed, gets a-ground without our ex-
 pecting  it, or we are assailed unawares with a smart stroke of elec-
 tricity.
   Now, whenever a forcible and anomalous movement of this kind
 has  once been excited in any chain of muscular fibres whatever,
 there is  a strong tendency in  them to repeat the same  movement
 even from the first:  and  when from accident or a  continuance of
 the exciting cause it has actually been repeated,  it forms a habit of
 recurrence  that is often broken off with great difficulty.  Hence the
 convulsive spasm ofthe hooping-cough always outlasts  the disease
 itself for some weeks, and is best removed by the introduction  of
 some counter-habit obtained by a change of residence, atmosphere,
 and  even hours.  A  palpitation  of the heart first  occasioned by
 fright, in an irritable frame, has in some cases continued for many
 days afterwards, and in a few instances become chronic.
   A habit of sneezing has sometimes been produced in the same
 manner, and has followed upon an obstinate  catarrh ; after which
 the  slightest stimulants, even  the sneezing of another person, has
 been sufficient to call up fresh  paroxysms, and in some cases which
 I have seen of very long and troublesome continuance.
   Hiccough affords us another example ofthe same tendency to a
 recurrence of muscular abnormities.  This is usually produced by
 some irritation of the stomach, not  unfrequently that of fullness
 alone : the irritation is by sympathy communicated to the diaphragm,
 which is thrown into a clonic  spasm, and the spasm being a few
 times repeated, the series of hiccouping becomes so established, as,
 in many  instances to be broken through with considerable difficulty.
   It is to these phisiological laws that most of the affections we are
 now about to enter upon are referable; and the concentrated view
 we have  thus taken of their operation, will render it less necessary
for us to dwell at much length upon any of them.
  The genus clonus comprises the  six following species:

 1.  CLONUS SINGULTUS.           HICCOUGH.
2.  ------ STERNUTATTO.        SNEEZING. 
268
NEUROTICA.
[CL. IV—OR. III.
3. ——— PALPITATIO.           PALPITATION.
4. ------- NICTITATIO.           TWINKLING OF THE EVE LIDS.
5. ----— SUBSULTUS.           TWITCHING OF THE TENDONS.
6. ———• PANDICULATIO.       STRETCHING.
                        SPECIES I.

                CLONUS SINGULTUS.

                         fg?tctoush.

CONVULSIVE CATCH OF THE RESPIRATORY MUSCLES, WITH SONOROUS
          INSPIRATION ; ITERATED AT SHORT INTERVALS.

Though the spasmodic action in this affection exists chiefly in the
diaphragm, the principal  seat ofthe disease is the stomach, when
strictly  idiopathic ;  an observation which was long  ago made  by
Hippocrates, and has  in  recent times  been more copiously dwelt
upon by Hoffman.
  Debility is  perhaps  the ordinary remote  cause, and irritability,
or some accidental stimulus the exciting.   Thus excess of food, and
especially in a weak stomach, is often a sufficient stimulus: and
hence the frequency of this complaint among infants.
  For the same reason it  is occasionally produced by worms, acid-
ity, or bile in the stomach.   External  pressure on the stomach is
another exciting cause : and hence it has sometimes followed, on an
incurvation of one or more ofthe ribs,* or ofthe ensiform cartilagef
of the sternum produced  by violence, and pressing on the coats of
this organ.  The stomach, however, is not at all  times the only
organ in which the morbid cause is seated that excites the diaphragm
to this spasmodic action.  The liver is frequently to  be suspected.
" I have often," says Dr. Perceval, in his manuscsipt notes on  the
volume of Nosology, " found hiccough  symptomatic of an enlarge-
ment or inflammation ofthe liver  on the upper convex  side."   It
also frequently follows upon strangulated hernia ; and, according to
Mr. John Hunter, in numerous instances accompanies local irritation
after operations of various kinds.   It has sometimes attended the
passage of a stone in one of the uterers, and has continued through
its entire course.!;
  The affection is often  very troublesome, but it cures itself in
ordinary  cases, and where the  exciting cause is  lodged  in  the
* Schenck, Lib. 111. Obs. 49. ex Fernelio.
■j- Bonet. Sepulchr. Lib. III. Sect. V. Obs. 8. Appex.
* Darwin, Zoonom. IV. I. i. 7. 
GE. II.—SP. I.]
NERVOUS FUNCTION.
269
stomach ; for the spasmodic action very generally removes the ac-
cidental irritant; and if not, the disorder usually yields  to very
simple antispasmodics,  as  a  draught of cold water, or a dose of
camphor or volatile spirits.  Where these have failed, a  nervous
action of a different kind, and which seems to operate by revulsion,
has often been found to succeed, such as holding the  breath, and
thus producing a voluntary spasm of a rigid and opposite kind in
the diaphragm; or  a  violent fit of sneezing.   An emetic,* will
sometimes answer the purpose ;  and still more effectually, a sudden
fright, or other emotion  ofthe mind.t  If these do not  prove suffi-
cient, we must call in the aid of opium:  and in the intervals have
recourse to tonics internal  and external, the warm bitters,  bark,
pure air, exercise, and cold bathing.
   We have already pointed out the tendency which these irregu-
lar actions have to form  a habit, and the  more so in proportion to
the  general  weakness and irritability of the frame;  and hence,
indeed, their arising so  readily in  the later stages of  typhus and
other low fevers, and their continuing to the last ebb of the living
power.
   Even  where the  constitution is possessed of a tolerable share of
vigour, hiccough is too apt to become  a chronic and periodical
affection; and as the frequency of the spasm is also usually increas-
ed with  the frequency of the series,  it has sometimes  become al«
most incessant, and  defied every  kind of medical treatment that
could be devised.   As a chronic affection it has been known to re-
turn at irregular periods from four| to four and twenty  years ;§ and
as a permanent attack to continue without ceasing for eight,|| nine,1[
twelve days.** and even three months.ft  Dr. Parr tells us that he
once knew it continue for a month with scarcely any intermission
even at night.   " The sleep," says he, " was at last so profound
that the convulsion scarcely awoke the patient."   In a few instances
it has proved fatal.   Poterius mentions one;^ and another, pro-
duced by cold beverage, occurs in the  Ephemerides  of Natural
Curiosities.§§
   In the Gazette de Sante for 1817, is the case of a young  girl who
had been tormented for  six months with an almost incessant hic-
cough.   It ceased during deglutition,but re-appeared immediately
* Rigaud, Ergosolvunt Singultum Vomitus et Sternutatio. Paris 1601.
f Riedlin, Lin. Med. 1696. p. 276.
t Bartholin, Hist. Nat. Cent. II. Hist. 4.
§ Alberti, Diss. Casus Singultuschronici viginti quatuorannorum. Hal. 1743.
|| Riedlin, Cent. I. Obs. 15.
1 Act. Nat. Cur. Vol. V. Obs. 108.
** Tulpius, Lib. IV. cap. 25.
ff Schenck, Lib. III.  Obs. 49. ex Fernelio.
*$ Cent. II. Obs. xxvii.
§§ Eph. Nat. Cur. Dec. IU. An. i. Obs. 48 
270
NEUROTICA.
[CL. IV.—OR. m
afterwards.  The sleep was frequently disturbed.   M. Dupuytren,
on being consulted, after antispasmodics and the warm bath had fail-
ed, applied an actual cautery to the region of the diaphragm, and
the hiccough immediately ceased: but perhaps terror operated in
no slight degree in this mode of cure.
                        SPECIES  II.

              CLONUS STERNUTATIO.

                         £bnrr?fng.

IRRITATION OF  THE  NOSTRILS, PRODUCING SUDDEN, VIOLENT, AND
        SONOROUS EXPIRATION THROUGH THEIR CHANNEL.

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

                CLONUS PALPITATIO.

                        palpitation,

       SUBSULTORY VIBRATION OF  THE HEART OR ARTERIES.

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

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

   The vibratory and irregular action, which we denominate palpi-
 tation of the heart, is sometimes sharp and strong, in which case
 itis called a throbbing of the heart, and sometimes soft and fee-
 ble when it is called a fluttering of this organ. Both  may possibly
 proceed from two  distict causes;  ihe one a morbid irritability  of
 its muscular fibres, or some sudden stimulus applied to it, either ex-
ternal or internal, by which its systole becomes harsh and unpliant, 
GE. II.--SP.III.]      NERVOUS FUNCTION.
273
 and evinces a tendency to a spastic fixation;  and the other an irre-
 gular motion of the entire organ of the heart in the pericardium
 by which it literally strikes against the chest: the cause of which
 we do not always know, though we see  it very frequently occasion-
 ed by a sudden and violent emotion  of the mind, and have reason to
 believe that it is often a result of the spastic systole or contraction
 of the heart which we have just noticed. When, however, the sub-
 stance of the heart is thus irregularly acted upon,and jerked back-
 ward and forward from a cause extrinsic to itself, the palpitation is
 confined to the pericardium, and the pulse does not partake ofthe
 abnormity.
   The last is, perhaps, the most common  proximate cause of the
 palpitation  of this organ, and we are indebted  to Dr. William Hun-
 ter for having first pointed it out to  us.  The heart, in its natural
 state,  lies loose and  pendulous in the pericardium :  and when the
 blood  which it receives is,  from  an  irritation of any kind, thrown
 with a peculiar jerk into the aorta, the moment it reaches the cur-
 vature of this trunk it encounters so strong a  resistance as to pro-
 duce a very powerful rebound in consequence of the aorta being the
 first point against the spine : the influence of the heart's own action
 is now, therefore,  thrown back upon itself, and this organ, in con-
 sequence of its being loose and pendulous,  is tilted forward against
 the inside of the  chest, between the fifth  and  sixth  ribs on the
 left.*
  The rebound of so strong a muscle as the  heart against the inside
 of the  chest must depend for its violence upon the violence of the
jerk with which the blood is  spasmodically thrown into the aorta ;
and this has often been so powerful as to be distinctly heard by by-
standers.f Castellus has given an example of this sonorous effect:
and Mr. Dundas has observed it in various cases.   " The action of
the heart,"  says the latter,  "is sometimes  so  very strong as to be
distinctly heard, and to agitate the bed the patient is in so violently,
that his pulse has been counted by looking at the motions of the cur-
tain of the bed.":}: I have already observed, under the genus parop-
sis, that ihe point of a knife when introduced  into the cornea, for
the extraction of a cataract, has, occasionally, been broken off by a
spasm of the muscles of the eye.  And we shall  hence hear with
less wonder that the heart has sometimes palpitated with a force so
violent, as to dislocate,§ or break  the ribs,|| for both  are stated to
have occurred  on respectable authorities, and, in one  instance, to
  * See J. Hunter on Blood, p. 146.  note.
  f Castellus, P. Vascus. Exercitat. ad affectus Thoracis. Tr. IX. Toloso.
1614. 4to.
    Lettsom, Med. Soc. Lond. Vol. I.
    A Vega, De Art. Med. Lib. III.  Cap. 8.
  $ Trans. Medico-Chirurg. Soc. I. "27.
  § Horstii II. 137—139.
  y Schenck, Observ. 215. ex Ferneho.
vol. in.—35 
274
NEUROTICA.
[CL. IV.—OR.  Ill
 rupture its own ventricles.* Upon the wonderful power of the soft
 parts, or rather of the muscles over the bones, when thrown into
 vehement spasmodic action, wc had occasion to observe in the Phy-
 siological Proem  to the present order: and it is hence that we have
 sometimes had examples of the humerus, and other long bones, be-
 ing broken by a convulsion-fit.   A contraction of the left aurico-
 ventricular opening is sometimes found to produce the phenome-
 non of a double pulse.f
   I have said that we are not always acquainted with the remote or
 exciting causes of the palpitation of the heart.  Violent emotion
 of the mind, as already observed, is a frequent excitement, and one
 or two others have  been already indicated.   The remote causes
 arc rarely to be discovered till after death, and for the most part
 seem to consist in a morbid structure of the heart itself, or the peri-
 cardium, by which last the muscular walls of the heart have either
 been obstructed in their play, or have had too  much  liberty of ac-
 tion.  The heart  has sometimes been found ossified in its  general
 substance, as in the case of Pope Urban the VHIth ; and more fre-
 quently in its valvules or its connexion with the aorta. It has some-
 times been thickened and has grown to an enormous size—in one
 instance to a weight  of not less than fourteen pounds.^:  A case oc-
 curred to the present author not long ago in a young lady of four-
teen, in whom it reached half this weight, and was the cause of a
most distressing palpitation, as well as of a general dropsy. By close
 confinement and quiet, and the  use of elaterium and scarification to
 carry off the water,  she recovered an apparently good share  of
health;  but the exercise of dancing, a few  months afterwards, pro-
duced a recurrence of all the symptoms in a more violent and ob-
stinate degree, and she gradually fell a sacrifice to them.
  In other cases the heart has  been peculiarly  small and contract-
ed, chiefly, perhaps, in the disease of tabes,  or  marasmus; and
consequently there has not been a sufficient capacity  for the regu-
lar influx of venous blood.
  The space ofthe pericardium has often been morbidly diminish-
ed by inflammation, or an undue growth of fat; and hence, again,
the heart has been impeded in  its proper  action ; while occasion-
ally it seems to  have  been filled, or nearly so, with a dropsical
fluid.
  To these causes maybe added a scirrhous or other morbid struc-
ture of the lungs, and, perhaps, of the spleen, liver, stomach or in-
testinal canal; for it  is a frequent accompaniment upon most spe-
cies of parabysma: and in these cases appears as a symptomatic af-
fection alone.  For reasons already assigned it is also an occasional
symptom in hydrothorax: during which it shows itself in  a  very
* Portal. Memoires de Paris, 1784.
f Hodgson on the Diseases of Arteries and Veins
* Eph. Nat. Cur. Dec. HI. Ann. III.  Obs. 166. 
GE. II.—SP. III.]
NERVOUS FUNCTION.
275
violent degree upon mental agitation, especially that produced by
fright or vehement rage.
   We should not, however, be hasty in deciding upon any structural
affection of the heart, or of any of the larger organs that  closely
associate with it, nor in reality upon any incurable cause whatever.
For it has not unfrequently happened that a palpitation  of long
standing, and which has been regarded as of a dangerous kind, has
gradually gone away of its own accord, and left us altogether in the
dark.   Dr. Cullen gives a confirmation of this remark in the follow-
ing very instructive case : " A gentleman  pretty well advanced in
life, was frequently attacked with palpitations of his heart, which,
by degrees, increased both in frequency and violence, and thus con-
tinued for two or three years.  As the  patient was a man of the
profession he was visited by many physicians  who were very una-
nimously of opinion that the disease depended upon an organic af-
fection ofthe heart, and considered it as absolutely incurable. The
disease, however, after some years, gradually abated both in its fre-
quency and violence, and at length ceased altogether; and since
that time, for the space of seven or eight years, the gentleman has
remained in perfect health,  without the slightest symptom of his
former complaint."* A case precisely similar, and  in a professional
gentleman somewhat beyond the  middle of life, also, has occurred
to the present author, with  a spontaneous  termination  equally  as
favourable.
   The same alternating spasmodic motion into which the muscular
substance of the heart is occasionally thrown by one or other of the
causes thus glanced at, seems, at times, to take place in  some of
the larger arteries,  and extends to a greater or less length in pro-
portion to the nature ofthe cause or the extent of  the morbid irri-
tability by which they are affected, producing the second variety
before us.  That a morbid irritability may exist in a part of an ar-
tery while  the  rest is free from any such condition is easy to  be
conceived, since a like partial  irritability is often found to exist in
organs in which we are capable of tracing it in the most manifest
manner.  Yet even in arteries  themselves we can sometimes ascer-
tain the same to the conviction of our senses : as for example in the
case of phlegmonous inflammation ; in which, also, we find it ac-
companied with the throb or alternating spasm and relaxation which
constitutes what is meant by palpitation.  In a healthy and ordina-
ry flow of the blood through the arteries it is very  well known that
there is no sensible  series of contractions and dilatations  whatever;
and we have already observed  in the Physiological  Proem to the
third class thai there is no actual change of  bulk of any kind, and
that it is the pressure of the finger or  of some other  substance
against the side of an artery  that alone produces a feeling of pulsa-
tion, f In a phlegmonous inflammation, however, every one is sen-
* Mat Med. Part II. Chap. VIII. p. 357.
f Vol. II. p. 14. 
 276                      NEUROTICA.          [CL. IV.—OR. HI.

 sible of a considerable change in this respect; for there is often a
 very smart and vibratory pulsation while the affected part is in per-
 fect freedom, and no finger is applied to it; and that this is a pulsa-
 tion unconnected with the regular pulsation ofthe heart is perfect-
 ly clear, because  it is frequently less uniform, rarely, if ever, syn-
 chronous wilh it, and in most instances, twice as rapid.   We have
 here,  therefore, a full proof of a local excess of irritability in an ar-
 terial  tube, and of a palpitation, or alternating spasm and relaxation
 as its  effect.
   Yet inflammation is but one cause of such subsultory action, or of
 the irritability which gives rise to it.   With other causes we are
 net much acquainted; but we have reason  to believe  them very
 numerous,  and wherever they exist, the  artery operated upon will
 evince the same  kind of vibratory throb, though,  in general,  the
 stroke will  not be found quite so smart as that which takes place in
 the pulse of a phlegmon.  It may appear singular  that  this abnor-
 mal action,  whether of the heart or arteries, should evince so much
 punctuality in  its vibration, but there is often a wonderful tendency
 to punctuality in all intermissive affections whatever. We see it in
 hemorrhoidal discharges, in  gout, and above all, in intermitting fe-
 vers :  and till the cause of such punctuality is explained  in this last
 instance, it  will be in  vain to expect an explanation in the case be-
 fore us
   In very irritable habits, or perhaps where there is a morbid sen-
 sibility through the whole  of the sanguiferous  system, the palpita-
 tion will not unfrequently shoot from one artery  to  another; and
 one or two cases are given in the Ephemerides of Natural Curiosi-
 ties,* in which it appears to have been  universal.  It was  so,  in-
 deed, in the very irritable organization of that singularly constitut-
 ed character J. J. Rousseau,  if we may  credit the account he gives
 of himself in relation to this subject:  far he tells  us that after a pe-
 culiar  paroxysm of high  corporeal  excitement, he became all of a
 sudden, sensible of a pulsation in every part of his body, which from
 this time  accompanied him  without  intermission : and he adds,
 somewhat extravagantly, that the  throbbing  was so distinct  and
 strong, that  he  was often capable of hearing as well as feeling  it.
   The temporal arteries are peculiarly apt to concur in this migra-
 tory throbbing, and occasionally the carotid ; and the throbbing of
 both is sometimes synchronous with that of the heart and sometimes
 successive to it.   Mr. Dundas has observed that this affection of
the carotids is  most common to persons in the prime of" life ; and
that, on dissection, the heart is often  found enlarged in its  size,
but without  any increase of muscular  power : an assertion  col-
laterally supported by the case of a young lady described  under the
preceding variety.   We here, also, sometimes meet with polypous
concretions,  and very generally adhesions to the pericardium.
  And it is highly curious and interesting to notice the  ramifying

               * Eph. Nat, Cur. Dec. I. Ann. VI.— VII. 
UE. II.—SP. HI.]       NERVOUS FUNCTION.
277
chain of morbid action of which the heart sometimes forms the first
link.   I have at this moment a lady under my care, of delicate con-
stitution and highly nervous habit, in the third month of pregnancy,
who has for several  weeks past been  uniformly attacked  in  the
evening with a violent  palpitation in the heart, that  continues for
nearly an  hour or upwards; it is  then  transferred to the temples
which throb with as much violence and for as long a  period of
time ;  vertigo follows with a  tendency  to deliquium, immediately
after which  there is a general reaction in the system ; the skin be-
comes heated and at first very dry ; but the dryness at length yields
to a gentle diaphoresis which  concludes the morbid series;  for the
patient at  this time becoming  tranquil,  drops into a sound and re-
freshing sleep, and  wakes  free from all these  symptoms  in the
morning.
  In this  case, also, there is a  considerable tendency to that univer-
sal subsultus or alternating spasm ofthe arterial system to which we
have just  adverted : for all the arteries  ofthe  extremities pulsate
or palpitate  whenever accidentally pressed upon by any substance,
though  it  requires this additional stimulus to excite the spasmodic
action.
  Arterial palpitation, however, is to be found, though not more
frequently,  still far more alarmingly in  the epigastric region than
in the head  ; and  appears to proceed from  some particular excite-
ment ofthe  aorta, the superior mesenteric, or  some branch of the
coeliac artery.  Its beat has here seme resemblance to  that of an
aneurism  of these vessels,  and has often been pronounced to  be
such  without the slightest foundation,  to the great  terror of the
patient, and consequently to a considerable exacerbation ofthe dis-
ease.   It may,  for the most part,  be easily  distinguished from an
aneurism by being destitute of any circumscribed pulsatory tumour,
that can be ascertained by a pressure of the finger;  by  a smarter
vibration  in the arterial stroke ; and by that degree of irregularity
in the return  ofthe stroke by which palpitation  is distinguished
from pulsation.   In some cases, indeed, the line of the affected ar-
tery can be  distinctly felt and  followed up to a considerable length;
and the vibration has occasionally been  so strong as to  be  visible
to the eye, even at some distance, when the surface ofthe epigas-
tric  region  has been exposed to view.   " From a good deal of ex-
perience upon this subject," says Dr. Baillie, « I am enabled to say
that the increased pulsation of the aorta in the epigastric region,
very rarely  depends upon  any disease of the aorta itself, or of  its
large branches in that place ;  and that  this occurrence  is  almost
constantly of very little importance."*   This distinguished physi-
ologist tells us further that he has had an opportunity of examin-
ing the state of the arteries in the epigastric  region after  death,
in two persons who  had this  pulsation  very  strongly marked, and
who died from other diseases.  In both cases all the  arteries were
*  Med. Trans. IV. XIX, 
^7b
NEUROTICA.
[CL. IV.—OR. Ill
 perfectly free from  every appearance  of diseased structure.  He
 was, also, some years ago, consulted by an old man upon a paralytic
 affection ;  who afterwards spoke to him incidentally concerning a
 palpitation of the kind before us, to which he had been subject for
 upwards of  twenty-five years.   The throb, on examination, was
 distinctly to be felt;  and on the patient's first perceiving it, and ap-
 plying to Sir Caesar Hawkins, Mr. Broomfield, and  Dr. Hunter,
 the two former had declared it to be an aneurism, while the latter,
 more modestly, confessed that he did not know what it was.
   Dr. Baillie, in the article now alluded to, has imitated the mo-
 desty of Dr. Hunter.  " It is, perhaps, difficult," says he, «to ascer-
 tain, in many instances, the causes of this increased pulsation ofthe
 aorta in the epigastric region : but in most cases it will be found to
 be connected with an imperfect digestion, and an irritable consti-
 tution."   And hence, whatever may improve the digestion, and ren-
 der the constitution  less irritable, will be of use in mitigating the
 complaint: and above all, it will be  found highly serviceable to re-
 move the patient's anxiety on the subject, whenever it  can fairly
 be done.
   But the throbbing or pulsatory  motion is often communicated to
 other organs  than the sanguiferous vessels, and forms that variety of
 affection to which we have given the name of complicated palpi-
 tation. This is clearly dependent, in many cases, upon the vicinity
 or close  connection of such organs with the heart or arteries that
 form the seat of disease; and it may also in other cases be produc-
 ed, as ingeniously conjectured by  Dr. Young, upon an accumulation
 of fluid in the pericardium or thorax, which transmits a pulsatory
 motion from  the heart itself to  whatever other organ or surface of
 a cavity such fluid may  reach ; in the same manner as the fluctua-
 tion  produced by a slight blow  given  to one side of the abdomen,
 was distended with water, is distinctly propagated  to the opposite
 side.   In the case of a  middle-aged woman, of a rheumatic habit,
labouring under symptoms of general  dropsy,* " a  palpitation," he
 tells us, " was observed in the right hypochondriac region, and on
 the right side ofthe neck, which'exhibited a vibratory motion more
rapid and less regular than that  of the pulse felt at the  wrist; and a
 similar vibration was observable in the heart itself:  the pulsation in
the neck was not confined to the jugular veins; it was more forci-
ble and extensive than it could have been if it had originated from
those vessels; and it had more the  appearance of a violent throb-
 bing of the carotid artery ; although in the axillary artery the pulse
was comparatively regular and natural."  Dr. Young found, never-
 theless, upon making a strong pressure on the right side ofthe neck
with a single  finger, that the motion of the carotid artery was very
 perceptible, and totally independent of that of the superficial parts,
 being precisely  synchronous with  the pulse at the wrist, although it
 required considerable  attention to  distinguish it  from the  more
* Med. Trans. Vol. V. Art. xvU. 
GE. II.—SP. III.]       NERVOUS FUNCTION.
279
 irregular palpitation.  The symptoms, however, of a dropsy of the
 chest or pericardium in this patient appear to have been obscure ;
 and at the time when the general hydropic enlargement, which had
 been much reduced in the course ofthe autumn, began to increase
 towards the end of October, the palpitation was  considerably less,
 as well as the pulsations in the abdomen and neck, though the mo-
 tion of the heart  was still fluttering, the pulse at eighty, intermit-
 ting and very irregular.  On the death of the patient, which oc-
 curred soon afterwards, a considerable  quantity of fluid was found
 in the pericardium, in the right cavity of the  thorax, and  in the
 ventricles of the brain, but little or none  on  the left side  of the
 chest: the heart was inconsiderably enlarged, and some of its valves,
 as also some of those of the pulmonary  artery, were much ossified,
 so that the free passage of the blood was impeded.
   I have said that palpitation is sometimes dependent upon a mor-
 bid irritability of the sanguiferous system in general.   In some in-
 stances, however, we find it rather dependent upon a morbid irrita-
 tion and debility of the entire frame, and consequently connected
 with a very irregular performance of many or all the functions of
 the body.  Of this highly complicated state of the disease we have
 a striking example in Dr. Batemen's history of himself as given in
 one of the volumes of ihe Medico-Chirurgical Transactions,* which
 he ascribes to a poisonous action of mercury employed on his own
 person copiously in the form of an unguent to relieve an amaurosis
 of the right eye,  and which seems to have produced something of
 the mercurial erethism described by Mr. John Pearson,f as taking
 place in some singular idiosyncrasies, already noticed by us under
 the head of Syphilis.f   In this  case the heart and arteries  were
 equally subject to subsultory and violent motions, sometimes sepa-
 rately, and sometimes  synchronously, but inaccordantly as to the
 number of the  throbs in a  given time,  and almost perpetually ac-
 companied with a most distressing sense of languor and sinking.
 There was also a very  irksome cough,  an occasional sense of con-
 striction across the region of the diaphragm, and such a difficulty of
 respiration as to render an erect position at night imperatively ne-
 cessary.  Life was, in  this case,  unquestionably a forced state of
 being, and all the stimuli of the external senses and of the  will
 seemed necessary to excite the sensorial organ to a secretion of
 vital fluid sufficient for  the mere preservation of life.  And hence,
 during sleep, or as soon as  these stimuli were cut off, there  was
 such  an increase of languor, irregular action of the heart, and
 sinking, as though in the act of dying, that it was at times necessary
notwithstanding the extreme drowsiness of the  patient from  a
previous and long continued watchfulness, to interrupt the sleep

  * Vol. IX. p. 227.
  f Observations on the effects of various articles of the Materia Medica in
Lues Venerea, ch. xii.
  • Vol. H. p. 562. 
2bO
NEUROTIl-A.
[CL. IV.—OR. HI
 every two minutes ; since by this time or even sooner, the failure
 of the pulse and  the  appearance  of the  countenance indicated a
 supervening deliquium.  The  powers of the stomach, from the
 repeated paroxysms of the disease, seem to have declined rapidly.
 Frequent supplies of food and cordials, as spiced wine, appeared at
 first serviceable in warding off the languor;  but at length  nothing
 but fluids could be taken  and retained without increasing  the dis-
 turbed action ofthe  heart.   Yet so extreme was the sense  of sink-
 ing and immediate dissolution, that, on one occasion, after a quar-
 ter of an  hour's sleep, air was importunately demanded, and three
 glasses of undiluted brandy were  drank in five minutes,  without
 much relief; and  afterwards ammonia and ether repeated every ten
 minutes for two hours: when the paroxysm rapidly declined after
 a  copious  discharge of limpid  urine.  The  disease continued a
 twelvemonth before the patient felt, in any essential degree,  amend-
 ed : and little benefit was derived from medicines of any kind.   It
 is well known, however, that this acute pathologist, and excellent
 man, has  since fallen a sacrifice to a return of the complaint.
   In  a disease  produced by so  great a diversity of causes, often
 obscure, and very  generally complicated with other affections,  it is
 impossible to lay down any one plan of treatment that will apply to
 every case.  Our  first endeavour should be to ascertain, as far as
 we may be able, whether the palpitation  be idiopathic or sympto-
 matic ; and if the  last, while we endeavour to palliate the  present
 distress, our attention  should chiefly be  directed to the primary
 malady.   If acrimony  or any other morbid state of  the stomach or
 bowels be suspected, this, as far as possible, should be removed ;
 and if we have reason to suppose hydrothorax or any other  kind of
 dropsy, the means hereafter to be recommended  for this tribe of
 complaints should  be resorted to from the first. In  pregnancy, the
 disease will most probably cease upon a cessation  of this state of
 body, and usually, indeed, ceases during the latter  months,  or after
 the period of quickening.  And if it  seem to be chiefly dependent
upon  a general irritability of the  sanguiferous system, or of  the
whole constitution, the sedative antispasmodics, tonics, and espe-
cially the metallic, quiet of mind as well as of body,  regular hours,
light meals, pure air, and such exercise as agrees best with  the in-
dividual, will often produce  an essential  service  and sometimes
effect a radical cute.
   Much of this plan will also  be requisite where we have  reason
to  apprehend some structural affection of the heart or larger blood-
vessels : and when, from any incidental excitement the irritation is
here more than  ordinarily troublesome, recourse must be  had to
narcotics.   Opium is  by far the best where it agrees with  the
 system : but its secondary effects are often very distressing, and we
cannot employ it. In such cases we must find out, by trial, what is
its best succedaneum:  the hop, henbane, hemlock, and prussic acid,
have all been essayed in their turn, and sometimes one has suc-
 ceeded where the rest  have all failed.  But upon the whole  the 
CE. II.—SP. III.]
NERVOUS FUNCTION.
281
henbane has answered far better, and more generally Under the
author's own hands ;  and in one or two instances of great obstinacy
he has known it effect a perfect cure,  when all the rest had been
tried in succession and had totally failed.
i  In Dr. Bateman's case, however, which was peculiarly severe
and complicated, the henbane though it seemed serviceable at first,
taken in doses of from three to five grains of the  extract every
night, gradually lost its effect even when  repeated three times a
night, in  doses  of five grains at a time.   The tincture of hop, in
doses of thirty drops, every six hours, was next tried, but produced
no other effect  than a  slight drowsiness. Musk seemed most
successful in draughts of ten grains each; yet even  this was of
transient  duration, and was abandoned as  of no  use.  Where the
palpitation is accompanied with a distressing tendency to deliquium.
I have occasionally relieved it by camphor pills, with  the ammo-
niated tincture of valerian or the aromatic spirit  of ether.
  The disease has occasionally been carried off by a sudden attack
of some other complaint, as gout, herpes, diuresis, or the formation
of an abcess ; and hence, setons, and issues  have been recommended
and have occasionally proved serviceable.   Zacutus Lusitanus found
the latter produce a radical cure in a palpitation of the heart which
he ascribed to the rapid  healing of some chronic ulcers.*  Schenck
advises the wearing a bag of aromatics at  the pit of the stomach ;t
and hence, perhaps the origin of camphor-bags  as  a  specific for
irregularities ofthe heart of another kind.
                        SPECIES IV.

               CLONUS  NICTITATIO.

               arfofufclfnfl  ot the 15ge=injis.

         rapid and vibratory motion of the  eye-lids.

To a certain extent, twinkling or winking of the eyes is performed
every minute without our thinking of it.  It is a natural and instinc-
tive action for the purpose of cleansing and moistening the eye-ball*
and rendering it better fitted for vision.  Dr.  Darwin  has some
ingenious remarks upon this subject. " When the cornea," says he1,
w becomes too dry it becomes at the same time less transparent,
which is owing to the pores of it being then too large ;  so that the
particles  of light are refracted by the edges of each pore instead of
passing through it; in the same manner as  light is refracted  by

           *  Prax. Hist. Lib. VIII. Obs. 30.
           f  Lib. II. Obs. 216.
  vol. hi—36 
i>S2                     NEUROTICA.           [CL. IV.—OR. III.

passing near the edge  of a knife.   When  these  pores are filled
with water, the cornea becomes again transparent."*   Moisture is,
indeed, a  frequent cause  of transparency in various bodies ;  and
hence, in dying  people  whose  eye-lids are become  torpid  and
do not  nictitate,  the  cornea  is  sometimes so dry that its want of
transparency is visible to by-standers.   So  when  white  paper is
soaked in oil, and its pores filled with this fluid from an opake body
it becomes transparent, and radiates the light that is thrown upon
it; air itself is most transparent when as much moisture is dissolved
in it as it will hold ;  when void of moisture, indeed, it forms a dry
mist, which is occasionally met with in the morning,  and through
which distant objects are seen indistinctly ;  while, on the contrary,
when distant objects are seen with perfect clearness it is a sign of
rain.   In  a mist, distant objects, are also seen indistinctly : yet here
the moisture is not dissolved in the atmosphere but merely suspend-
ed and formed by the attraction of cohesion into collected spherules.
We may hence account for the want of  transparency  in the  air,
which is seen in tremulous motions over corn-fields, on hot summer-
days, and  over brick-kilns, after the flame is extinguished, while the
furnace still remains light.  It is  this dryness and want of trans-
parency in the  atmosphere over the summits of hot and arid hills,
in a bright unclouded sky, as in Italy,  which constitutes what is
called by  the painters the blue shade of light, and which is copied
in most pictures of Italian  scenery.
   The ordinary use  of nictitation is therefore obvious: butithere
are  many persons  who  wink or  twinkle their eyes far more
frequently than is  necessary for the  purpose  of moistening the
cornea, and in whom it forms an unsightly habit.   This has usually
been  produced at first  by some local irritation, as inflammation or
dust in the eyes, which quickens the natural action, and, where the
stimulus is considerable, renders it irregular and convulsive.  If
indeed the stimulus  be very  vehement, the nature of the spasm is
changed,  and the eye-lids, instead of irregularly opening and shut-
ting with great rapidity  become rigidly closed ;  and such is the
force with  which the orbicular muscles contract themselves on
some occasions that they will snap a steel instrument that happens
at the time to be introduced between them ; a fact that, as we have
already observed, has in one or two instances occurred in perform-
ing the operation for extracting^ cataract, during which the knife
has been broken short off. ^
   We have seen  in many of the preceding species of diseases with
what ease morbid actions are  continued when once introduced into
an organ  : and hence when any permanent irritation of the eye has
excited and maintained for some days or weeks a quick repetition
of twinkling, this iterative action will often be  found to become
habitual, and remain after the irritation has  subsided.
* Zoonom.  CI. I. i, 4. 2. 
GE. II.—SP. IV.]      NERVOUS FUNCTION.
283
  This morbid habit has been sometimes cured by a powerful ex-
ertion of the will; but more generally by using one  eye only at a
time, and closing the other: the open eye being employed in ex-
amining an object for a considerable period with great attention
and steadiness.  A minute examination of the stars at night through
a telescope has a  like corrective tendency and may  fye employed
for the same purpose.
                          SPECIES V.

                 CLONUS SUBSULTUS.

                         srtottcfutifls,

     sudden and irregular snatches of the  tendons.

 This affection is to the tendinous extremities of the muscles, in
 which the principle of irritation is often apt to accumulate, what
 palpitation is to the irritative fibres of the heart and arteries : and
 hence, as we have already seen, it is included under the general
 term of palpitation by Vogel.
   We witness these starts or twitchings most frequently in extreme
 stages of debility produced by atonic fevers, and especially just be-
 fore the act of dying.  They are, in such cases, weak convulsions
 interruptedly undulating from one limb or part of a limb to another,
 too feeble to raise the limb itself, although sufficiently powerful  to
 give  slight but transient swellings to the belly of a muscle, and
 consequently a slight involuntary flickering to its tendons.  In the
 ordinary close of life they are the precursors of the fatal scene, the
 harbingers of the dying struggle, and generally indicate that the
 will has lost its hold, and the power of sensation is rapidly  ceasing:
 thus affording another proof, if other proofs were wanting, to those
 adverted to in the Proem to the present class, that the irritative fibres
 are capable of secreting their peculiar fluid for themselves, and of
 maintaining their function, under  particular  circumstances, for a
 much later period than the organs of perception and sensation, oc-
 casionally, indeed, for  some  hours  after the death of every other
 part of the body.  And as debility and irritability often exhibit  a
 joint march, the subsultory motions are apt to become stronger, as
 the regular motion of the pulse becomes weaker, and at length
 work up those agonizing convulsions under which the little and
 loitering flame of life  is sometimes extinguished instantaneously.
 Such twitchings ofthe tendons, however, do not always prove fatal:
for they often show themselves where the case is not  so extreme :
and hence, they may occasionally be allayed by cordials, antispas-
modics, and warmer sedatives, and are altogether lost in a favour-
able turn of the disease. 
2S4
NEUROTICA.
[CL.IV.—OR. IH.
   It occasionally happens, that the debility producing these weak
conv.b; .••;■ acii ns is local, and habitual; and in such  cases they
m.        n t  ".ri-'.-e and play over a limb without any influence
ov    ,.•-!'        !.i<), and without much injury to the limb itself.
G j '  ?. stat» .* nervous constitution  may be produced by accident,
but    i' for the most pa>'t strictly idiopathic: and there  are few
pra   uoneis. perhaps, who have not met with examples of it. Dr.
Da v. in gives us  rn  instance in the following words: "A young
lady, about eleven years old, had for five days had a contraction of
one muscle in her fore-arm, and another in her arm, which occur-
red four or five rimes every minute ; the muscles were seen to leap
but without bending the arm.   To counteract this new morbid ha-
bit, an issue was placed over the convulsed muscle of her arm, and
an adhesive plaster wrapped tight like a bandage over the whole
fore-arm, by which the new motions were immediately destroyed,
but the means were continued  some weeks  to prevent a return."*
The author has sometimes seen it about one of  the shoulders, but
the extremities are its most usual seat; and he was lately consulted
by a lady of a strikingly irritable habit, who was  suddenly attacked
with it both in her hands and feet, so as to throw her into  a consi-
derable degree of alarm.  Upon  inquiring into the patient's age
and state of health, he was informed that she was between forty and
fifty, that menstruation was on  the point of leaving her, and had of
late appeared very irregularly,  and that she had  a considerable op-
pression in her head.  The cause was therefore obvious, and the
cure was not difficult; for it yielded to a moderate venesection and
an habitual attention  to the state of the bowels.
                        SPECIES VI.

             CLONUS  PANDICULATIO.

                      Pairtrtculattou.

TRANSIENT ELONGATION  OF THE EXTENSOR MUSCLES, USUALLY WITH
          DEEP INSPIRATION AND A SENSE OF LASSITUDE.

This is, perhaps, the slightest modification of spasmodic actions, but
as it often occurs, as in nausea on the first stage of a febrile pa-
roxysm, whether the  will consents or not, and is frequently and ir-
regularly repeated, it cannot but be regarded as belonging to the
present family on many occasions.  The muscles chiefly concerned
are the extensors of the lower jaw and of the limbs: the particular
kind of pandiculation to which the first of these movements gives rise
• Zoonomia, Catenation, Sect. XVH. i. 8. 
CE. n.—SP. VI.]        NERVOUS FUNCTION.                 285

being called oscitancy, yawning or gaping;  and that produced
by the second stretc hing. The muscles are excited to this peculiar
action by a general feeling of restlessness or disquiet; and the
spread of the action from one muscle or set of muscles to another
is from that striking sympathy or tendency to catenate in like move-
ments which we so often behold in different parts of the body with-
out being able to explain.  It  is possible, however, that the syn-
chronous motion of the muscles of the lower jaw, and of thelimbs,
for it is rarely that yawning and stretching do not accompany each
other, may be dependent  upon the  same line of intercourse by
which trismus so often accompanies a wound in one of the extremi-
ties, and which  we have already attempted to illustrate: the irri-
tant power in the one case, leading to a fixt or entastic ;and in the
other to  a transient and clonic spasm.
  Pandiculation, considered physiologically, is an instinctive exer-
tion to recover a balance of power between the extensor and flexor
muscles, in cases in which  the former have been encroached  upon
and held in subjection by the latter.
  A very slight survey of  the animal frame will show us that the
flexor muscles have,  in every part, some preponderancy over the
extensors; and that this preponderancy is perpetually counteracted
by the stimulus of the instinct or of the will.  We see it, from the
first stage of life to the last, and most distinctly in  those states, in
which there is most feebleness, and consequently in which the con-
trolling powers are least  capable of exercising  and maintaining a
balance.   In  the fetus, therefore, in which the weakness is most
pressing, the power of instinct is merely rising into existence, and
no habit  of counterpoise established  in the nascent  fabric, every
limb, and part of every limb capable of bending,  undergoes some
degree of flexure,  and the entire figure is rolled into a ball as the
hedge-hog habitually rolls himself, even after  birth.   As the fetus,
however, increases  in size and age, and the powers of instinct, sen-
sation, and volition become more perfect, this general conflexure
produces occasionally a sense of uneasiness ; and hence every par-
turient mother is sensible of frequent internal  movements and
stretchings of the little limbs of the fetus to take off the uneasiness
by restoring  some degree of balance to the antagonist powers.
After birth, and during wakefulness,  the stimulus of the will, di-
rected rather to  the extensor than the flexor muscles, renders the
counterpoise complete for all the purposes for which it may be ne-
cessary.   But the  moment we repose ourselves in sleep, and the
will becomes inactive and withdraws its control, the flexor muscles
exercise  their preponderancy afresh,  though in  a less degree than
in fetal life, since the extensors, from habitual use, have acquired
a more than proportionate increase of power.  The preponderancy,
however, when  long  exerted, still  produces some degree of dis-
quiet, and hence, occasionally during sleep, and still more vigor-
ously, the moment we begin to awake, we instinctively  rouse the
extensor muscles into action; or, in other words, yawn, stretch the 
286
NEUROTICA.
[CL. IV.—OR. HI.
limbs, and breathe deeply,  to restore the equipoise that  has  been
lost during unconsciousness.
   In all these cases, pandiculation is a natural action; it is an effect
produced by the  will when it is called to  the particular state of
these two sets of muscles, or by  the  instinctive or remedial power
of nature, which supplies its place, when it is  dormant or inatten-
tive, to restore ease to a disquieted  organ.  But in  an infirm or
debilitated  condition of the  system, it evinces a morbid and convul-
sive character, and takes place without our being able to prevent it
even when  the will uses its utmost effort to resist instead of to en-
courage it.
   How far its repetition may be of use in the shivering  fit of an
ague, or in  a nauseating deliquium of  the stomach it may be difficult
to say. Yet we are at no io^s to account for its  frequency  of recur-
rence : for  as  the whole system is, in such circumstances,  thrown
into a sudden prostration of strength, the extensor-muscles in con-
sequence of being naturally  weaker than their antagonists,  must be-
come soonest  exhausted, and give way with a  more than ordinary
submission to their power.   And hence we behold a painful retrac-
tion over the whole system, and the preponderancy assumes a rigid
and spastic character: and we may  fairly conclude that  much of
the yawning and stretching«that ensues is for the purpose of getting
rid of the constrictive spasm, though these  counteractions them-
selves often run, in  the attempt,  into  a spasm of another kind,  and
become convulsive.
   Yawning and stretching,  then, are among the signs of debility
and lassitude.  And hence,  every one who resigns himself inglori-
ously to a life  of lassitude and indolence will be sure to catch these
motions as  a part of that general  idleness which he covets. And in
this manner a  natural and useful  action is converted into a morbid
habit;  and  there are loungers to be found in the  world, who, though
in the  prime of life, spend their days as well as  their nights in a
perpetual routine of these convulsive movements over which they
have no power;  who cannot rise from the sofa without stretching
their limbs, nor open their mouths to answer a plain question with-
out gaping  in one's face.  The disease is here idiopathic and chro-
nic : it may, perhaps, be cured by a permanent exertion of the will,
and ridicule or hard labour  will generally be found the best reme-
dies for calling the will into action. 
CE m.—SP. I.J       NERVOUS FUNCTION.               2S7



                       GENUS IIF.

                     SYNCLONUS.

                    Stjuclomc  Spasm.

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

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

                                TREMBLING.
                                ST. VITUS'S DANCE.
                                SHAKING PALSY.
                                RAPHANIA. «
                                BARBIERS.
                        SPECIES I.

               SYNCLONUS  TREMOR

                        Evtmblinq.

SIMPLE TREMULOUS AGITATION OF THE HEAD, LIMBS, OR BbTH J MOST
               LY ON SOME VOLUNTARY EXERTION.

The proximate cause of this disease is an irregular secretion or flow
of irritable power into the motory fibres of the muscles that consti-
tute its seat.  It is hence strictly  a disease of nervous  debility.
either general or local: debility produced by sudden exhaustion, as
in the case of great muscular fatigue, from violent exercise, severe
cold, or a vehement exertion of the passions, and  particularly the
passions of fear and rage ; or debility produced slowly and insensibly
by causes of tardy operation, as an injudicious use of mercury, lead,
opium or other mineral and narcotic poisons ; an habitual excess in
1. SYNCLONUS TREMOR.
2.---------CHOREA.
3.-----—— BALLISMUS.
4. --------- RAPHANIA.
5. ——------ BERIBERIA. 
288
NEUROTICA.
[CL. IV.—OR. in
hard drinking or sexual commerce, and, in some idiosyncrasies, an
immoderate indulgence in tea.   And, as this disease is a result of
debility? it necessarily occurs as a symptom on the general spasm
and prostration of strength that so peculiarly distinguish the acces-
sion of an ague-fit, and the interrupted flow of sensorial power that
takes place in paralysis.
   There are some persons, however, in whom the same convulsive
action  exists habitually  without any morbid state of any other or-
gans, or any other inroad upon the general health.  I once knew a
lady, considerably  beyond the  middle  of life, who was strikingly
affected with this complaint, insomuch  that the slightest voluntary
exertion of any  of the muscles threw the  head  and  arms into as-
great a tremor as if they had been hung upon wires, but who en-
joyed at the time, and had for a long term of years continued to
enjoy,  as perfect health as possible  in every other respect; was
lively,  cheerful, animated, possessed of brilliant powers of conver-
sation, and able  to use a more than  ordinary portion of exercise
without fatigue.
   The earlier part  of her life had been  passed  in India, but her
constitution did not appear to have suffered from this circumstance ;
and so gradual was the attack of the affection, that though she had
laboured under it for many years, she could not date its commence-
ment from any point of given time.   She at length died at the age
of seventy-two or seventy-three, her corporeal powers progressively
declining, and laying a foundation for a general dropsy,  while her
mind continued firm to the last
   In all cases of this kind the course  of the nervous fluid in its
passage through the motory fibres of the  affected muscles, is mor-
bidly interrupted at every jet, and where the organ or the constitu-
tion is in a state of debility, it flows also less abundantly as well as-
less  uniformly.  We have already observed that this fluid, in its
natural course, flows only by waves or vibrations, and consequently
with an interposing pause or relaxation  after every efflux : but that
the pause is instantaneous, and the supply so regular as to answer
the purpose of a permanent and continuous tenour.  In clonic tre-
mor the pauses are, however, prolonged, and for the most part irre-
gular or untrue to  themselves ; and the greater the retardation
and irregularity the  more marked  and  alarming the spasmodic
shake.
   In the case just  adverted to,  there was no other diseased action
whatever; the nervous fluid was unquestionably supplied in suffi-
cient abundance, and the pauses, though prolonged, were uniform;
and it was singular to observe the influence the will possessed over
the affected muscles under these circumstances, and how complete-
ly they were still under its control:  for in consequence of the uni-
formity of the  morbid interruptions, and from the force of habit, I
have seen this patient, in the midst of a shaking that threatened
every moment to overturn whatever  she  took hold of, raise a cup
brim-full of tea,  or a glass brim-full of wine to her lips by way of
experiment, without spilling a single drop. 
GE. HI.—SPf I.]      NERVOUS FUNCTION.
289
   Where the corporeal health is so little interfered with as in the
 present case, a  course  of medical treatment might, perhaps, do
 more mischief than benefit. But where the constitution is generally
 affected, or the muscles that form  the seat of the convulsion are
 manifestly debilitated, general and local tonics and stimulants may
 sometimes be tried with advantage, though they frequently fail of
 producing any good effects.   Sea-bathing  and  horse-exercise,  a
 generous diet, change of air and scene, may be found useful auxilia-
 ries m the general treatment; and long continued and daily friction
 by a skilful rubber, ammoniacal embrocations, blisters, setons,  and
 a course of voltaism or electricity offer the best promise, as topical
means of relief.   The affected limbs may be also put into a train of
 gradual exertion for the purpose  of obtaining  both  strength  and
steadiness : and to this end the head or shoulders may be occasion-
 h  madC t0 baIance *" easy weiSht for a given period of time,  and
the hands to  suspend or carry a wine-glass or tumbler brim-full of
water.
                        SPECIES II.

                SYNCLONUS  CHOREA.

                    St. Sftttts's HJance.

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

The term chorea from %«fes" chorus" " ccetus saltantium," is com-
paratively of modern date in its application to  the present disease,
nor is it easy to determine satisfactorily who first employed it.  It
was  first more limitedly denominated chorea  sancti viti, under
which limitation it occurs in  Sydenham, and  is  still known in
popular language, being called  in colloquial English,  St. Vitus's
Dance, and in colloquial French, Dance de St. Guy.  According to
Horstius the name of St. Vitus's Dance was given to this disease, or,
perhaps, more probably to a disease possessing some resemblance to
it, in consequence of the cure produced on certain women of disor-
dered mind, upon their paying a visit to the chapel of St. Vitus, near
Ulm, and exercising themselves in dancing from morning to night,
or till they became exhausted.   He adds that the disease returned
annually, and was annually cured by the same  means.
  The marvellous accounts of this dance,  as related by old writers,
are amusing from their extravagance.   The paroxysm of dancing,
we are told,  must be kept up whatever be the length of  the time,
  vol. m.—37 
290
NEUROTICA.
[CL. IV.—OR. Ill-
till the patient is either cured or killed ; and this, also, whether she
be young or old, in a state of virginity or parturition ;  and in the
growing energy ofthe action we are further told that stools, forms,
and tables, are leaped over without difficulty if they happen  to  be
in the way.  Felix Plater  gravely tells us that he knew a woman
of Basle, afflicted with this complaint, who on one occasion danced
for a month together :* and the writers add generally  that it was
hence  necessary to hire  musicians to play in rotation, as well  as
various strong sturdy companions  to dance with  the patients till
they could stir neither hand nor foot.f
   The nearest approach to this kind of gymnastic rrfedicine which
I am acquainted with in modern times, is  a singular case of the
same disease described by Mr. Wood in the seventh volume ofthe
Medico-Chirurgical Transactions.   The morbid movements were
in measured time, and  constituted  a sort of regular dance as soon as
music was struck up, but ceased instantly upon a change of one time
to another, or upon a more rapid roll of the drum, which was the
instrument employed  on the occasion, than the morbid movements
could keep up with.  Advantage was taken ofthe last part of this
very singular influence, and the  disease was cured  by  a perse-
verance in discordant or too rapid  time.  The form of the disease
appears to have a near relation to the  tarantismus  of Sauvages,
which  is the  carnevaletto delle  donne  of BagLivi, all  of  them
probably nothing more than modifications of the present.  Linneus,
and after him Macbride, from the epithet of sanctus, as applied to
chorea, or a belief that such affections are induced by the imme-
diate agency of a superior order of beings, have applied to  it the
name of hieronosos, or" morbus sacer"—a name, however, which,
by earlier writers, was appropriated to convulsion fits.
  In Galen chorea seems to be included  under a disease which he
calls scelotyrbe, literally, " cruris turba or purturbatio,"—" com-
motion of the leg ;" and his description, which is as follows, is ex-
tremely accurate.   " It is a species of atony or paralysis  in  which
a man is incapable of walking straight on, and is turned round  to
the left, when the right leg is put  forward, and to the right when
the left is put forward, or alternately.  Sometimes he is incapable
of raising the foot, and hence drags it awkwardly as those that are
climbing up steep cliffs."
  One of the best general descriptions which have  been  given
us of chorea, is the following of Dr.  Hamilton, contained in his
valuable  treatise on the utility of  purgatives: " Chorea Sancti
Viti attacks boys and  girls indiscriminately ; and those chiefly
who are of a  weak constitution,  or whose natural good health
and vigour have been  impaired by  confinement, or  by  the use
of scanty  or improper nourishment.  It appears most common-
* De Mentis alienat. Cap. iii.
f Paracels. De Morb. Amentium. Tract. I.
  Shenck, De Mania.  Lib. I. 
GE. III.—SP. n.]        NERVOUS FUNCTION.
291
ly from the eighth to the fourteenth year.  I saw it in two young
women who were from sixteen to eighteen years of age.  The ap-
proaches of chorea are slow.   A variable and often a ravennus ap-
petite, loss of usual vivacity and playfulness, a swelling and hard-
ness of the lower belly, and,  in general,  a constipated state of the
bowels, aggravated as  the disease advances, and slight, irregular,
involuntary motions of different muscles, particularly those of the
face, which are  thought to be the effect of irritation,  precede the
more violent convulsive motions, which  now attract the attention
of the friends of the patient.
  " These convulsive motions vary.  The muscles of the extremi-
ties and ofthe face, those moving the lower jaw, the head, and the
trunk of the body, are, at different times, and in different instances,
affected by it.  In this  state the patient does not walk  steadily; his
gait resembles a jumping or  starting;  he sometimes  cannot walk
at all,  and seems palsied; he cannot perform the common and ne-
cessary motions with the affected arms.   This convulsive motion
is more or less violent; and is constant except during  sleep,  when,
in most instances, it ceases altogether.  Although different muscles
are sometimes successively convulsed, yet in general, the muscles
affected in the early part of the disease remain so during the course
of it.  Articulation is  now impeded, and is  frequently completely
suspended.  Deglutition is also occasionally performed with diffi-
culty.   The  eye loses  its lustre and intelligence ;  the countenance
is pale and expressive of vacancy and languor.  These circum-
stances give  the patient a fatuous appearance.   Indeed there is
every reason to believe that when the complaint has  subsisted for
some time, fatuity to a certain extent interrupts the exercise of the
mental faculties."
  Thermaier gives a case in  which it was connected with a deeply
melancholy temperament, and the limbs were in a state of constant
snatching and trepidation :* but this  is a rare  concomitant;  nor is
fatuity a constant sequel of it even in  its most obstinate and chronic
form.  The present author has met with various instances in which
the disease has continued with considerable violence from  an early
period to  old age, without  making any inroad whatever on the
mind,  or  even spreading to  any  other  joints, limbs, or muscles,
than those at first affected.   He once knew a  man under the ha-
bitual  influence of this complaint who was  a good orator, always
reasoning with great clearness, and  delivering himself with much
animation.  The movements of his arms were indeed in ungrace-
ful snatches, and the muscles of the neck frequently evinced  a
like convulsive start, yet not so as to intercept the flow of his pe-
riods,  or  to abridge his  popularity.   He knew another person for
many years severely afflicted with  the  same  complaint, who was
an excellent musician, public singer, and composer of music ; and
this, too,  notwithstanding that he was blind  from birth.  The per-
son alluded to is the late Mr. John Printer ofthe Foundling Hospi-
* Consil. Lib. II. cap. xi. 
292
NEUROTICA.
[CL.  IV.—OR. HI.
 tal.   In walking he was always led on account of his blindness, and
 used a staff on account of the unsteadiness of his steps; but, not-
 withstanding every exertion, his gesticulation was extreme, and so
 nearly approaching the  antics of a buffoon, that it was often difficult
 for a spectator to suppress laughter. Yet in singing and playing he
 had a perfect command over the muscles of the larynx and of the
 fingers; his tones were  exquisitely clear and finely modulated ;
 but his neck and head curvetted a  little occasionally.   He died
 when about sixty years  of age, without ever exhibiting any debility
 of intellect.
   There is a singular form of this disease which has been called by
 some writers malleatio, consisting in a convulsive action of one or
 both  hands which strike the knee like a hammer.  In this case the
 hands are  usually open, but  sometimes clenched.   Morgagni* re-
 lates a case in which it  came on even in the sound hand, if the fin-
 ger of the affected one  were extended.   If the motion be forcibly
 stopped, the convulsion becomes afterward  still more violent and
 general.
   Where the system is disposed to hysteria the paroxsm is  some-
 times extremely vehement, and partakes of the constitutional dia-
 thesis, making an approach to epilepsy, but distinguished from it
 by a continuance of consciousness and sensibility.  Dr. White, of
 York, has  given us a striking example of  this mixed affection in a
 lady forty-two years of age, who " had always a very weak system
 of nerves," and was rendered speechless for an hour or two upon
 any sudden surprise.  In  November, he tells us  she was affected
 with a fresh paroxysm, which, upon being  sent for, he describes as
 follows:—" She complains of a violent pain in the  right side of her
 face, and of universal erratic aches and soreness. There is a scorch-
 ing heat all over the skin, except  from the feet up to the ancles,
 which are  as cold as marble.  Pulse not quickened but full;  mouth
 dry but no great thirst; body costive, which is indeed her natural
 habit, so as to oblige her to the frequent use of magnesia.  She is
 regular as  to the menses,  the return of which she expects in  five
 or six days.  Appetite good, rather voracious;  but  her spirits al-
 ways  low after a full  meal, especially dinner.  Has  a violent pain
 in the loins, which often  shifts from hip to hip : the  leg of the aching
 side being so much affected  with stupor and numbness, that she
 drags  it after her in walking.  She falters in her  speech at times,
 but this does not continue long. All the muscles ofthe body evince
 convulsive motions ; not simultaneously but successively : thus, her
 face is first violently affected, then her nose, eye-lids, and whole
head, which is thrown forcibly backward, and often twitched from
 one side to the other with exquisite  pain.  From this quarter tne
 convulsive action removes first into one arm, and then into the other;
after which both legs immediately become convulsed with violent
and incessant motions,  and  in this manner  all the  external parts
• Pe Sedibus, X. 16, 
GE. HI.—SP H.]      NERVOUS FUNCTION.
293
 of her body are affected by turns.  She is all the time perfectly sen-
 sible, and knows what limb is going to be attacked next, by a sen-
 sation of something running into it from the  part already convulsed,
 which she cannot describe in words : but the foretoken has always
 been found to be true, though the transition is  surprisingly quick.
 She is easiest in a prone posture."  " Such," continues Dr White,
 " has been her situation upwards of forty-eight  hours with searce a
 moment's remission, by which she complains of great and univer-
 sal soreness.  No words can convey an adequate idea of her odd
 appearance : and I do not in the least wonder  that in the times of
 ignorance and superstition, such diseases were ascribed to super-
 natural causes and the agency of demons."*   Even Dr. White him-
 self applies to it, perhaps in  imitation to Sauvages,  the  name  of
 hieronosos.
   The predisponent cause  of this disease is an irritability of the
 nervous system  chiefly dependent upon debility, and particularly a
 debility ofthe stomach and its collatitious organs.  Most ofthe dis-
 eases  of children  are seated in this quarter;  and it  is from this
 quarter therefore, that chorea commonly takes its rise, and shows
 itself in an early period of life ; the ordinary occasional causes be-
 ing bad  nursing, innutritious  diet, accumulated feces,  worms,  or
 some other intestinal irritant.
   About the age of puberty there is another kind of general irri-
 tation that pervades the system;  and where this change  does not
 take place kindly, which is frequently the casein weakly habits, the
 irritation assumes a morbid character, and is exacerbated by a con-
 gestive state of the vessels that constitute its more  immediate seat:
 and chorea takes its rise from this cause.
   In  effect where the predisponent cause of an  irritable state ofthe
 nervous system  is very active and predominant, a local or tempo-
 rary excitement of any  organ, and almost at any period of life, by
 increasing the irregular flow  or disturbed balance of the  nervous
 fluid, will give rise to the convulsive  movements of chorea: and
 hence it is that  we find  it so  frequently united with  an  hysteric
 diathesis.  On this account it has  been produced by a fright,! by a
 wound penetrating the brain through the orbit of the  eye,| by an
improper use  of lead, mercury or some other metal,§ and by sup-
 pressed cutaneous eruptions.||
  From this view ofthe general nature and origin of the disease,
 we can be at no loss to account for the great benefit which has been
 derived from  a  steady course of brisk purging in recent  cases or
 those of early  life:  for this, while  it carries  off the casual acrimo-
• Edinb. Med. Comment. Vol. IV. p. 326.
f Stoll, Rat. Med. Part III. p. 405.
t Geash, Phil. Trans. Vol. LIH. 1763.
§ De Haen. Rat. Med. Part. III. p. 202.
I|  Wendt, Nachricht von dem Krankeninstitut zu Erlangen, 1783. 
294
NEUROTICA.
[CL. IV—OR. HI
ny, or unloads the infarcted viscera, seems at the same time to act
the part  of a revellent, and to prohibit the return of the paroxysm
by a new excitement.  It may appear perhaps strange to those who
have not thought upon the subject, that where the disease has pro-
ceeded from intestinal irritation, it should be carried off by  intesti-
nal irritation also.   But the irritations  are of very different kinds:
and it is so far from following of necessity that, because one kind of
irritation applied to a particular organ excites a particular effect in
a remote part, another will do the same, that the converse is more
commonly true, and that  any other kind of irritation applied to the
same organ, by exciting a new action, will be the most effectual way
of taking off or preventing such effect.   And it is upon this ground
alone that we often endeavour to cure  rabies, trismus, and tetanus,
by laying open the original  wound to a  considerable  extent, or
the application of some  new stimulus that may answer the same
purpose.
   The principle being a  general one it does not seem of much con-
sequence what purgative is employed, provided it be sufficiently
powerful:  though, were  worms are suspected, the essential oil of
turpentine, from its  being a  good anthelmintic, as well as a good
cathartic, will be found one of the best.  It seems, indeed, to have
been occasionally serviceable where worms have not been the cause,
for Dr. Powell relates a case in which he completely effected a cure
in a girl of seventeen by  a single dose of fluidounce :*  and hence
its antispasmodic power may  at times co-operate with its purgative
quality as well as its vermifuge power.
  Sydenham who recommended an alternation of bleeding and purg-
ing, probably derived far more advantage from the latter than the
former part of his  plan: it has been found peculiarly advantageous
in the hands of Dr. Hamilton : and Dr. Parr, who ascribes to Syden-
ham the first hint he obtained upon this subject, affirms that having
pursued the purgative plan with  great activity through sixty cases
of the disease which occurred to him in a course of twenty years'
practice, he was  successful in the whole of these cases except one  ;
and that in  all but this one he  found the disease yield, not only soon,
but with few instances of a relapse.
  There is, therefore, no malady whatever, perhaps,  that calls so
peremptorily for stimulating  the abdominal viscera into increased
action ; and as chorea often  precedes puberty or occurs  about this
period of life, we have another reason  for  directing an augmented
stimulus to the lower regions of the living frame, and rousing into
energy the tardy development ofthe sexual organs.
  But it is  necessary  to attend to the state of the system generally
as well as locally ; to take off the  constitutional weakness and irrita-
bility, as well as the topical  acrimony, and especially  where  the
disorder has acquired a chronic character.  And hence other reme.
* Transact. Medico-Chir. Soc. Vol. V. p. 358. 
GE. HI.—SP. II.]
NERVOUS FUNCTION.
295
 dies must be had recourse to as well as purgatives.   The German
 physicians have strongly recommended the use of antispasmodics
 and sedatives, and especially musk, bella donna and fox-glove, with
 a view of allaying the irregular action, and Dr. Cullen speaks as
 decidedly of the benefit of opium.*   But the advantage derivable
 from these seems to be merely palliative ; and the stimulant tonics
 and alterants promise a better success.
   The cuckoo-flower or lady's-smock, cardamine firatensis, so com-
 mon to the meadows of our  own country, was at onetime supposed
 to be of essential  service  in the cure of this and various  other
 spasmodic affections.  Michaelis, who is a great advocate for its
 use, employed it in the proportion of a drachm every six hours.f
 But it owed of late its reputation in this  country chiefly to the re-
 commendation of Sir George Baker who published  five cases of
 spasmodic diseases, two of them instances of chorea, in  which he
 conceived a  most decided  benefit was  obtained from the use of
 these flowers.   In the hands of later practitioners, however, they
 have  not supported  their credit, and have consequently sunk into
 disuse.  The leaves of the Spanish or Seville orange-tree as a
 stimulant and tonic bitter, are far more  entitled to attention, not
 only in this but in various other cases of convulsive spasm.  They
 were  first recommended to De Haen by Westerhoef, who as well
 as Werlhoff employed them with considerable  success: and they
 were afterwards  introduced by Hoffman, as a valuable ingredient,
 into his celebrated stomachic elixir;  and for the same reason form-
 ed a part in the composition of Whyt's stomachic tincture.  They
 were  given in the form of decoction, and in that of powder :  in the
 last case the dose is from half a drachm to a drachm, three or four
 times a day.
   The metallic salts andoxydes have been tried in every form, with
 apparent benefit in a few individual cases, but without any decided
 or general success.  The most popular of these were at one time the
 flowers of zinc.  Dr. Gaubius first brought them into reputation,
 and gave to the metal the name of cadmia ; and according to his
 statement they worked wonders in all clonic affections whatever,
 chorea, hooping-cough,  hysteria,  convulsion,  and epilepsy: on
 which account they were afterwards  employed upon  a still larger
 and more popular scale by the famous empiric Luddeman, under
 the name of luna fixata.J  This medicine has,  however,  by no
 means been able to  maintain its high character;  and even Stoll,
 who once employed it as a favourite, at length abandoned  it as
 good for nothing, and returned to the bella donna in its stead, which
 he employed in the form of an extract from  the juice of  the root;
 giving it from a sixth to a quarter of a grain every quarter of an hour,
and, as he affirms, with very  great advantage.
* Mat. Med. Part II. Chap. VI. p. 246.
f Richter Chirurg. Bibl. B. v. p. 120.
t Dissertatio Medicai naug. de Zinco. Aut. Jacob. Hart. Lugd. Bat. 4tc 
296                     NEUROTICA.          [CL. IV—OR. III.

  For the  information  of  practitioners  in  general, however, it
should be noticed that when the  stomach has reached its full dose
of this medicine, it will  still bear a full dose  of ammoniated copper
in conjunction with it, by which means the metallic power may be
very much  increased.   Thus  a  delicate  stomach will  rarely bear
more than two grains of either of these without nausea ; yet it has
been found that the same stomach will continue at ease under a
mixed powder of two grains of the former,  and two and a half of
the latter, at a dose.*
  The preparations of iron have for the most part been found too
stimulant:  but silver in the form of its nitrate seems to have been
radically successful in various  well established cases.  It has com-
monly been  given in the guise of pills, from one to five or six grains
to a dose.  Yet the metal that seems by far most  entitled to credit
in the present day, is arsenic;  for it is difficult to resist the evidence
from various quarters in which it seems not only to  have produced
benefit, but to have established  a perfect cure.  It is commonly
given in the form of the solution of the London College, in doses
of ten drops to  a  youth of twelve or fourteen  years of age three
times a-day, increasing  the dose as there may be  occasion.
  In this disease, however, as in various others, it will often  be
found, and the remark  is well worth attending  to, that different
remedies are required  for different  individuals, even where the
cause is obviously the same ;  and that what  produces no benefit in
one case, is highly advantageous in  another.  Camphor in large
doses has succeeded, where turpentine or the nitrate of silver has
completely failed ; and  a brisk  purgative plan has  sometimes an-
swered where all the preceding have proved of  no use whatever.
It is hence, we are to reconcile Dr. Cullen's peculiar attachment to
the bark, which he tells us he has found " remarkably useful" and'
prefers to any of the preparations of  copper, zinc or iron:f while
Dr. Powell informs  us  that  in a lady  of seventy years of age of a
very irritable habit, attacked for the first time with  this complaint
severe paroxysms  at night, he found musk, in doses of ten grains
every six hours, succeed and produce a cure, when purging, blis-
tering, the ammoniated  spirit of amber, nitrate of  silver, ammoniat-
ed  tincture of valerian,  castor, muriated tincture of iron, bark, and
opium had all failed.f
  I am inclined, however, to think that reports of a successful use
of medicines under the circumstances here stated should be received
with some  degree of caution : for first the very repose itself from
so aclive a campaign of the Materia Medica may have proved the
best means of cure; and next, some mortal blow,  though it did not
immediately show itself, may  have been  given to the disease from
so extensive an assault,  before the plan of attack was changed, and
* Letter from Dr. Ocier to Dr. A. Duncan, Edin. Med. Com. HI. p. 191.
f Mat. Med. Part. II. ch. II. p. 112.
\ Medic. Transact. Vol. V. p. 192. 
GE. HI.—SP. II.]       NERVOUS FUNCTION.
297
the general charge, so to speak, converted into an affair of outposts.
And hence the musk, as being the last medicine  employed,  may
have run off with the claim of victory, as an empiric often  does
when called in at the lucky moment for him  in  which a disease is
on the point of yielding to ihe plan of a more skilful, though dis-
carded, practitioner.
  How far in this disease voltaism or electricity, as warmly recom-
mended by De Haen, may be depended upon it is difficult to deter-
mine. Like the preceding remedies, either appears to have been ser-
viceable in some cases, but they are far outbalanced  by the instances
in which they have  failed.   It is very possible that  in some cases a
long and punctual discipline ofthe affected limbs, where the disease
is not  very  severe, to  regular and  measured  movements,  may
progressively recal  them to their wonted order and firmness,  as a
like discipline of the vocal organs in stammering has not unfre-
quently been found to restore  them to a regularity of utterance :
and with this view the gymnastic  exercises of dancing, whose
movements are all measured with the  greatest nicety, and which
was so much depended upon in former times, and asserted to have
been so successful, may  be well worthy of attention in the present
day, provided it be kept within due bounds,  and not be  carried to
:he ridiculous extreme we had occasion to notice a few pages above.
                        SPECIES III.

              SYNCLONUS  BALLISMUS.




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

This is the scelotyrbe festinans of Professor de Sauvages, and
the shaking palsy of Mr Paikinson.* The genus Tantarismus of Ba-
ligvi, seems to hold an equal point between ballismus and chorea,
and the species usually arranged under it may be resolved into the
one or the other, and are done so under the present arrangement.
  The term Ballismus ((3*AA< «?«>$,) is not used in a  medical sense
by the Greek writers, but occurs in Athenseus  and  various  other
authors, in the literal sense of tripudiatio, or  "tripping, capering,
curvetting on the toes :" from (ZxtMgu, "tripudio, pedibusplaudo ;"
and is hence, well designed to express the characteristic feature of
the patient's being thrown involuntarily, when be attempts to walk

                 • Essay on the Shaking Palsy.
  VOL. III.—38 
29S
NEUROTICA.
CL. 1V.-OR. HI
"on the toes and fore-part of his feet," to employ the language of
Mr. Parkinson, " and impelled unwillingly, to adopt a  running
pace :" or as Dr. Cullen, who  has indiscriminately blended  this
species with the preceding, expresses it, to " various fits of leaping
and running."*
   Ballismus, however, though  not  found in  the  writings of the
Greek physicians, has been long established as a technical term in
the medical nomenclature of later times,  in which it has been used,
with little discrimination, to import almost  all or any of the species
that belong to the present genus.
   Sauvages observes that while chorea,  or scelotyrbe Sancti Viti
attacks the young, ballismus, or scelotyrbe festinans-, attacks those
in advanced life ; and the remark is founded on a just distinction of
the characters of the two diseases :  though  there are other features
also of as striking a peculiarity, and which are here introduced into
their respective definitions.   Shaking palsy, as it is called by Mr.
Parkinson, who has adopted the colloquial name, is by no  means a
correct designation ;  for though in  the disease before us there is a
weakness of muscular fibre, and a diminution of voluntary power in
the parts affected, there is none of that diminution of sensation by
which  palsy is peculiarly characterised.  Mr. Parkinson's  descrip-
tion of the disease, however, is the best we have hitherto had, and
is as follows :
   " So imperceptible is the approach of this malady, that  the  pre-
cise period of its commencement is seldom recollected by the pa-
tient.  A slight sense of weakness  with  a proneness to trembling,
sometimes in the head, but most commonly in  the  hands or arms,
are the first symptoms noticed.  These affections gradually increase,
and at  the period, perhaps of twelvemonths, from their first being
observed,  the  patient, particularly  while walking,  bends  him-
self forward.   Soon after this his legs suffer similar agitations and
loss of power with the hands or arms.
   " As the disease advances, the limbs become less and less capable
of executing the dictates of the will, while  the unhappy  sufferer
seldom experiences even a few minutes'  suspension of the tremu-
lous agitation :  and should it be stopped in  one limb by a sudden
change of posture, it  soon makes its appearance in another. Walk-
ing, as it diverts his attention from  unpleasant reflections, is a mode
of exercise to which  the patient is in general  very partial.  Of this
temporary  mitigation of  suffering,  however, he is now deprived.
When he attempts to advance  he  is  thrown  on the toes and fore
part of his feet, and impelled unwillingly to adopt a running pace,
k^danger of  falling on his face at every step.   In the more ad-
j^tneed stage of the disease the  tremulous motions of the limbs oc-
cur during sleep, and augment in  violence till they awaken the
patient in much agitation and alarm.  The  power of conveying the
food to the mouth is  impeded, so that he  must submit to be fed by
* Pract. of Phys. Part II. Book IH. ch. iii. MCCCLIII. 
GE. HI.—SP. III.]      NERVOUS FUNCTION.                 299

others.   The torpid bowels require stimulating medicines to excite
them into action.  Mechanical aid is often necessary to remove the
feces from the rectum.  The trunk is permanently bowed ; muscu-
lar power diminished ; mastication and deglutition difficult; and the
saliva constantly dribbles from the mouth.   The agitation  now be-
comes more vehement and constant: and when exhausted nature
seizes a small portion of sleep, its violence is such as to shake the
whole room.  The chin is almost immoveably bent down upon the
sternum ; the power of articulation is lost; the urine and feces are
discharged involuntarily, and  coma, with slight delirium, closes the
scene."
   The remote cause is involved in some obscurity. Long exposure
to damp vapour, by lying from night to night on the  bare earth, in
a close unventilated prison, seems to have produced  it;  and possi-
bly other causes of chronic rheumatism : and hence it has frequent-
ly supervened on chronic rheumatism itself.  Long indulgence in
spiritous potation has often given rise to it; and probably any thing
that debilitates the nervous power.
   And on this account miners, and others exposed to thejdaily ex-
halation of metallic vapours,  and  especially those of mercury, are
frequentand severe sufferers, of which Hornung has adduced many
interesting examples from the quarrymen in Carniola.*   It has also
followed upon worms in the intestines ;t and in this case, has some-
times assumed a periodical type4
   The part of the nervous organ  more immediately affected has,
also, afforded some ground for controversy.   Bonet ascribes it to a
diseased state of some portion of the cerebrum, and has given ex-
amples of its being found, on  dissection, to contain, in various quar-
ters, proofs of scrum, sanies, and other morbid secretions.§  But the
misfortune is here, as we have already observed in similar appear-
ances after mania,  that it is impossible for us  to determine whether
these diseased fluids give rise to the  disease or the disease to them.
And hence  Mr. Parkinson  seems  to pay  no attention to them, at
least as a cause, and fixes the seat of the  affection in the cervical
part of the spinal marrow, from which he supposes it to shoot up by
degrees to the medulla oblongata.  We have already shown suffi-
eiently in the Physiological Proem to the present Class,  that the
nervous fibres which ramify over  the extremities, whether sensific
or motific, originate from the chain of the  spinal marrow ; and we
have also shown, in discussing the diseases of trismus, tetanus, and
lyssa, how acutely one extremity of a chain of any kind, and parti-
cularly  of a continuous  fibrous chain, sympathizes with another:
and there can be no difficulty, therefore, in  conceiving that wher-
ever the cutaneous ends of t,he nerves  of  motion are torpified, or
 » Cista, p. 280.
 f Commerc. Liter. Nor. 1743. p. 55.
 t Act. Nat. Cur. Vol. II. Obs. 143.
.,§ Sepul. Lib. I, Sect. XIV. Obs. 7, 9. 
300                      NEUROTICA.          [CL. IV.—OR. HI

otherwise affected by any ofthe causes just adverted to, the verte-
bral column must itself very  seriously participate in the mischief,
and consequently the upper or cervical part of this column: and
that from this point the  disease must ramify to the brain before the
general functions ofthe system become affected, as in its latter stages.
  The remedial process is not very plainly indicated. Vesicatories,
and other stimulants applied  to the neck or even the dorsal verte-
brae, have appeared useful.   A seton or caustic, and especially the
actual cautery, as practised so generally in France,  might possibly
be of more avail applied to different parts ofthe spine.  Beyond
this an active purgative  system, as strongly recommended by Ried-
lin, has certainly been found efficacious ;* and the solution of arsenic
bids as fair for a favourable result here as in the preceding species.
Stark tried musk, and carried it to very large doses frequently re-
peated every day :f but it does not seem to have produced any de-
cisive success.
  Friction of the affected extremities resolutely persevered in by
a skilful rubber, with stimulant embrocations  of camphor or am-
monia, should also be tried in an early stage of the  disease, and be
alternated  with  the use ofthe voltaic trough.  Here, too, we may
expect to derive advantage from a free  use of diaphoretic and alter-
ant apozems,  as the decoction of the woods,  and especially where
the disease is suspected to be of a rheumatic origin:—to which
may be added a regular course of bathing  in the Bath springs.
                        SPECIES  IV.

                       RAPHANIA

                         Itajrfiattfa.

SPASTIC CONTRACTION OF THE JOINTS ; WITH TREMBLING AND PERIO-
                         DICAL PAINS.

Of this species we know little or nothing in our own country.  It
was first described by Linneus, who called it Raphania, from his
supposing it to be produced  by eating the seeds of the raphania
Raphanistrum, a wild raddish or sharlock that grows indigenously in
our native corn-fields as well as in the corn-fields of most parts of
Europe.   By other writers, as Hermannand Camerarius, it hasbeen
ascribed  to the use of darnel or  rye| infested with the spur, or
* Lin. Med. 4695. p. 101.
•}■ Klinische und Anatomische Bemerkungen.
* Abhandlung von der Kriebelkrankheit, &c. Cassel, 1775-8,
  Be Lall. Lolio. temulento. Tubing, 1710, 
GE. HI.—SP. IV.]      NERVOUS FUNCTION.
301
ergot, or some other parasitic plant, which, as we have already ob-
served, is a frequent cause of other very severe complaints, as mil-
dew mortification (gangrjena ustalaginea)* and erythematous
plague (pestis  erythematica.)\  All these diseases, however, are
so distinct from each other, that though there can be little doubt of
their  being severally produced  by some poisonous material con-
tained in the patient's food, the poison must be of different kinds,
and we do not seem to be acquainted with the cause of this differ-
ence; and hence the question  has given rise to  much controversy,
and been discussed with some warmth on the Continent;  for, while
the greater number of writers refer the disease  to the raphania,  or
spurred rye, (secale cornutum), many deny that it  is produced by
either of these,! a°d Lentin ascribes it to the honey-dew  of various
plants,§ concerning which we shall have to speak in the fourth vo-
lume, under parurta mellita.  That it is a vegetable poison, how-
ever,  seems to be admitted by common  consent, and  it is possible
that the poison is not confined to a single plant.
  That many poisonous plants have a direct  tendency to  affect the
nervous system and excite entastic or clonic spasm, or a mixture of
the two according to the  peculiarity of the poison itself,  or of the
habit into which it is introduced we have frequently had occasion
to notice already, and particularly under the head of eruptive sur-
feit (colica cibaria efflorescens.)||   This is particularly the case
with several of the deleterious agarics or funguses, some of which
seem to operate chiefly on the sensific nerves,  and produce  a ge-
neral stupor;  and others on the motory, and produce palpitations,
cramps, or convulsions over the whole system.H  It is very proba-
ble, therefore, that the  ordinary cause assigned for the present spe-
cies of disease is the true one.
  There is an excellent paper upon this subject in the Amoenitates
Academicae** furnished by Dr. Rothman, a pupil of Linneus, from
which the disease seems to be  not unfrequently epidemical, and
always to commence in the autumn.  It  is  found, however, only
among the lower orders of people,  and, in the  epidemic referred
to, is sufficiently traced to impure admixtures with their grain, and
the employment of this vitiated grain in too new a state. Dr. Roth-
man delineates the disease  from actual observation, and does not
believe it  to be a new malady, as generally supposed, but thinks he
has traced it in the writings of various authors  from the year 1596
to 1727; which would establish, moreover, that it has been common
to other parts of Europe as well as to Sweden. And in confirmation
* Vol.H. p. 608.
f Id. p. 427.
\ Wichmann, Beytrag. zur Geschichte der Kriebelkrankheit. Leips. 1771-8.
§ Beobachtungen einiger Krankheiten, &c.
H Vol. I. p. 141.
f See Heberden, Med. Trans. II. 218,
*» Tom. VI. Art. CXXHI. 1763. 
302
NEUROTICA.
[CL. IV.—OR. Ill
of this we may observe, that Dr. Mercard* describes a disease very
much resembling raphania that appeared at Stade in the winters of
1771, 1772, was evidently epidemic,  and accompanied with symp-
toms of fatuity, or that narcotic effect which many deleterious plants
are sure  to produce.
  Dr. Cullen who has generalized far too much his description of
chorea, in his Practice of Physic, seems to have  embodied this spe-
cies as well as the preceding in the common delineation, and hence,
when he  tells us that  " there  have been instances of this disease
(chorea) appearing as an epidemic in a certain corner of the coun-
try ,"t there can be little doubt  that he alludes to the species before
us originating from the cause now assigned,  although without some
such interpretation as  the present the  passage  is not  very intelli-
gible.
  The disease commences with cold chills and lassitude, pain in
the head, and anxiety about the praecordia.   These symptoms are
followed  by spasmodic twitchings and afterwards rigid contractions
of the limbs or joints, with excruciating pains,  often accompanied
with fever, coma or delirium, sense of  suffocation, and a difficulty
of articulating distinctly.  It continues from, eleven days to three or
four weeks ; and those who die generally sink under a diarrhoea or
a paroxysm of convulsions.
  The warm antispasmodics, as valerian, castor, and camphor, ap-
pear to have been employed with decisive success.  An emetic,
however, given at the onset of the symptoms, as recommended by
Henman, would probably cut  short  the course of the disease, and
mitigate  its violence.   This writer advises also blistering or bath-
ing with Dippell's Animal oil.|  Camphorated vinegar, as employed
by other  practitioners, would probably be found  a more  useful em-
brocation^
  Towards the close of the disease purple exanthems or vesications
are said to  be sometimes thrown out, which approximate it to mil-
dew-mortification, and the  erythematic pestis,  both which, as we
have already observed, have been traced to a similar cause.
• Medinische Versuche. Zweyter Theile, 8vo. Leipzig.
f Part 11.  Book HI. Chap. iii. MCCCLUI.
t Abhandl. von der Kriebelkrankheit.
§ Nechricht von der Kri^elkrankheit 
 GE. III.—SP. V.)      NERVOUS FUNCTION                  3^3


                         SPECIES V.


               SYNCLONUS BERIBERIA

                    Heritors.  Eartoers.

 SPASMODIC RIGIDITY OF THE  LOWER LIMBS IMPEDING LOCOMOTION •
   OFTEN SHOOTING TO THE  CHEST,  AND OBSTRUCTING THE  RESPI-
   RATION AND THE VOICE ; TREMBLINft AND PAINFUL STUPOR OF THE
   EXTREMITIES ; GENERAL EDEMATOUS INTUMESCENCE.

 Bontius seems first to have introduced the term beriberi or beri-
 beri a into medical nomenclature, and tells us it is of oriental origin :*
 and Sauvages has  hence copied it into his list of "nomina barbara
 seu nee Graeca, nee Latina."  Mangetus affirms that  the  disease
 was known  to Erasistratus, but certainiy not under this  name.
 Eustathius, however, has jSc;|3<f <, but in the  sense of « concha or
 ostreum" « conch  or shell,"—and tells  us that it is a term of Indian
 origin.   He might have said, with more propriety, of oriental ori-
 gin, for  it is common both in its primary, and its duplicate form
 na or ma,  pan  or rzna-ia to the Hebrew, Chaldee,  Syriac'
 and Arabic, in which last it  is  berabir,  and in all  of them is a
 nomadic term, importing tillage and its  production* which is grain
 or  pasturage and its production which  is sheep, or other  cattle •'
 and hence, probably  the origin of brebis or  sheep, in the French
 tongue.  The term is said to be applied to this disease in India
 from the patient's  exhibiting, in walking,  the weak and tottering
 step of a sheep that has been over-driven.
   This disease, though common to various parts of India, is chiefly
 met with on the Malabar coast and  in  Ceylon : and seems to be
 produced by sudden transitions in the atmosphere  from dry to
 damp, and  from sultry  calms to freshening breezes, by which the
 nervous and absorbent systems, are peculiarly debilitated and torpi-
 fied.  In this region it attacks both natives and strangers, but par-
 ticularly  the latter, during the rainy season  which commences in
 November and terminates in March ; through a great part of which
also, the  land-winds blow from the neighbouring mountains  every
 morning  about sun-rise with great coolness ; and hence those who
 sleep abroad, or without sufficient shelter, are  equally exposed to
 the influence of a penetrating chill and damp.
  Fresh troops, partly from  their being new to the climate, but
 chiefly from their want of a sufficient degree of caution, very fre-
quently  suffer severely from this complaint  so long as the rainy
 season continues.   Thus we learn from Mr. Christie  that the 72d
* De Medicina Indorum, Cap. 1 
304
NEUROTICA.
[CL. IV.—OR. III.
 regiment was severely attacked with it in the summer of 1797, not
 many months after its arrival, and continued to suffer from it till
 the ensuing  spring ; and that the 80th regiment which relieved the
 72d in March 1797, was equally attacked with it in the ensuing
 November.  It is, however, in all such cases most frequently to be
 found amongst those who have previously weakened their constitu-
 tions by sedentary habits or a life of debauchery : and particularly
 where too free an indulgence in spirits has co-operated with seden-
 tary habits, as among the tailors and shoemakers  of a battalion,
 who, in order to give them time to work at their respective trades,
 are often excused from the duties of the field, and by their double
 earnings, are enabled to procure a larger quantity of spirits than
 other men.  And we may hence in some degree  account for  Mr.
 Christie's remark that during his stay at Ceylon,  he  never  met
 with an instance of this complaint in a woman, an officer, or a boy
 under twenty.
   The disease commences with a lassitude and painful numbness of
 the whole body, the pain sometimes resembling that of formication.
 The legs and thighs become stiff, the knees are spasmodically re-
 tracted, so that the legs are straightened with great difficulty and
 instantly relapse into the retracted state, whence  the patient is apt
 to fall if he attempt to walk.   In  some cases, indeed,, the  motory
 and sensific power, instead of flowing through the muscles  of loco-
 motion irregularly, does not flow at all, and the limbs become para-
 lytic.  And even where the spasmodic action exists, it often travels
 or extends to other parts of the body, and particularly to the chest
 and the larynx, so that speaking and respiration are conducted with
 great difficulty.
   At the  same time the whole of the absorbent  system exhibits
 equal proofs of  torpitude, the legs first,  and afterwards the entire
 surface of the body becomes bloated and edematous, and  all the
 cavities,  particularly those of the chest, are progressively loaded
with fluid : and hence towards the close of the disease, where it ter-
minates fatally, the dyspnoea is extreme, and accompanied with an
intolerable restlessness  and anxiety, and constant  vomiting; the
muscles are convulsed generally ; while the pulse gradually sinks,
the countenance becomes livid, and the extremities cold.
   Such is the  course of the  disease as it shows  itself at Ceylon,
where it seems to rage more severely than on the Malabar coast,
 and where we are told by  Mr.  Christie,  inspector general of  the
 hospitals  at this station, whose account is confirmed by Mr.  Col-
 houn,* that its progress is so rapid that the patient is often  carried
 off in six, twelve, twenty-four, or thirty-six hours  from  its onset,
though it ordinarily runs on for several weeks.
   The curative intention is to re-excite the  absorbent system and
  *  Essay on the Diseases incident to Indian seamen, or Lascars on long
Voyages; byW Hunter, A. M  &c.
    Lord Valentia's Travels, Vol. 1. p. 318, 
GE. HI.—SP. V.]       NERVOUS FUNCTION.
305
 the affected branches of the nerves to a discharge of their proper
 functions by a process of diaphoretics and stimulants.  Squill pills
 and calomel are chiefly depended on for the latter, and James's
 powder for the  former, though the compound  powder  of ipeca-
 cuan seems better calculated for the purpose, as containing a seda-
 tive admirably adapted for allaying nervous irregularities.
   On the Malabar coast, it is no uncommon practice to excite per-
 spiration in this complaint by burying the patient in a sand bath : for
 which purpose a hole is dug in the  sandy soil,  into  which he is
 plunged as deep as to his neck, and confined there as long as he can
 bear the  heat of the sand  that surrounds him.  The  strength,
 throughout the whole, is supported by cordials, and in  many in-
 stances even by ardent spirits diluted for the purpose ; punch is  a
 common drink on this occasion, and the  refreshing   and  sedative
 power of the acid entitles it to a preference.  To remove the numb-
 ness and pricking or formicative pain from the limbs, friction and
 stimulant liniments are applied locally, and not unfrequently the
 legs are plunged into  a pediluvium.   And where the disease as-
 sumes an alarming appearance, and the spasmodic symptoms  are
 very violent, recourse is had to a hot bath, and the strongest cordials
 and antispasmodics as brandy, sulphuric ether, or its  aromatic spi-
 rit, and laudanum, which it is found sometimes necessary to conti-
 nue for several weeks.
   In convalescence the patients should be removed as soon as may
 be to a drier and more equable temperature, and be  put upon the
 ordinary plan of tonics, regular exercise, and nutritive diet.  In
 milder cases they generally recover  with the shifting of the mon-
 soon, which carries off the  remote  cause of the disease, and brings
 a change of temperature home to them.
   Beribery has not been hitherto described as existing in any other
 part of the world, and if it  should be  found it will probably exhibit
 a modification of some of the  symptoms according to the quarter in
 which it appears. I am induced to  make this remark from observ-
 ing  in  the Transactions of the Medico-Chirurgical  Society,* an
 account of a very singular spasmodic disease by Dr. Bostock, which
 evidently belongs to the present genus, and  seems to be a variety
 ofthe present species assuming a chronic form. The palient, who
 was  in  the middle of  life, was  first attacked with achings in the
 lower limb on one side, accompanied  with a difficulty and irregu-
 larity of motion, which  soon spread to the other side, and then gra-
 dually to the throat, so as  to  hinder deglutition except with great
 pain and severe exertion : the larynx next became affected so as to
 prevent speech, and afterwards the back of the neck,  the muscles
affected being the voluntary alone.   From the spastic rigidity of
the limbs they were both bent and straightened with a like difficul-
ty.   The pricking pain like that of pins, or of a limb awaking from
stupor, common to the extremities in  beribery, was  present here

                       * Vol. IX. Art, I. p. l
  ^ol. in.—39 
306                      NEUROTICA.           [CL. 1V.--OR. HI.

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

NEUROTICA.
                        ORDER IV.

                     8YSTATTCA.

diseases affecting  several or all the  sensorial  joiners
                     stmultaneottslg,

IRRITATION OR INERTNESS OF THE MIND EXTENDING TO THE CORPO-
  REAL SENSES OR THE MUSCLES ; OR OF THE CORPOREAL SENSES OR
  THE MUSCLES, EXTENDING TO THE MIND.

The sensorial powers are those which are dependent on the senso-
rium or brain as their instrument or origin; and are three in num-
ber, the intellectual, the  sensific, and the motory.  Thus far we
have only contemplated these as they are affected singly, or, where
more are affected than one, as influencing the rest only secondarily
or sympathetically.   The diseases of the  present order are of a
more  complicated origin  and nature, and affect several or  all the
sensorial powers conjointly from the first.  The order is hence de-
nominated systatica, a Greek compound from <rwirrupt," congre-
dior, consocio."   Syncoptica might have been employed and upon
as large a scale, so as to  denote increased as  well as  diminished
action, impellentia as well as concidemia; but that this term  is
usually limited to express maladies of the latter kind,  and, conse-
quently, might have produced confusion, since the present order,
like all the preceding, includes diseases evincing different and even
opposite states of action. 
201                     NEUROTICA.          [CL.1V.—OR. IV


                       GENUS  I.


                     AGRYPNIA.

                      Sleeplessness

        DIFFICULTY OR INABILITY  OF OBTAINING SLEEP.

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

    1. AGRYPNIA EXCITATA.    IRRITATIVE WAKEFULNESS.
    2.--------PERT^SA.      CHRONIC  WAKEFULNESS.
                        SPECIES I.

              AGRYPNIA EXCITATA

                Krrftattbe Wakefulness.

SLEEP RETARDED BY MENTAL  EXCITEMENT :  LISTLESSNESS TO SUR-
                      ROUNDING OBJECTS.

On the physiology of sleep and dreaming, we briefly touched under
the genus paroniria or sleep-disturbance in the first order of the
present class, but the subject is  of great extent and complexity,
and cannot be followed up into any detailed explanation in a work of
pathology.  At present, therefore, I can only observe that natural
sleep is a natural torpitude of the voluntary organs of the animal
frame, produced by a general exhaustion of sensorial power in
consequence of an exposure to the common stimulants or exertions
of the day.  And hence, if such  exhaustion do not take place, na-
tural sleep cannot possibly ensue, though morbid sleep undoubted-
ly may as producediby other causes.
  Now it often happens that, from an energetic bent of the mind
to a  particular subject, the sensorial power continues to be secreted
not only in a more than usual quantity, but  for a more than usual
term of time ; and, in consequence of this additional supplv, thcrr 
GE. I.—SP. I.]
NERVOUS PUNCTION.
S09
is no exhaustion at the  ordinary period, and therefore no sleep.
Severe  grief is often a  stimulus of  this kind ;  during which  a
morbid  redundancy of sensorial power continues to be secreted,
followed by a morbid excitement of the system generally, from day
to day, and from night to night, till the frame is  worn out  by the
protracted watchfulness or sensorial erethism. And it is astonishing
to witness in various instances how long the frame  will  support
itself before it is worn out, or the irritation that prevents sleep suf-
ficiently subsides for its return, and particularly where the mind is
labouring under the influence ofthe depressing passions, or of de-
pressing pain.   A hemicrania has kept a person awake for three
months ;* and  a melancholy or gloom on the spirits for fourteen
months.   Overwhelming joy has often a similar effect though sel-
dom in an equal degree, or for so long a period of time.  The mind
may also be intensely directed to some peculiar  object of study;
and the energy of the will becomes in this case a like stimulus to
the secretion of a fresh or protracted tide of sensorial power, so that
the usual exhaustion of the nervous system does  not take place at
the accustomed period.  This is peculiarly the case in a pursuit of
the abstract sciences, or those of a more strictly intellectual nature,
as the higher branches of the mathematics.
   Where the determination of the  mind to a particular subject is
exquisitely intense, whether that subject be a passion or a problem,
by far the greater part  of the sensorial  secretion is expended at
this  particular  outlet; and, consequently, the frame at large, with
the exception of those organs to which such outlet  peculiarly apper-
tains, is so far drawn upon, as a common bank, for a contribution of
sensorial power, that it labours under a certain degree of deficiency,
and, hence, a certain degree of torpitude, so  far as to become insen-
sible to the world around it; making, in this respect, an approach
to the state of mind we have already described under the name of
aphelxia inlenta, or mental abstraction.
   The cure of this species of sleeplessness is to  be accomplished
by allaying the mental excitement by which it is produced.   This
is best  done by recalling the mind from the pursuit that leads it
astray, and a free surrender of the will to  listlessness and quiet.
The perturbation will then subside; the sensorial organs become
tranquillized and inactive;  the secreted tide of sensorial power will
be at its ebb, and the habit of refreshing slumber  resume its influ-
ence.  But where this cannot be obtained by the  mere exercise of
the will, we must call opium or  some other narcotic to our aid,
which, by its revellent stimulus, may coincide with the consent of
the will and produce the exhaustion, and, consequently, the quiet
that is requisite for sleep.
• Bartholin. Hist. Anat. Cent. I. Hist. 64.
 Schenck, Lib. I. Obs. 256. 
 310                     NEUROTICA.          [CL.IV.  OR. IV


                        SPECIES. II.


                AGRYPNIA PERTjESA.

                  (Ehrome Waftefttlness.

  sleep retarded by bodily disquiet; ATTENTION alive to
                   surrounding objects.

 The exhaustion in which the very essence of natural sleep consists
 supposes a perfect quiescence and inactivity of the sensorial powers.
 Uneasiness  of any kind  will become an obstacle;  and hence, an
 aching coldness of the extremities or of any other part will prevent
 it;  an uneasy sensation at the stomach or any other part will prevent
 it;  an absence of the common pleasurable feeling with which we
 ordinarily prepare ourselves for sleep will  prevent it: " And on
 this account," as Darwin observes,  " if those, who are accustomed
 to wine at night, take tea instead, they cannot sleep. And the same
 evil happens from a want of solid food for supper to those who are
 accustomed  to use it; as, in these cases, there is an irksome or dis-
 satisfied feeling in the  stomach."   And hence, also, too great an
 anxiety or desire to sleep, is another cause  of its suspension; for
 this as  a mental  disquiet will only add to the  corporeal disquiet
 which has produced it;  and, as already observed, the emotions of
 the mind must be as quiescent as those of the  body, and the  will,
 instead of commanding or interfering, most tranquilly resign itself
 to the general intention.
  Where  uneasiness of this kind has  been  permitted  to continue
 for  several nights in succession, the sleeplessness is apt to become
 chronic and  to be converted into a habit.  We have hence had ex-
 amples, as noticed with their appropriate references in the volume
 of Nosology, in which vigilance or  sleeplessness has continued for
 a month without intermission ;* for six months ;f and even for three
 years4
  Mr. Gooch gives us a singular case of a man who never slept and
 yet  enjoyed  a very good state of  health till  his  death, which  hap-
 pened in the seventy-third year of his age.   He had a kind of doz-
ing for about a quarter of an hour once a day, but even  that was
not  sound, though it was all the slumber he was ever known to
take.§
  The cure of this disease demands a  particular attention to its
* Griding. Cent. IV. Obs. 90.
f Fanarol, Pentecost. V. Obs. 4.
i Plinii Lib. V. vii. Cap. 51.
§ Medical and Chirurgical Observations, &c. 8vo. 
GE. I.—SP. II.]
NERVOUS FUNCTION.
311
 cause ; for if we can get rid of the organic disquiet on which it de-
 pends,  we shall be pretty sure  to succeed in obtaining our object.
 All irksome chills, and especially those ofthe feet should be taken
 off by a sufficient warmth of clothing; and the habitual supper or
 other indulgence which has hitherto preceded and  introduced sleep,
 should be freely allowed.
   The lulling sounds of soft and agreeable music, or agreeable read-
 ing, have  been  tried as concomitants, and not unfrequently with
 success. And narcotic aromas, especially the hop has at times been
 had recourse to, heaped into pillows; but so far as I have seen, and
 I have once or twice witnessed the experiment, with as little effica-
 cy, as the pillows of the male fern in cases of rickets, which were
 once, according to Van Swieten, in equal estimation for this last
 complaint.  A pediluvium as recommended by Lang,* will often be
 found a much better prescription, or any means which will excite
 that breathing moisture, which is indicative of general ease.  Soft,
 gentle,  and general friction, and especially where there is any chill
 or rigidity upon the limbs, will frequently produce the same effect
 in a very agreeable way:  and  this too without combining it with
 the external use of opiates as proposed by De la Prada,t and vari-
 ous other writers.^
   Mossh was  the favourite medicine of Thilenius,§ and hyoscyamus
 of Stoerk.|| But a free and exhilarating glass of wine, as proposed
 by Fordyce, will often answer much better than either of them.  In
 many cases of disquiet and particularly in the stomach and praecor-
 dia it might be well to try the hypnotic powers of the nutmeg, as
 warmly  recommended by Dr. Cullen.   We have already noticed
 this reputed effect in the East Indies which  Bontius confirmed by
 his own experience, and which has since been confirmed by practi-
 tioners in Europe.  And when taken in a large dose there can be
 little  doubt of its somnolent  virtue.  In the  case recited  by Dr.
 Cullen in proof of this the  person had swallowed more than two
 drachms by mistake, and the effect was a drowsiness commencing an
 hour afterwards which gradually increased to a complete stupor and
 insensibility.  After this he was delirious, and continued to be al-
 ternately stupid and delirious for several hours:  but in six hours
from the attack he was pretty well recovered from every symp-
tom-lf
  Where, however, the morbid  habit is too rigidly established to
 give way to any of these means we must forcibly break through it
* Epist. xlv.
f Journ. de Medicine, Tom. XXXVI.
t Ansert. Abhandl. B. I. IV. St. 45.
§ Medinische und Chirurgische Bemerkungen, &,c.
|| Libellulus quo continuanturExperimenta, &c
* Mat. Med. Part H.Ch. V. 
312
NEUROTICA
tCL. IV.—OR. IV.
by the use of opium, till the habit itself be overcome, when all nar-
cotics should be gradually omitted.
  The wakefulness so common to  old people is hardly a disease.
They use but little exertion, and hence require but little sleep|; and
the internal inactivity is upon  a par with the external.  A third
part of the vessels perhaps that took a share in the  general energy
of the middle of life, is obliterated  and the wear and tear of those
that remain are much less. The pulse beats feebly; the muscles of
respiration are less forcibly distended; the stomach digests a small-
er portion of food, for only a smaller portion is required; the in-
tellect is less active ; the corporeal  senses less lively, and a minuter
quantity of nervous fluid secreted by the brain and its dependencies.
And hence, though there is far more weakness than in earlier life
there is a less proportionate demand for exertion, and hence a far
smaller necessity for sleep.
  From such  a line of reasoning  we may see  why sleeplessness
should be found as a symptum in excessive fatigue, violent pain of
any kind, inflammation, fevers, and various affections of the brain.
                        GENUS II.


                     DYSPHORIA.


                       Restlessness.

lROUBLhSOME  AND  RESTLESS UNEASINESS OF  THE MUSCLES ;  IN
  CREASED SENSIBILITY ;  INABILITY OF FIXING THE ATTENTION.

This is the inquietudo of many authors, which the Greeks express-
ed by the generic term now chosen, importing literally, " toleran-
di difficultas," " a difficulty of enduring oneself." It does not ex-
pressly enter into the classification of Sauvages or that of Cullen,
but is nearly synonymous with the anxietas of the former,  which
in the present system becomes a  species of this genus.   Molesta
sensatio, says Sauvages, quae ad jectigationem cogit, sed quomodo
ab affinibus morbis discrepit,  dicant qui exporti sunt.
  The genus embraces two species as exhibiting restlessness or in-
quietude chiefly confined  to the sensific or the irritable fibres; or
as dependent upon the state of the mind.

       1. DYSPHORIA SIMPLEX.             FIDGETS.
      2-------——  ANXIETAS.            ANXIETY. 
ge. n —SP. I.]
NERVOUS FUNCTION.
313
                        SPECIES I.

                DYSPHORIA  SIMPLEX.

                           iFftgrts.

RESTLESSNESS GENERAL, AND ACCOMPANIED WITH A PERPETUAL DE-
                SIRE OF CHANGING THE POSITION.

This is what we mean by the English colloquial term Fidgets from
fidgety, most probably a corruption of fugitive, though the lexico-
graphers have given us no origin ofthe term.  Both import restless-
ness, unsteadiness and perpetual change of place.  The proper La-
tin term is titubatio ; and, indeed, most languages have some pecu-
liar term to express this troublesome and irritable sensation, though
it has been rarely introduced as a disease into the nosological cata-
logue.  The actual cause seems to consist in an undue accumula-
tion  of sensorial power, which seeks an outlet, so to speak, at every
pore, for want of  a proper  channel of expenditure.   Thus every
one  becomes  fidgety who is  obliged to sit motionless beneath a
long-drawn and tedious story  of common-place facts  totally desti-
tute of interest: and still more so when he is eagerly waiting, and
fully bottled up,  as it were, to reply to  an argument loaded with
sophisms, absurdities, or untruths, and over which he  feels to have
a complete mastery.   So the high-mettled horse is fidgety that,
called out, in  full  caparison, and still restrained in his career,  is
panting for the. race or  the battle.  " So the squirrel, when confined
in a cage, feels," as Dr. Darwin  has ingeniously observed on  this
disease which he calls jaclitatio, " a restless  uneasiness from the
accumulation  of irritative power in his muscles, which were  before
in continual and violent exertion from his habit of life, and  in  this
situation finds relief by perpetually jumping about his cage to ex-
pend a part of his redundant energy. For the same reason children
that are constrained to sit in the same place at school  for hours to-
gether, are liable  to acquire a habit of playing with  some  of the
muscles of their face, or hands, or feet, in irregular movements
which are called tricks, to exhaust a part of the accumulated irri-
tability  by  which they are goaded."
   In the two  last  instances  this irritability is simply accumulated
for want of a proper outlet,  and not from inordinate secretion.   In
the  two preceding cases, of the restrained horse and the restrained
orator, there is added to this simple accumulation, for want  of dis-
bursement, an accumulation also from inordinate excitement.
   It is this last source alone that can give the present affection any
thing of a morbid character: and in irritable temperaments this is
often the case : for there is a diseased excess of sensorial power se-
creted constitutionally, which  is apt, on various occasions, to show
  VOL. III.—40 
314
NEUROTICA.          [CL.IV.-OR. IV.
itself by a perpetual restlessness  or jactitation as troublesome to
those who are of the company, as to those who are afflicted with it.
  Paulini* observes, that worms, and Lentinf that atony alone, is a
cause ; and hundreds of other sources of irksome irritation may be
added to these ; one of the most common of which is an obstinate
and unconquerable itching like that of prurigo s>ndis, and especially
in a part of the body that we cannot conveniently get at to scratch:
and hence ascarides in the rectum or  pudendum, into which last
organ they have sometimes been found to creep, is a most distress-
ing, and, in some cases, a maddening cause.
  A course of cooling purgatives, warm bathing, or increased exer-
cise,  will p  obably  be  found most serviceable in this  harassing
complaint; with  an  attention  to the primary  disease where it is
sympathetic.
                        SPECIES  II.

              DYSPHORIA  ANXIETAS.

                          gtnrretg.

THE RESTLESSNESS CHIEFLY  AFFECTING THE  PRiECORDIA ;  WITH DF
  PRESSION OF SPIRITS AND A PERPETUAL DESIRE OF LOCOMOTION.

This species, in persons of an irritable or highly nervous tempera-
ment, and especially among those inclined to hysteria or hypochon-
driac symptoms, is occasionally to be met  with as an idiopathic
affection, to which such a temperament gives a peculiar  predispo-
sition.  But we see it more frequently as a feature in the first attack
of fevers, in nausea, in various affections of the praccordia, and most
powerfully and most distressingly in lyssa or canine madness.   It
has been ascribed to the want of a free passage for the blood through
the heart, in consequence of a polypous concretion or some other
obstruction ; to a similar difficulty of its passage through the lungs :
and  to a constriction of the vena porta?, producing a like impedi-
ment in the  lower belly; and the anxiety  has been denominated
precordial, pulmonary, or epigastric, according to the part affected,
which, however, we cannot always trace out.  The complaint is
particularly noticed by Hippocrates  who distinguishes  it by  the
name of alysmus (xXvo-pLos,) literally restlessness or inquietude.
   It has sometimes, and especially in persons of an acutely irritable
habit, been accompanied with great excitement of the nervous sys-
tem generally, and spasmodic action of some or even all the muscles,
* Lanx. Sat. Dec. II. Obs. 10.
f Beobacht. der EpidemischenKrankheiten. p. 47. 
GE. II.—SP. HO        NERVOUS FUNCTION.                315

displaying, according to the idiosyncrasy, the symptoms of chorea,
hypochondrias, or lyssa; and has occasionally, as I have reason to
believe, been mistaken for lyssa, where the morbid mind has pored
incessantly on the recollection of some former scratch or bite of a
dog or cat: and like lyssa it has sometimes terminated fatally though
by no means with a like rapidity.
  Where the  affection  is  idiopathic, an emetic will be generally
found to  produce the readiest assistance : after this, the  warmer
antispasmodics,  and, if necessary, narcotics  may be successfully
employed, with gentle exercise and a light diet.
                      GENUS  III.

                    ANTIPATHIA.

                        ^nttpathg.

INTERNAL HORROR AT THE PRESENCE  OF  PARTICULAR OBJECTS OR
      SUBJECTS ; WITH GREAT RESTLESSNESS OR DELIQUIUM.

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

    l. ANTIPATHIA  SENSILIS.         SENSILE ANTIPATHY.
    2.-------—— INSENSILIS.        INSENSILE ANTIPATHY
                        SPECIES  I.

              ANTIPATHIA  SENSILIS.

                    Senstle ^nttpathg.

ANTIPATHY  PRODUCED  THROUGH  THE  MEDIUM  OF THE EXTERNAL
                           SENSES.

Very singular examples of both species belonging to this genus are
recorded by the collectors of medical curiosities; while others are
of every day occurrence.   Some may be accounted for from early 
316
NEUROTICA.
[CL. IV.—OR. IV.
fright, stories told in the nursery, or that incongruous association of
ideas in early life, which we had occasion to notice in the Proem to
the present class.*  But many are of difficult solution,  and others
altogether inexplicable.
   Under the species before us, we may mention an antipathy pro-
duced by the smell of roses; of strawberries; of mint  and some
other herbs: by the sound of music : or the sight of a drawn sword,
which  is said to have existed in King James I.;  or the  rattling of
a carriage over a bridge,  which  continued  for some years  after
mature life in  Peter the  Great of Russia, who was frightened,
while an infant, by a fall from  a  bridge into the water; and who
only overcame the antipathy by  resolutely accustoming  himself to
the object of disgust.
   The sight of crabs and  lobsters, and, still more frequently, of
toads and vipers, has produced the same effect. And we  have a few
instances of its  being occasioned  by what  we should much less
expect as a cause,  the appearance of bread and cheese, or even
bread alone.f  The  object itself, however, seems to be  of little or
no importance; the  feeling in most of these cases results from an
association of such object, whatever it may be, with some painful
occurrence in early life, of  which it continues to be  as much the
symbol or expression as letters  are of  ideas.   In many instances
the original occurrence is forgotten, but the impression indelibly
remains, and the object recalls the  mind to its influence. There is
reason to believe, however, that the antipathy is often a result of
idiosyncrasy or something peculiar in the frame-Work of the in-
dividual constitution.
                        SPECIES II.

             ANTIPATHIA  INSENS1LIS.

                   Knsenstle &ntfjrathg.

     THE ANTIPATHY PRODUCED THROUGH AN UNKNOWN MEDIUM.

In the preceding species the feeling of antipathy is excited through
the medium of one of the external senses, to which the object of
antipathy presents itself, or with which it is associated on recollec-
tion ; for it is the sight, or taste, or smell, or touch, or hearing of
such object or the idea of sush sensible impression, that alone calls
the antipathy into action.
  * Vol. m. p. 37.
  f Ephem. Nat. Cur. Dec. I. Ann. I. Obs. 144. et in Schol, Dec. III. Ann
III. Obs. 149. 
GE. III.—SP. H.]      NERVOUS FUNCTION.
317
  There are some persons, however, that are struck with a pecu-
liar and indescribable kind of horror at the presence of an object
which is unperceived by any of these senses, as soon as  it comes
within the atmosphere of some unknown influence.   The presence
of a  cat has  been often known to produce this effect, under the
circumstances now adverted to, or when the animal though, present
has been concealed, and not one of the senses has been alive to its
presence.  Instances of this kind are to be found in most of the
collections of medical curiosities, as well as in various other works ;*
and I have  met with several decided instances in the course of my
own practice.   The  affection, in this case, depends unquestionably
upon an extraordinary idiosyncrasy;  but by what means such an
idiosyncrasy is influenced we  know not. Sauvages inquires whether
the effluvium  thrown from  the object of aversion into the atmos-
phere may not, in combining  with the fluids of the affected person,
produce an irritating and  distressing tertium  quid, as  corrosive
sublimate is produced by a combination of mercury with oxymu-
riatic acid.   The fact, at present, appears inexplicable: but it is
not more singular than the  wonderful power so  well known  to be
possessed by the viverra noctula (common or  great  bat,)  which
renders it conscious of the  presence and position of objects, when
all its senses are muffled, and which enables it, when flying in this
state, to avoid  them.  This  extraordinary faculty to which  we
adverted in the Proem to the  present class,f has been called a sixth
sense by several naturalists.
  In all these  cases,  whether  of the  preceding or of  the present
species, the only means in  our power of destroying the anomalous
or morbid impression is by introducing a counter-habit; or, in other
words, by gradually inuring the sensorium to the influence of the
disgustful object.  By being familiarized with what at first we most
shrunk from, our courage  becomes hardened and the painful im-
pression blunted : and sights, and sounds, and smells, and the most
imminent dangers that could not at one time be encountered, or
even  contemplated without fainting, in process of time no more af-
fect us than the roar of cannon affects the war-horse, or the moun-
tain-tempest the mariner.
• Eph. Nat. Cur. Dec. II. Ann. II. Obs. 50.
  Borelli, Cent. IV. Obs. 61.
  Emercetanus, Dijetet. Polyhistor. p. 82.
t Vol. III. p. 17. 
318                    NEUROTICA.          [CL. IV.—OR. IV


                       GENUS  IV.

                     CEPHALJEA

                        fiteafcache.

ACHING  PAIN IN THE  HEAD ;  INTOLERANCE OF LIGHT AND  SOUND ;
   DIFFICULTY  OF  BENDING THE  HEAD TO MENTAL OPERATIONS.

Cephal^a, (xeQxXxix from xityxXv, caput,) is employed by Galen,
chiefly, in the sense of chronic head-ache ; whence the term cepha-
lalgia has been invented  in later times  to  express  affections of
shorter duration.  Head-ache* of all kinds, however, form a natural
group, and should be described under a  common genus, which  is
here named after the oldest and most authorised term.  Sauvages
has particularly marked the symptom of disability of the mental
powers in the first species we are about to notice, and the remark
may be applied to  all  the others : " difficultas coghandi,  distincti
ratiocinandi, reminiscendi."  The species which may be enume-
rated under this genus are the following.

  1. CEPHALiEA GRAVANS.             STUPID HEAD-ACHE.
  2.---------INTENSA.             CHRONIC  HEAD-ACHE.
  3. ---------  HEMICRANIA.          MEGRIM.
  4. ---------  PULSATILIS.           THROBBING HEAD-ACHE.
  5.     .      NAUSEOSA.            SICK  HEAD-ACHE.
                        SPECIES I.

               CEPHALiEA  GRAVANS

                   Stujiiti fi^ea u=acuc.

PAIN OBTUSE ; WITH A SENSE OF HEAVINESS  EXTENDING OVER THE
           WHOLE HEAD ; SOMETIMES  INTERMITTENT.

The remote causes of head-ache are so numerous, and so compli-
cated that it is difficult to catch or arrange them :  and many of them
are so completely  concealed from view, by a confinement to the
brain itself, that we vainly endeavour to discover and analyze them.
Repelled discharges from the hemorrhoidal vessels, repelled or re-
tarded catemenia, repelled fluids from the surface, are very fre-
quent causes of one or other of the species of cephalaea now enu-
merated.  Whatever retards the current of the blood in the sinuses 
GE.1V.—SP. I.]       NERVOUS FUNCTION.                  3J9

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

               CEPHAL^EA INTENSA

                   <£urontc fi£rati=&cfie.

PAIN VEHEMENT, WITH A SENSE OF TENSION OVER THE WHOLE HEAD :
                  PERIODIC ;  OFTEN  GHRONIC

This species is, perhaps, always dependent upon some local irrita-
tion ; and may be produced by many, probably most, of the irritants
noticed at the opening of the preceding species : and as not a few
of these have a seat in the brain itself, and must remain concealed
till disclosed to us by dissection, and would be still beyond our reach
if we could ascertain them from the first attack, there is no difficulty
in conceiving why this  form of  headache  should often defy all
medical aid whatever, and run parallel with the life itself.
   Among the external causes, those productive  of rheumatism are,
perhaps, the most frequent, as exposing the feet for a long time to
cold and damp, or lying  in a damp bed with  a small quantity of
covering.  And  as all  rheumatic affections, when they become
chronic,  have a tendency to  intermit, and return periodically, we
may easily see why the disease before us should do so in many in=
stances. 
 GE. IV.—SP. II.]       NERVOUS FUNCTION.                 321

   This species may, therefore, be distinguished by its being rather
 limited to some particular part of the head than extending over the
 whole  organ ; by its remissions or intermissions;  by the acuteness
 of the  pain during the return of the paroxysm; by an intolerance of
 all  motion of the  head, far more than of light or  sound, both of
 ■which, however, are  sometimes highly irksome; and by a peculiar
 feeling of tenseness or contraction over the encephalon, as though
 its membranes  were  muscles and spasmodically contracted.
   This last symptom rarely takes place till  the disease has estab-
 lished  itself for some time, and seems to indicate a thickening of
 one or  more ofthe tunics ofthe brain from increased action, pro-
 duced  by a long course of irritation; a result which has frequently
 been discovered on  dissection.   Where the affection is entirely
 rheumatic, the  local  pain in the head ceases as soon  as a rheumatic
 pain takes place in any other part of the body.  There  is, indeed,
 no great difficulty in  accounting for a  cessation  of pain in this case
 upon the principle of a transfer of action.  But we find it cease also,
 or very much  remit, not unfrequently  in other  cases, in which
 post-obit examinations have proved the disease to  be dependent  on
 local irritation,  as some bony protuberance from the interior ofthe
 skull, ossification, or calcareous  concretions in some part of the
 substance  of the brain, a  tumour in a  pineal gland, or some other
 ganglion or commissure, or an aneurism of the  carotid artery ; the
 two last of which are particularly described by Sir Gilbert Blane, as
 having  been detected after death, in persons who had been long and
 severely troubled  with this modification of cephalaea.  To account
 for the  intervals of ease that occur under these circumstances in
 "which the cause of irritation is permanent and  perpetually acting,
 we must call to our recollection that most organs, when they have
 been long exposed to a more than ordinary stimulus, become gra-
 dually exhausted and  blunted in their sensibility in consequence of
 such exposure.  And hence the pain they are occasionally sensible
 of, and  which returns in irregular paroxysms, is produced by fresh
 causes  of excitement, periodical or incidental, or a serious aggrava-
 tion of  the disease itself.
   In a  few instances, an obstructing material, forming ihe exciting
 cause, appears to have been carried off, and in one or two very rare
 cases, by channels, whose communication it is  peculiarly difficult
 to account for.  A caries,  or some other disease, affecting a small
 part of  the bony substance of one of the sutures, is a cause noticed
 by many pathologists; and this cause  has, in some instances, been
 so obvious, that while the patient has been able  to point out the
precise  spot of pain with his finger, the practitioner has  been able
to discover a considerable indentation or vacuity, proving that a
part  ofthe suture  had been absorbed  or detached.*  In a case of
* Bonet, Sepulchr. Lib. I. Sect. I. Obs. 92.
  Morgagni, De Sed. et Caus. Morb. Epist. III. Art. 8
  Stalpart van der Weil, Cent. I, N. 1.
VOL. ill.—41 
SZ"Z
NEUROTICA.          [CL. IV.—OR. IV.
this kind, related by Mr. Henry, of Manchester, the immediate seat
of distress was in the lower part of the coronal suture about an inch
above the sphenoides.  The pain was excessively acute and  lanci-
nating, the integuments directly over it, to the extent  of a  half-
crown piece, were puffed up like an inflated bladder, and the tem-
poral artery appeared tense like a chord on  its full stretch.   Upon
the subsidence of the tumour, a chasm of about an inch long, and a
sixth part of an inch broad, was felt  in its late course.   Wilh the
disappearance ofthe tumour the pain was transferred a little lower
to the processus condeloides, and afterwards to a situation about an
inch  and  a  half below the angle of the  lower jaw-bone.   Shortly
after this it ceased altogether;  but the patient's breath, from this
time, evinced an earthy and disagreeable smell; and within a few
days, without any previous fit of coughing or retching, he was sud-
denly seized with a feeling of suffocation from something that had
dropped into the oesophagus and stuck there ; but which he threw
up after great exertion, and found to be an angular solid substance,
about the size ofthe last joint ofthe thumb, consisting  as he  de-
scribed it, for, unfortunately, he did not preserve it, of a hard, brown
and white matter, the latter of  which on being pressed fell  into a
dry powder.  The whole was covered with  a greenish mucus, and
resembled exactly in smell the  fetor which had antecedently affect-
ed his breath and  had now subsided.  About six weeks afterwards
he had a slight return of the pain in the same part of  the  head,
which lasted about two minutes, when he again became sensible of
something  falling into  his throat  which he soon hawked up,  and
which proved  to  be similar to what he had brought up before,
though in smaller quantity, and broken into fragments.  This was
examined by Mr. Henry, and was found to be calcareous matter
covered with a layer of brown  tenacious mucus.  The vacuity in
the cranium filled up from this period, and the patient could bear
the integuments to be pressed upon without pain.*
  That the calcareous substance thus ejected from the oesophagus
had travelled there  from the coronal suture, where, before its se-
paration, probably  in the form of a caries, it  had for so long  a
time been  the  cause of cephalaea, is sufficiently  clear from the
course it seems to have taken, and the symptoms that accompanied
that  course ; and  a  passage  having been once  formed,  probably
through the nasal sinus, we can readily account for the more easy
and  rapid descent of the  second separation than of the first,  and
particularly as it was so much smaller in quantity.  And although
the nature of the passage it thus opened for itself cannot but be a
matter of astonishment, it is not more mysterious than the migra-
tion  of  needles, and even small  bullets, which  have sometimes
travelled almost over the whole body with little inconvenience to
any part.   Thus, a fish-bone after having long fixed itself in the
oesophagus, has worked its way  into its substance, and been, at
• Mem. Med. Soc. Lond. Vol. I. 
GE. IV.—SP. II]         NERVOUS FUNCTION.
323
length, thrown out at the skin :* and the point of a sword, buried
thirty  years  before  in  the  eye,  has at last been ejected by the
palate.t   Why, under this slow course of migration, inflammation
is not produced, has been ingeniously shown by  Mr. J. Hunter ;$
but the general progress is still wonderful and unaccountable.
   For the few remarks we shall have to make under the  head of
medical treatment, it will be most convenient, as already observed
under the preceding species, to refer the reader to the close of the
genus, in order that the plan proper  to be  pursued  under one
species may be compared with that under another.   At present it
is only necessary to add further, that  the irritating causes of chronic
head-ache we have thus noticed, excite, occasionally, other symp-
toms than acute pain, and particularly clonic agitations of the mus-
cular fibres adjoining the seat of pain, not unlike those of neuralgia;
and severe and irremediable hemiplegia.
                        SPECIES HI.

             CEPHALiEA  HEMICRANIA

                          J&eflrtm.

 PAIN VEHEMENT : CONFINED TO THE FOREHEAD, OR ONE SIDE OF
                THE HEAD ; OETEN PERIODICAL.

 This is, in most cases, a disease of far less importance than the
 preceding.  Its seat seems to be chiefly in the integuments of the
 head, and its  principal symptoms  are  tenderness on pressure, an
 obscure redness of the skin, and a suffusion of the eyes.  And with
 these there is  frequently a nauseating uneasiness at the stomach,
 but  whether as a cause or  a consequence of hemicrania, it is not
 easy to determine ; it is  most probable,  indeed, that in some in-
 stances it is the one, and in others  the other.
  The disease is  most  common to  persons of delicate health or
 relaxed  habits and an irritable temperament, and particularly when
subject  to dyspepsy and hypochondrism.  In such persons all the
 causes of catarrh and rheumatism  are sufficient for its production,
as is any thing that disturbs the  balance of the circulation.  And
hence, it is often a result of cold feet, or the chill that follows on a
dinner not comfortably digested.
  Hemicrania frequently assumes a periodical  character, in which
* Articulari, Practica.
f Hoechstetter, Observ. Medic. Dec. VI. Cas. 9. Francf. 1679.
* On Blood and Inflammation, p. 239. 
324
NEUROTICA.
[CL. IV.—OR. IV-
case the pain mostly fixes itself on the same side, or the same part
of the head, in some  caseb being limited  lo a small disk of the
integuments, with little affection  of the encephalon, and in others
striking deeply into the interior of the head, and down towards the
eye, which cannot endure the least  glimmer of light.   In  many
instances, its intermissions are perfectly regular, and the paroxysm
returns daily at the hour of noon  :*  but more commonly its attacks
are produced by some incidental excitement, and are consequently
of uncertain recurrence.   Yet it is more  frequently found in the
afternoon than in the morning.   So far as I have observed, indeed,
it  usually takes place in the evening during,  or soon after, the
digestion of the dinner, and in persons of the middle age of life
who live  temperately.   In  one instance, in which  the  disease is
still very obstinate, it returns  at this hour after an interval of two
or three wreeks, continues through the whole of the night and the
ensuing day, and subsides towards the evening;  the paroxysm thus
lasting about twenty-four hours.   In a very active  and otherwise
healthy man, however, about thirty years of age, who has no apparent
disorder ofthe stomach or bowels, it commences uniformly before
breakfast, continues with great violence about six hours, and  then
subsides ; leaving intervals of about six weeks or a month.
                        SPECIES  IV.

            HEMICRANIA  PULSATILIS.

                  HthvobbitiQ f^eaiDf=acfie.

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

In discussing  the genus palpitation (clonus palpitatio) we
entered  into an explanation of the very curious phaenomenon of the
throbbing or beating of the heart, or of a particular artery, or part
of an artery, which frequently takes place without any connexion
with the regular systole of the  circulation, often, indeed, discor-
dantly with it  both in time and moment: and we endeavoured to
show that these anomalies, for the most part, depend upon a pecu-
liarly nervous  irritability, and spastic tendency of the  muscular
fibres of the arterial fabric, sometimes limited to the artery, or por-
tion  of an artery, in which the  palpitation occurs, and sometimes
common to the whole arterial system.
  Whenever any of the preceding species of the present genus are
* Schenck, Libr. Obs. 78,79.
  £eccbii, Consult. Med. 90, 98.  Franc. 1650 
OE. IV.—SP. IV.]       NERVOUS FUNCTION.                325

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

              €EPHAL.EA  nauseosa.

                     St'cfc fiteatr=acue.

This is the spasmodic affection of Dr. Fothergill, who has described
it at great length and with much accuracy.  As the  last species
consists of almost any of the preceding set down upon a constitution
peculiarly predisposed to irregularity of arterial action, the present
consists ofthe same set down upon a constitution peculiarly predis-
posed to irregular action of the intestinal  canal.  In its  general
symptoms, however it is  chiefly related to the stupid head-ache.
and the hemicrania, particularly to the last, only that while proper
hemicrania most frequently makes its attack in the afternoon, sick-
head-ache usually shows itself in the morning ; though the latter,
like  the former,  occasionally varies its hour, as it does  also its
length of intermission.
  The patient, observes Dr.  Fothergill,* commonly awakes early
in the morning with a head-ache that rarely affects the whole head,

           • FotbergilPs Works, p. 597, 4to.
             Medical Observ. and Inquir. Vol. VI. p. 103. 
326
NEUROTICA.         [CL. IV.—OR. IV.
   but only some particular part of it, most frequently the forehead,
   extending over one or both eyes.   Sometimes it is fixed about the
   upper part ofthe parietal bone of one side only ;  sometimes the oc-
   cuput is the part affected ; or it darts from one  place to another;
   and equally varies  during its continuance in its degree of intensity.
   There is some degree of sickness usually connected with it,mostly
   limited  to nausea, but occasionally amounting to  vomiting.   If the
   pain commence in  the morning before any meal is taken,  phlegm
   only is thrown up,  unless the straining be severe, in which case bile
   is intermixed with  it.   After this  the pain soon  begins to abate
   leaving  a soreness  about the head, a squeamishness at the stomach,
   and a general uneasiness which induces  the patient to wish for re-
   pose.   Perhaps after a short sleep  he  recovers perfectly, only a
   little weakened by  his sufferings.   The  duration of this species of
   head-ache differs, however, in different persons: in some it subsides
   in two or three hours; in others it  extends to  twenty-four hours or
   longer, and with a violence scarcely to be endured, the smallest light
-/ or noise rendering the pain intolerable.   In young persons the pa-
   roxysm  goes off soon :  but after the disease has been a companion
   for years, it is of longer duration, and the system becomes extremely
   debilitated.  Its returns are very irregular :  some persons  suffer
   from it every two or three days : some  every two or three weeks;
   and others have still longer intervals.   Those  who use but little ex-
   ercise, and are inattentive to their diet, are afflicted most severely :
   costiveness when habitual is a frequent  predisposing cause ; and
   hence a protracted  laxity of the bowels supervening on habitual
   constipation, has removed the complaint altogether.
     Dr. P. Warren in a very valuable paper on this  subject, seems
   to think that a  line of distinction may be drawn between the disease
   as produced by a morbid  state of the stomach, and of the  collati-
   tious viscera, or, in  other words, as it makes an approach to  the
   first or to the third species before us.  "  Upon the whole," says Dr.
   Warren, " that form of head-ache, which is  attended more with
   confusion  than pain,  and in  which there is a  temporary  dim-
   ness of sight, appears to depend chiefly upon a defective action or
   secretion of the stomach; the other (that in which the  pain  is
   acute or exceeds the confusion) which is the most prevalent  form,
   more particularly upon inactivity ofthe  upper bowels, from what-
   ever cause it may be produced, and an imperfection of that part of
   digestion in which the biie is concerned."*
     The connexion between all these species of head-ache is so close,
   and several ef them are so apt to run into the others,  that the au-
   thor has reserved  the few  remarks he  will  have to make  upon
   the remedial treatment till the whole have, as now, passed under
   review, and have furnished us with an opportunity of concluding
   how far any thing like a common plan of treatment may  be advan-
   tageous, and upon what points  it ought to vary.

     * On  Head-aches which arise from a defective action of the Digestive Or-
   gans.  Med. Trans. IV. Art. XVHI. 
GE. IV.—SP. V.]       NERVOUS  FUNCTION.
327
   A very slight  recurrence to the preceding history will show us
 that  the  chief causes of head-ache are local irritations, suddenly
 checked  perspiration, or exposure to cold and damp; a peculiar
 irritability of the nervous system, and particularly a  spastic idio-
 syncrasy  of the temporal arteries, and a  morbid condition of the
 chylopoetic viscera.
   The last is,  perhaps, the most  common cause :  and  hence,
 wherever there is any doubt as to the specific character of the dis-
 ease, we  can never do better than treat it as chiefly appertaining to
 the fifth species, and implicated with a diseased action of the sto-
 mach or its collatitious organs.
   It  is on this account that emetics, with  an anodyne  given after-
 wards,  have been so generally found serviceable,  and have often
 effected a cure in a few hours. And hence  also the great advantage
 of keeping the bowels not only free from costiveness, but with some
 kind of warm irritant slightly, though constantly, acting upon them,
 of which  one of  the best is aloes, where there is  no  tendency to
 piles; and copaiba, or the extracts of  rhubarb and colocynth, where
 there is.   Piles, however, are not an  affection to be much  regard-
 ed in cephalaea,  for  it is  probable that they may often become a
 useful revellent: and Dr. Arbuthnot  was so firmly  of this  opinion
 that he was  in the constant habit of employing suppositories of
 aloes, rock-salt, and honey, and asserted that nothing relieves the
 head so much as piles.
   When  the disease  is evidently of a  rheumatic character,  an open
 state of the bowels should be combined with mild sudorifics,and,if
 necessary, narcotics.   And hence the benefit that is so often found
 from adding four or five  grains of antimonial powder to an aloetic
 pill given at  night, which rarely disturbs  the  patient before the
 morning: and, where this does not answer alone, or we have rea-
 son to fear from a constitutional debility of  the bowels that the ape-
 rient may act in the night, we should unite a grain of  opium with
 the other ingredients, or employ  Dover's powder instead.
   Such a plan will, indeed, often be  found to succeed even in the
 pulsatory  head-ache or hemicrania; though here we may often em-
 ploy such sedatives as hyoscyamus, conium, aconite, and flammula
 Jovis, or the antispasmodics of musk, camphor, valerian, and am-
 monia,  with somewhat more benefit  during  the paroxysms; and
 epithems  of cold salt  water, or a diluted solution of acetate of am-
 monia, applied round  the head every morning. In some cases thin-
 ning  the hair, where it is profuse, has also been  found serviceable :
 but in others it has failed, and the following remarks ofthe author's
 late  valued friend, Dr. Parr, upon the subject of shaving, are well
 entitled to  attention. " This practice,"  says  he, « has not the
 sanction of long experience, nor is it  supported by  reason.  Each
 hair is a vegetable, nourished by a bulbous root, supplied by nume-
 rous blood-vessels.   These, though small from  their number, con-
 vey no  inconsiderable quantity of fluids; and as  the external and
internal carotids  arise from a common trunk,  and  anastomose in 
328
NEUROTICA.
[CL. IV.—OR. IV-
some of their branches, whatever cause increases the circulation in
the former, must lessen it in the latter."   He adds that he himself
was for many years a sufferer from an irregularly returning parox-
ysm of head-ache  for which he could assign no cause,  but at last
discovered that it frequently returned after shaving the  head: he,
consequently, suffered his hair to grow, and from that time the dis-
ease gradually lessened in violence,  in duration, and in  frequency
of its return. " From being a complaint," says he, " highly serious,
and beginning to affect the memory,  its returns are now rare, and
never so violent as to unfit the frame for any exertion of body or
mind."
   Temporary relief has also, in many cases, been obtained by the
external application of volatiles and  aromatics, as  ammonia,  cam-
phor, oil of cajeput, and  ether; and where the disease has been
produced  by cold or rheumatism, from blisters, burning  moxa,* or
the actual cautery,! an issue or a seton.:}:   In  the  Transactions of
Natural Curiosities, is a case of ten years duration completely cured
by the last application^  So the use of errhines has also been found
useful,  and particularly in chronic hemicrania, by  stimulating the
mucous membrane of the nostrils, and exciting a considerable dis-
charge : but as we have already observed that taking snuff is inju-
rious in cases of indigestion, where  head-ache is  connected with
the chylopoetic organs, sternutatories should be avoided.
   In the interval of most of the cases thus far adverted to, tonics.
and especially the  metallic, should be employed with steadiness.
It is here the nitrate of silver  has been  found eminently  useful,
when every other  remedy has antecedently failed.   A tonic  regi-
men, however, of exercise, and early hours should  combine, or
little advantage will be gained by any plan. Linneus is said to have
cured himself of a severe and obstinate hemicrania, which returned
at the interval of a week, and continued for twenty-four hours, by
merely drinking  a draught of cold  water, early in the morning, and
then walking himself into a  glowing heat: and in many cases no-
plan can offer a better promise.
   The verticillated stimulant plants  have, in  many instances, also
been found serviceable in  most of  the species thus far considered,
whether the disease originate in the head  or in the  stomach, and of
these the  most active,  as well as the most pleasant, are lavender,
rosemary, and marjoram.   How far the arum may answer the  same
purpose, the author cannot say from his own practice, but it is very
strongly recommended by Bergius, who tells us, that when taken in
doses of half a scruple of the compound powder, he never knew it
fail of  giving relief, even  after the most  celebrated remedies had
proved useless, or even added to the  distress,  lt is  certainly a very

                * Wepfer, Observ. p. 81.
                f Velschius, Episagm. 11.
                $ Ruysch, Observ. 40.
                § Vol. IX. Obs. 91. 
GE. IV.—SP. V.]       NERVOUS FUNCTION.                329

acrid stimulant, and seems to have been dropped from the Materia
Mcdica too precipitately
   There  is one species of head-ache, however, to which but little
of what we have thus far recommended will in all cases apply, and
that is the second or chronic cephalaea: and on this account it is of
great importance that we endeavour to distinguish it from the rest:
or rather that we endeavour to distinguish those causes of it under
the operation  of which it is necessary  to pursue a different plan:
for in many instances even here  the cause of irritation may be pal-
liated, or even destroyed, by some part ofthe process already re-
commended.  But we have stated that this form of the disease is
often  dependent upon some structural irritation within the cavity of
the skull, such as  a node or toph, or caries of the interior table of
the cranium, a scirrhous or other tumour in some part ofthe brain,
or a thickening of the membranes that surround it.
   And here, in conjunction with the aperient plan, or even a brisker
plan of this kind than  has yet been recommended, local bleeding by
cupping or leeches should be had recourse to without delay.  Free
venesection, indeed, has often been of great service  in diminishing
the inflammatory  action, and  taking off the topical irritability for
many weeks or even months.  And hence,  the temporal artery has
often been opened  on  the continent, and with very good effect: and
we may see why a vicarious hemorrhage from the nose, the mouth,
the liver,  or some  other organ, has been followed, in various cases,
by a perfect cure.*  And, where some other obstruction has been
the cause, it has occasionally  yielded to a severe fright,! or a fortu-
nate concussion of the brainy or a wound on the head.§   Hildanus
refers to several inveterate cases effectually overcome by accidents
of this kind.||
  Here also, if any where, we may possibly expect advantage from
a long continued use  of mercury as an alterant and absorbent, in
connexion with apozems of sarsa, bardana, or some other warm di-
luent.   In organic enlargements and obstructions in other parts of
the body such a plan  has often answered, and analogy will there-
fore lead us to expect some benefit in the present disease.  Velschius
describes a case of a most obstinate cephaiaea in which it completely
succeeded.!
  But where every other mean has failed, and the  symptoms are
violent, and the painful spot  is  clearly detineable, and  we have
strong reason to apprehend some local organic irritation, it may be-
come a question how far the use ofthe trepan has a chance of being
* Heister, Wahrnemungen, I. p. 70.
  Abhandl. der Konigl. Schwed. Acad, der Wifsenchaft. xiii. 39.
| Riedlin, Cent. II. Obs. 55
* Ephem. Nat. Cur. Cent. IX. Obs. 6.
§ Desgranges, Journ. de Med. Tom. LXII. p. 360.
Q  Cent. II. Obs. 8.
i Hecatost. II. 67.
VOL. IH.—42 
330
NEUROTICA.
[CL.  IV—OR. IV.
serviceable.  Vogel gives a case in which the pain was  hereby
considerably mitigated ;* and  Baglivi another,  in which a radical
cure was effected.!  But in this instance, a portion ofthe brain was
found in a state of suppuration, and the confined pus hereby obtained
a way of escape.  Marchetti gives an example of a temporary cure,
the head-ache  being suspended so long as the wound was open, but
returning after it was healed-!  And hence, even where no struc-
tural cause of  irritation has been reached, this operation has some-
times proved  serviceable as a revellant.  It must, however, be
admitted, that it  has often  been performed without any  benefit
whatever.
  It is hardly  needful to  observe  that where cephalsea is evidently
a secondary disease, as in  plethora, chlorosis,  gout, or neuralgia,
our attention must be chiefly directed to the malady on  which it is
dependent.  Where it appears as a sequel upon any suppressed and
habitual evacuation, or repelled eruption, the best means of obtain-
ing relief will  always be found in restoring the system to its former
state ; and where  this cannot be done we must furnish the best  sub-
stitute we can  by  some temporary irritation or drain.
  As a general palliative,  strong coffee has been proved service-
able ; and where  its own sedative virtue is not sufficient, it forms
one of the best vehicles for the administration of laudanum in doses
of eighteen or twenty drops.  It  diminishes, in some degree, the
hypnotic power of  the latter, but it counteracts its  distressing se-
condary effects.  When laudanum is intermixed with strong coffee
for the cure of many modifications of head-ache, tranquillity and
ease are produced, though  there may be no sleep : when laudanum,
on the contrary, is  taken alone, sleep will, perhaps, follow, but is
mostly succeeded by nausea and a return of the pain.   Hence, the
Turks and Arabians make  strong coffee their common vehicle for
opium, from its tendency  to counteract the  narcotic principle  of
the latter.§
                        GENUS V.

                          DINUS.



ILLUSORY GYRATION OF THE PERSON WHILE AT REST, OR OF OBJECTS
   AROUND THE PERSON, WITH HEBETUDE OF THE SENSORIAL POWERS.

The distressing sensation of dinus, a strictly Greek term, occurs in

  * Chirurgische und Medic. Beobachtungen, p. 410.
  ! Specim. Quatuor Librorum de libra motrice et morbosa.
  \ Observ. 36, 38.
  § Phil, Med., and Experimental Essays. By Thomas Percival, M.D. Vol. IH 
CE. V.—SP.  I.]        NERVOUS FUNCTION.
331
different persons and different circumstances, under very different
modifications, or is connected with very different symptoms  It
is often united with cephalaea, and hence, by some nosologists, it is
made a mere species of this last genus, but there are few practi-
tioners who have not witnessed  instances of both that have com-
menced, continued, and terminated their career without any inter-
ference with each other: and hence, Linneus has not only separated
them from each other and regarded them as distinct genera, but
has even made scotoma, or dizziness with blindness and a tendency
to swoon, a distinct genus also.
  In  the author's  volume of Nosology,  scotoma,  with two  other
forms of dinus, were  regarded as separate species.  But as, on a
fuller consideration of the subject, I am induced to think that all
these diversities originate from the particular habit or temperament
of the individual or the nature of the exciting cause, it will be more
correct to reduce them to a single  species, and to contemplate the
diversities of symptoms and sensations they produce as varieties or
modifications alone : and hence, adopting the common name for this
purpose, we  shall denominate  this  species

       1. dinus vertigo.               vertigo.
                         SPECIES I.

                   DINUS  VERTIGO.

                          Q8tvti&o.

             DIZZINESS, WITH A FEAR OF FALLING.

Common as this  complaint is 1 have not hitherto met with any
satisfactory explanation of  its cause.  Sauvages,* indeed has enter-
ed upon the subject pretty fully, as has Darwin! since his time, and
Crichton| since the time of Darwin ; while on the continent it has
been investigated with much patience and ingenuity  by Dr. Herz
of Berlin.^  For the most part it has been ascribed to a morbid ex-
citement, or increased action in the organ of vision,  which is the
view taken of it by Sauvages and Darwin, or to " a state of mental
confusion arising from too rapid a succession of representations,"
which is the explanation of Herz and Crichton.
  That there is, in all instances, some degree of mental confusion,
* Nosol. Method Class. VIII. vesanis.
f Zoonom. Class IV. II. i 10^
* Of Mental Derangement. Vol. 1. p. 324.
§ Versuch viber der Schwindel. Berlin, 1791. 
332
NEUROTICA.
[CL. IV.—OR. IV.
 may, perhaps, be allowed, and that there is often too rapid a suc-
 cession of representations, with a morbid increase of sensorial  ac-
 tion, may be allowed as readily : but if the following remarks be
 found entitled to  attention, and  succeed in  delineating  the  real
 nature  of vertigo, it will appear that the external sen3es are only
 indirectly, if at all, the seat of the morbid action ; that this action is
 far more  frequently in  a state of diseased diminution than  of  dis-
 eased increase; and that even a rapid succession of representations
 is not essential to  the sensation.
   We  have had frequent occasions of showing that the nervous
 power  which supplies the muscular fibres is communicated,  not,
 strictly speaking, in a continuous tenour, but in minute and succes-
 sive jets, so that the course of this delicate fluid is alternately bro-
 ken and renewed by a series of fine and imperceptible oscillations.
 In a state of health and vigour this succession of influx and pause
 is perfectly regular and  uniform, and hence whatever movements
 result from it will  partake of the same uniformity, and appear to be
 one continued line of action instead  of a successive series.   But
 as soon as ever the harmonious alternation through which the nerv-
 ous power is thus supplied, is interfered with, the oscillations be-
 come manifest; the apparently uniform  current is converted  into a
 tremulous undulation, and the muscular exertion to which it gives
 rise, instead of being seemingly one and undivided, is sensibly mul-
 tiplied into hundreds: of which any person may convince himself
 on observing a strong and healthy arm extended for a few minutes
 with a small weight at the end of the fingers, and an arm reduced
 in strength by a fever, or any previous labour ; for while the first
 maintains an even and uniform line, in  the second this line is bro«
 ken into perpetual tremours and undulations.
   That the nervous power which supplies the  muscular fibres is
 communicated in  this way there is no doubt;  and, as it is highly
 probable that all the different kinds of  nervous fibres are fed by a
 like process, there can be little doubt, also, that those which main-
 tain an intercourse between the brain and the external senses,  and
 even those which belong to the external  senses themselves are sup-
 plied by the same kind of alternating pause and flow.   And conse«
 quently that, as a perfect regularity and uniformity in this alterna-
 tion is  the means of conveying  from the  organ of vision  to  the
 sensorium one undivided perception of every single object preseiu-
 ed to it, so, an irregularity and want of uniformity in the alternating
 series, must confuse and complicate the perceptions, and  multiply
 them into as many as the series of jets themselves consist of, though
 each perception may, perhaps, be less distinct and perfect than  the
 single perception conveyed  in the ordinary course.   Thus, in look-
 ing through a window, or an eye-glass, the objects that pass  before
 us in regular  order,  pass singly and without confusion ; but if  this
 order be interrupted by  movements we  are not accustomed  to, or
 the objects jerked about, as in a magic lanthern, they make us dizzy
 with  their motion, and  we  see them confusedly and in  delusive
numbers. 
GE. V.—SP. 1.]        NERVOUS FUNCTION.
833
   In this manner then it appears to me that the increased motion,
and apparently rapid succession of representations is  produced in
the  affection we call vertigo: which  under this explanation is a
clonic action of the nervous fibres subservient to perception, in the
same manner as the rapid and tumultuous agitation ofthe muscles
in  remor, shaking pulsy, or epilepsy, are a clonic action of the
fibres subservient to voluntary motion.  In the last of these affec-
tions we find a considerable difference in the nature and intervals
ofthe clonic movements; for these must depend upon the greater
or less degree  of interruption, which the nervous power sustains in
its flow,  or upon the peculiarly relaxed or spastic state of the nerv-
ous fibres themselves, and probably, at times, upoisome other cause
of which we are totally ignorant   And we have, hence, reason to
expect, and do in fact perceive, an equal diversity in the clonic and
illusory  motionsof  vertigo; for the objects or their representations
presented to the perception appear sometimes to circumvolve hori-
zontally  from right to left, or perpendicularly  from above down-
wards, or from below upwards, or to be very whimsically changed
in their form.  And not unfrequently the patient himself seems to
be moving as well; and commonly in a contrary direction to the ap-
parent motion of the objects.  And as the intermediate nerves be-
tween the other external senses and the brain seem occasionally to
coincide in the same morbid agitation, we can easily conceive how
that very common modification of the  disease may be produced in
which the dizziness is combined with illusory sounds, as of whisper-
ing or murmuring, the ringing of bells, or beating of drums,or even
the roar  of cannon : for, as single objects may, under the influence
we are now contemplating, be prodigiously multiplied or magnified,
so may  single, and otherwise almost  imperceptible sounds:  and
especially where the auditory nerve is itself in a state of high mor-
bid acuteness, during which we have already had occasion to re-
mark that the gentlest and lightest tones, even the whisperings of a
mere current of air in a room, or the breathing of persons present
is intolerable, while sounds  before unperceived became highly dis-
tressing.*  And in like manner by an equal irregularity in the flow
of the nervous fluids subservient to the perceptions of smell and
taste, we may account for similar illusions  upon these  faculties.
  In many instances, we find the vertigo equally present whether
the patient be in the dark or light, whether the eyes be closed or
open; and we have hence a full proof  that  it is not dependent, as
Dr. Darwin  conceives, upon an increased energy in the irritative
motions of the  organs of vision.   In some cases the representations
of objects are very numerous and rapid, but in others  far less so,
and particularly where the affection is  severe from the first, or the
patient is in a state of constitutional debility ; under which circum-
stances we may conceive the pauses in the flow of the nervous fluid
to be more irregular or of longer duration than they otherwise would
* See Paracusis acris, Vol, III. p. 164. 
334
NEUROTICA.
CL. IV.-OR. IV.
be.  In many cases, indeed, the only sensation is that of a buoyant
undulation or swimming without any succession of representations
whatever;  affording us a proof that the rapid succession of repre-
sentations described by  Dr.  Herz, is not more essential to vertigo
than the increased energy of Dr. Darwin.
   But as  the disease advances,  or, in other words, as the flow or
secretion of  the nervous fluid becomes still more interrupted, the
representations are confused, indistinct, and  rapid  in succession,
often conjoined with a sense of dimness or darkness, existing equally
whether the eyes be shut or open, forming a state by Hippocrates
and the Greek writers generally called scotoma or scotodinus : and
as the disease makes a further progress by a further interruption
in the flow of the sensorial  fluid, every power of body  and mind
augments in languor, till at length sensation both external and in-
ternal fails altogether, the action of the heart, and the other involun-
tary organs is enfeebled, and the  patient swoons away or sinks into
a fainting fit, constituting the morbid condition we shall have to de-
scribe under  the next  genus.
   The great  predisponent cause in all  these cases, whether of mus-
cular agitation or of vertigo, is nervous debility or exhaustion: the
exciting causes are whatever has a tendency to disturb the unifor-
mity with which the nervous power  is supplied through  the whole
of its fibres, and from one fibre to another.  And hence those per-
sons are most subject to both kinds  of affection whose nervous
system is constitutionally weak and mobile, or has become debilitated
by disease  or accident.   Hence dyspeptic patients are peculiarly
subject to both these affections ;  as  are  those who are faint from
sudden  and violent evacuations, want of food, or  a long  course of
labour.  Hence  we meet with  it as a frequent and distressing
attendant upon those who have too freely indulged in the  pleasures
of the  table,  in those of sexual intercourse, and  particularly  the
gross gratification of self-pollution.   And, hence, we may see why
it is so often an accompaniment of cephalaea, as the nervous fibres
subservient to the organs of perception are here influenced from
contiguous, in some cases from continuous sympathy.
   The exciting causes we have stated to  be whatever has  a ten-
dency to disturb the uniformity with which the nervous  power is
supplied through the whole  line of its fibres.   Of these the chief
are motion or exertion to which the  strength is not equal, motion
to which the  system has not been accustomed, or hurried motion
whether external  or internal.
   In a state of great weakness, whether from hunger, hard labour,
hemorrhage,  or a protracted fever,  even the  ordinary motion  of
gentle   walking  is  more than the  little  remaining strength can
support: and the man who tries it trembles  in every  limb and
becomes immediately vertiginous.   In like  manner whatever be
''- 4egree  of strength he will feel vertiginous by exchanging the
     n  to which  he has been uniformly accustomed for one  of a 
GE. V.-SP. I.]
NERVOUS FUNCTION.
3$5
different kind, and which he has seldom or never engaged in ; and
hence, the reason ofthe vertigo that accompanies swinging, sailing
in a ship, walking in a circle, sitting backward in a carriage,  or
standing on one's head ;  for the uniformity ofthe external habit has
by length of time associated itself with the uniform flow or secretion
of the sensorial fluid, and the one cannot be interfered with without
interfering with  the  other.  And  that this  is the  cause of the
dizziness hereby  produced is obvious, since as soon as the old habit
is overpowered by a new one, or. in other words, us soon as the
man has accustomed himself to the new action, it may be persevered
in without any vertiginous sensation whatever.  In some persons
this sympathy of association is not so strong as in others, and hence,
they are not so soon affected : in infants and young children such a
kind of sympathy has rarely commenced, for while their age has
not given time  for it, they have had so little walking in  a straight
line, and been accustomed to so much swinging and tossing about
in the arms, in every direction, that they are equally prepared for
all; and hence  can  run round a circle, or even circumvolve on their
feet, without any feeling of giddiness whatever.
   For the same reason hurried, tumultuous, or confused, motion of
any kind, whether external or internal, has a tendency to produce
the same effect;  for the current of the nervous supply will partake
of the agitation, and  dizziness be a necessary result.  Hence the
vertigo that accompanies intoxication, in which, from the inordinate
excitement that prevails throughout the system,  the regular and
uniform  stream of the sensorial fluid is quickened into a confused
and disorderly rush.  And hence the same effect from congestion,
or compression of any kind,as also from a sudden influence of mental
emotion, and particularly ofthe depressing passions : though in such
cases, ihe uniformity  of the sensorial stream is interfered with by a
check, instead of by a rapidity of action :  and where the check is
considerable, as in cases of sudden fright or apprehension, a fainting-
fit is at once produced without the preceding  stages.
   It is to this cause, exercised indeed in a less degree, that we are
to ascribe the dizziness which is felt on looking down a precipice,
climbing a tall  ladder, or walking over a very narrow bridge, with a
roaring torrent below ; for in all these cases  we are conscious of
danger, and lose  our firmness in our fear. And that such is the real
cause is quite obvious from the fact that those who possess their
firmness, and have  no apprehension or trembling whatever, have no
dizziness : and  that we ourselves are able to endure an exposure to
the same scenes and the same motion with as great a freedom from
it, when habit has given us calmness, and we  have no  longer any
apprehension.  So  the sleep-walker has been known to tread firmly
and fearlessly over  planks and precipices the sight of which has
whirled all his brains when awake.
  Vertigo, then, as thus explained, consists in a clonic action of the
nervous  fibres subservient to the faculty  of perception ; and lays
open to us the three following varieties: 
336
NEUROTICA.
[CL. IV.—OR. IV.
a Undulans.                 Dizziness with a sense of swimming
   Swimming ofthe head.       or undulatory motion.
Q Illusoria.                 Dizziness with a dimness of sight, and
   Illusory Vertigo.            imaginary  objects before the ex-
                              ttrnal senses.
y Scotoma.                 Dizziness with blindness and tenden-
   Blind head ache.            cy to swoon ; often  succeeded  by
   Nervous fainting-fit.         head-ache.
   Vertigo is not generally an alarming affection, but it is only to be
remedied by a particular attention to its cause, and  especially the
predisposition of the system to a relapse.
   If we have reason to suspect congestion  or extravasation in  the
head, bleeding, and especially from the temporal artery, will often
afford effectual relief.  I have seen a very  severe attack of vertigo
cease instantly, as by magic, on opening this artery,  although  not
more than a tea-cup-full of blood was drawn from it.  Where  the
stomach has been gorged, an emetic and afterwards a purgative will
prove most effectual; where the cause, on  the contrary, is debility
or exhaustion, it is best relieved by cordials and a generous  diet:
and where it is an idiopathic affection of the nervous system  the
war n antispasmodics  and tonics, with a tonic regimen, will  bid
fairest to succeed.   Such  persons  will  derive great  benefit by a
change of air, of scene, and of company ; by visiting the most quiet
of our watering-places, cold bathing, and  a cold ablution ot the
head, or of the whole body every morning.  Here also a particular
attention should be paid to the state of the bowels, as costiveness is
always an exciting cause.  During the paroxysm, perfect rest and a
reclined position will be always found necessary; and  where there
is a tendency to fainting, stimulant odours may be applied  to  the
nostrils, and ether, ammonia, and the volatile fetids to  the stomach
in draughts of cold spring water.
                       GENUS VI.

                       SYNCOPE.

                          Sgucojie.

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

Syncope, from e-vyx»7rr»> "  concido," " to fell  or cut down," is a
neoteric rather than an antique term.   It occurs, indeed, among the
Greek writers,  but rather  in the description  of battles  than  of
diseases.  1 cannot find who first  introduced it into the medical 
GE. VI.—SP. I.]
NERVOUS FUNCTION.
331
 nomenclature.   In Hippocrates  the  common synonym is leipop-
 sychia, and in  Galen apopsychia: but it answers its purpose, and
 is, in the present day, so generally established, that there is no kind
 of necessity for exchanging it.
   Dr. Cullen's definition ofthe genus is " motus cordis imminutus
 vel aliquamdiu quiescens."   But this is by no means sufficient:
 for the heart has been  sometimes totally void of motion without
 syncope, as in acrotismus, and especially in the  well-known case of
 Mr.  John  Hunter, which we have noticed under  that division.
 The leipothymiaof Sauvages and other nosologists is, only syncope
 in its first attack or mildest degree. Its character is  " subitanea et
 brevis virium  dejectio, superstite pulsus vigore, et cognoscendi
 facultate."  The pulse is, perhaps, always affected  in some  mea-
 sure ;  but  in slight cases it still retains a certain degree of power j
the perception rarely fails  altogether: but the voice seems to  be
uniformly lost.
   The species in some systems of nosology are very numerous, and
unnecessarily multiplied. Out of deference to high and established
authorities, the author was induced, in his volume of Nosology to
offer five:  but as several of these differ only in  cause or some ac-
cidental symptom, they may be reduced to the two following, and
the accidental differences be regarded as constituting  varieties or
modifications alone :

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

                 SYNCOPE  SIMPLEX.

                         Stooouittg.

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

In vertigo the defective or irregular action is chiefly confined to
the nerves, and particularly to those of perception :  in swooning it
is sometimes a result of nervous exhaustion as in cases of exquisite
pain or torture, whether of body or of mind, but it more commonly
originates in the sanguific or digestive organs, though the sentient
participate in the affection.  Vertigo, as we have already observed,
occasionally terminates in swooning; and in like manner swooning
is not unfrequently succeeded by vertigo.
  To  maintain the faculty of  perception  clear and true to the
impressions that are made on the  external senses, we endeavoured
  vol. in.—-43 
338
NEUROTICA.
|CL. IV.—OR. 1\
 to show, under the preceding genus, that the motion of the nervous
 power which connects it with  those  senses must be capable and
 uniform ; and  to maintain the action of the heart in a firm and
 regular order, it is necessary that the blood should flow into it in an
 equal and uniform stream : for if its volume be altered from any
 cause, whether of obstruction,  surcharge, or deficiency, its motion
 will be checked and enfeebled: the brain and  respiratory organs
 will participate in the  debility,  and syncope be a frequent result.
 And hence, we may account for the fainting that frequently takes
 place on the commencement and  sometimes on the close of vene-
 section.  On tying the arm for  this purpose, a considerable stream
 of supply is cutoff, and ten ounces of blood flows, in perhaps five
 minutes,into a bason, which would otherwise have flowed into the
 heart in the same period of time.  The volume of blood is hence
 diminished and the heart must collapse or contract itself in propor-
 tion. In many habits this is done with great facility :  but in others,
 and particularly where there is a feeble supply of. motific or irri-
 tative  power, the contraction takes place slowly and irregularly
 and with a considerable degree of flutter, or, as we  have  already
 explained it, clonic spasm ; and fainting or a temporary failure of
 sensation, is the necessary consequence : during which the alter-
 nating systole is very feeble,  and the  blood  ceases to flow at the
 puncture.   This  effect  is  ordinarily  ascribed  to  a loss of the
 stimulus of distention ; and there may be  some degree of truth in
 such an explanation.  But that  there is a something beyond this is
 certain, because on removing the ligature from the arm this stimulus
 is once more obtained ; for the  blood, instead  of flowing away at
 the venous orifice, now takes its proper course and flows back to
 the heart.  Yet we see almost as often a syncope produced at this
 moment, and consequently by a renewal of the distention,  as well
 as by an interruption of it.   The fact is that the heart, which by
 this time has accommodated itself to the diminished volume of the
 returning current, has now once more to  change its diameter, and to
 expend itself in proportion to the increased measure and momentum
 of the inflowing tide.   And as a change  in its diameter produced a
 syncope in the former case, a change in its diameter in like manner
 produces it in the latter.
  For the same reason  we may see swooning takes  place when any
 extensive range of blood-vessels that  have been pressed upon by
any other means, suddenly acquire a power of dilatation, as when a
large cavity is formed in the abdomen by the process of  tapping
for  an  ascites,  or on opening an extensive  abscess in any other
quarter.*
  But the flow of sensorial power from the brain may also be  sud-
denly exhausted, or checked, or perhaps  its  secretion impaired;
and syncope may ensue from this source, the action  of the heart
* Meckel, Epist. ad Hallen. Script  Vol. III.
  Eph. Nat. Cur. Dec. II. Ann. V. Obs. 53. 
GE. IV.—SP. I.]       NERVOUS FUNCTION.
330
 being diminished not primarily, but secondarily,  or by  sympathy
 with the state ofthe sensorium.  In fainting from  entonic passions
 or emotions, as a sudden shock of vehement joy, the  sensorial
 power is perhaps abruptly expended, as also in severe pain.*  In
 fainting, under the influence ofthe atonic passions, as fear, or heart-
 sick grief, this power is unquestionably checked in its regular flow,
 and probably checked also in its secretion  as we have  reason to
 believe it is  where fainting occurs from a repulsion or retrocession
 of gout, exanthems, or various other diseases.  And to  the same
 cause  may be referred those cases  of swooning,  which, in  some
 idiosyncrasies, or indispositions of body, are  well known to take
 place-on exposure to particular odours, as  those ofcheese, apples,
 or, as we have already had occasion to observe, of  roses, lilies, and
 other fragrant plants.  Where it has followed instantly upon acrid
 poisons, there can be no doubt that these  have induced a rigid or
 entastic spasm upon the  muscular fibres ofthe heart; and, where
 the poisons are purely narcotic, the living or instinctive stimulus
 is suddenly  extinguished  or carried off, and the  nervous system
 becomes an exhausted receiver.
   Syncope then, in its simple state, as unconnected with any struc-
 tural disease of the heart or its adjoining vessels,  seems  to appear
 under the following  modified forms or varieties:
 ot  Inanitionis.                   The swooning produced by  fa-
   Swooning  from inanition.        tigue, long-fasting, or a sudden
                                  and excessive discharge of any
                                  fluid whether  natural or mor-
                                  bid, accompanied with a sense
                                  of inanition, and great prostra-
                                  tion of strength.
 S  Doloris.                     Preceded by severe pain or irri-
   Swooning  from acute pain.      tation of body,  internal, as from
                                  poisons, flatulency, or worms;
                                  or external, as from wounds or
                                  other injuries.
 y  Pathematica.                  Preceded by an exercise of some
   Swooning  from mental emo-     sudden and overwhelming pas-
       sion,                        sion or emotion.
 ^  Metastatica.                  Accompanied with a retrocession
                                  or repulsion of gout,exanthems
                                  or other diseases.

   The degree and duration of the paroxysm depend upon the pe-
 culiarity or the violence of the cause,  the  extent of the  sensorial
 exhaustion, or the nature of the constitution, and hence must great-
 ly  differ in different individuals.  In some  cases it ceases in a few
minutes, and  the patient, though incapable of speaking, retains

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


                        SPECIES  II.

               SYNCOPE  RECURRENS.

                       JFatnttiifl=iFtt.

RECURRING AT PFRIODS MORE OR LESS REGULAR;  OCCASIONAL PALPI-
  TATION  OF THE HEART DURING THE INTERVALS : AND UNQUIET
  UESPIRATION  DURING  THE PAROXYSM.

This is, in most cases, a far more serious form of syncope than the
preceding, and is commonly ascribed to some structural disease of
the heart or the large arteries that immediately issue from it, as an
ossification of the valves, polypous concretions, an enlargement or
thickening of the substance of the heart, an accumulation of water
in the pericardium, or an aneurism.
  Each of these may possibly be a cause in some instance or other ;
and where, during the paroxysm, the breathing,  though feeble, is
anxious and obstructed, the face livid, and the patient in the midst
of the swoon  shows a tendency to jactitation, or an uneasiness on
one side or on the other ; and, more especially still, where no ordi-
nary exciting cause can be assigned, and it has commonly followed
upon some unusual exertion,  or hurry of the blood  through the
lungs, it would be imprudent not to suspect some such lurking mis-
chief.
  But there are causes of a different and much slighter kind that I
cannot avoid believing,  frequently operate in the productionof re-
current syncope, and that too, with many of the peculiar symptoms
just enumerated.  And I now allude to any ofthe ordinary causes of
syncope, as set clown under the first species, or any other incidental
irritation whatever, occurring in a  constitution of great  mobility
and excitability, or where the  heart alone, or in conjunction with
the whole arterial system, is  peculiarly disposed to that irregular
and clonic action which we have noticed under the species palpi-
tation, and particularly under the first and second varieties.
  In such a  frame of body any sudden alarm, a longer abstinence
than usual, a fuller dinner than usual, unwonted exercise, and a
thousand minute excitements of daily occurrence will often succeed
in producing  a fainting-fit:  and especially where a morbid habit of
recurrence has been once established, and there is a predisposition
to return.   Atonic plethora is another frequent cause in the peculiar
constitution we are now considering, and a cause far too liable itself
to establish a circle of recurrence, and consequently to give recur-
rence to the  form of syncope  before us.   There is a singular ex-
ample of periodic swooning in the Ephemera of Natural  Curiosi-
ties,* which seems to have been dependent upon this state of body:
* Dec. II. Ann. I. Obs. 10. 
342
NEUROTICA.
[CL. IV.—OR. IV.
and another example in which  it was  evidently produced by a
return of the term of menstruation, and became its  regular har-
binger.*
  In all cases of this kind, therefore, it is of the utmost importance
to study minutely the character of the patient's  idiosyncrasy and
habit, and not to excite any alarm concerning organic mischief, and
thus add  another excitement to  those which  already exist, while
there is a  probability that  the affection may be  owing to  one or
other of these lighter and more manageable causes
  In the latter case tonics,  cold bathing, equitation, regular hours
and light meals will  form the best prescription we can lay down.
Where we  are compelled to suspect some  organic impediment or
other mischief about the heart, small bleedings that may anticipate
the usual time of the return, camphor, nitre, hyoscyamus, and what-
ever other  sedative may be  found best to  agree  with  the  patient
and diminish the rapidity of the circulation, will form the most ra-
tional medical plan we can devise ; while tranquillity of body and
mind, an abstinence from all  stimulant foods, and a regular atten-
tion to the slate of the bowels should form  a standard rule  for the
whole tenour of his life.
                      GENUS VII.

                       SYSPASIA.

                    (Comatose  Spasm.

clonic spasm; diminished sensibility;  INABILITY OF UTTERANCE.

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

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

  The author has entered so fully into the nature and principle of
clonic or agitatory spasm under the genus clonus, that a very few
* Id. Dec. n. Ann. V. Obs. 53. 
GE. VTI.]
NERVOUS FUNCTION.
343
 remarks, will be necessary in explaining the pathology of these
 three species.   They are all of them clonic spasms, as expressed
 in the definition, but complicated with other morbid affections, and
 particularly with those of the two preceding genera : for if we com-
 bine clonic or synclonic spasm with different modifications of ver-
 tigo or syncope we shall produce the  three species that are now
 before us.
   In explaining the nature of clonic spasm, we noticed the tendency
 there frequently exists when the uniformity of the flow or secretion
 of the sensorial power is once interfered with, to alternations of a
 hurried and excessive, as well as of a restrained and deficient sup-
 ply, and consequently to an intermixture of constrictive or entastic
 spasm with clonic or agitatory, of  which palpitation, and various
 other affections of this kind afford perspicuous examples.  In the
 diseases immediately before us the proofs of such an intermixture
 are still more striking ; for there is not one of them but evinces an
 union of  both descriptions of spasmodic action  in a high, though
 not an equal degree of vehemence.   In convulsion-fit the two kinds
 of spasm  are nearly upon a balance, commonly with a retention of
 some share of both sentient and percipient power.  In hysteria the
 spastic or entastic action, in its sudden and  transient irruptions, is
 more violent than the clonic, the force exercised at  this time is
 enormous, and there is also, in many cases, a small retention of sen-
 sation and understanding.   In  epilepsy the clonic action is most
 conspicuous, and the failure  of  the mental  and  sentient faculties
 generally complete.
   Of the essence of the nervous power we  have  repeatedly stated
 that we know nothing, for we can trace it only by its  effects: but
 we are compelled to conceive of it as a fine  volatile and energetic
 fluid, not  existing out of the animal system, and therefore, formed,
 and consequently secreted by some particular organ within it: which
 organ there can be no  difficulty  in contemplating as the  brain
 singly, or the brain and nerves jointly, which constitute only dif-
 ferent parts of one common apparatus. Admitting, then, the nervous
 power to  be a secreted fluid, like all other secretions, this may be
 produced in excess or in deficiency, or be imperfectly elaborated,
 and, however produced, it may be irregularly communicated in its
 flow, as well by precipitation as by interruption.   The  means by
 which these diseased actions take place,  we have already touched
 upon ; and have shown that the common causes are sometimes men-
 tal, sometimes mechanical, sometimes sympathetic, and sometimes
 chemical, as narcotics and other poisons, and particularly those of
 repelled erupiions.
   Now it is in persons of relaxed or debilitated fibres that we find
 these  exciting  causes chiefly operative.  For in those of high
 health, full vessels, and a firm constitution, however the circulation
 may be accelerated, or the nervous  power excited, it is rarely that
 we meet with clonic spasms, or indeed, spasms of any kind: or, at
least, we meet with a far less tendency  to such abnormities, than in 
344
NEUROTICA.
[CL. IV.—OH. IV.
persons of lax and debilitated fibres, possessing,  necessarily, more
mobility, or facility of being put into new actions from  the  very
quality of debility itself.
  The common predisponent then, is weakness,  particularly ofthe
nervous  system ;  and the  common excitement irritation.  The
peculiar effect must, however,  be modified by the idiosyncrasy or
peculiarity of the constitution, or of collateral  circumstances, by
which  it  may be influenced at the  time.   And hence,  the  very
exciting  cause that in one individual  may produce hysteria, in
another may produce epilepsy,  and in a third the more fugitive and
less impressive attack  of syspasia or convulsion.
  The nature of the idiosyncrasy, or particularity of the individual
constitution, is rarely within our control; but the collateral circum-
stances are often before us:  they constitute the occasional cause of
the disease,  and should form a prominent point in our attention to
its progress.
  There are, perhaps,  few more common causes of weakness than
over-distended vessels  ; and hence plethora is a frequent occasional
cause of each of the diseases belonging to the genus before us, the
species actually produced depending as just observed, upon  the
influence  of other circumstances.   Thus  if such plethora  take
place in a young woman of eighteen or nineteen, whose menstrual
flux  has  been accidentally  suppressed, or  retarded,  it  is most
probable,  if  an  irregularity in the  nervous system  be  hereby
excited, that such  an  irregularity will lead  to  a fit of  hysterics-
rather than to one of convulsion or epilepsy, since we shall find as
we proceed, that this species of spasm is peculiarly connected with
an irritable and especially an orgastic state of the genital organs.
  On the  contrary, if the plethora produce  chiefly a distention of
the vessels of the brain, epilepsy is more likely to be  the result;
in other words, that form of spasmodic action in which the  sensation
and the intellect suffer more severely than in either of the others.
While if the plethora be general we have reason  to  expect that
the spasmodic effect will be  general also, or, in  other words, take
the form  of convulsion  in v/hich no single organ is tried more than
another.   Yet plethora, in a firm and  vigorous  frame, is seldom
found to produce either of these affections, for the resistance of the
coats of the blood-vessels is  here sufficient to counter-balance  the
impetus of the sanguineous fluid, and consequently to  prevent  an
over-distention.   And hence, again, we see in what manner debility
becomes  a remote or predisponent cause of the diseases under our
consideration.
  Plethora thus acting by over-distention may be regarded as a
mechanical  stimulus,   upon  the removal of which, as upon  the
removal of other mechanical stimuli, the disease  will cease. Vene-
section is the most direct means of such removal: but it labours
under the inconvenience  of  being  only  a temporary remedy.  It
takes off the occasional cause, but by adding to the general debility
it gives strength to the predisposing cause. 
GE. VH.—SP. I.]       NERVOUS FUNCTION.
345
  The more direct mechanical stimulants are sharp-pointed ossifi-
cations formed in the membranes  of the brain, or arising from the
internal surface  of the cranium ;  splinters of a fractured cranium,
or the introduction of some wounding instrument.   The occasional
causes resulting from mental emotions, we have already been called
to notice more than once; as also  to show that while some of these
appear to act by  instantaneously exhausting the  sensorial organ of
its living principle, others operate by giving a check to the senso-
rial secretion.  These modes of action are indeed opposite, but the
result, which is a depletion of the nervous apparatus, is the same.
And as in weakly or relaxed habits there is in every  organ a greater
mobility, or facility of passing  from one state of action to another,
than in the firm and robust, we see also why the former should be
not only more subject to spasmodic actions from mental emotion,
but to sudden changes  of  mental emotion, and, consequently, to
caprice and fickleness of temper.
                         SPECIES  I.


               SYSPASIA CONVULSIO

                         CCOUuTlISiOU.

MUSCULAR AGITATION VIOLENT ;  TEETH GNASHING : HANDS FORCIBLY
                    CLENCHED : TRANSIENT.

In defining convulsion, most ofthe nosologists represent the facul-
ties of the mind and the external senses as .still sound and unaffected.
Sauvages says, " superstite in paroxysmis animae functionem exer-
citio."  Vogel distinguishes it, " cum integritate sensuum."   Dr.
Cullen is more exact than either of these.   His words are, « mus-
culorum contractio clonicaabnormis, citra soporem ;" " an irregular
clonic contraction ofthe muscles, bordering on but short of lethargy."
The influence of the disease on the sensation  and  perception vary
considerably in different cases, but  so far as I have seen, the sensi-
bility is always in some degree diminished, and I hence ventured
to introduce this feature into  the generic definition as a pathogno-
mic symptom.
  There are also some other differences that occur in the character
ofthe disease in its different attacks, and which have been laid hold
of as the ground-work of very numerous subdivisions by  many no-
sologists.   For these differences we cannot  always account: but in
general they will be found to  depend upon the idiosyncrasy, habit,
or stage  of life in which the disease makes its appearance, and to
give rise to the following varieties :
  vol. III.—44 
346
NEUROTICA.
[CL. IV.—OR. IV.
 « Erratica.                   The convulsion shifting irregularly
   Migratory convulsion.        from one part to another.
 £ Universalis.                The  convulsion  attacking  every
   General convulsion.           part simultaneously; occasionally
                                protracted in its stay.
 y Recurrens.                 The  convulsive  paroxysm return-
   Recurrent convulsion.        ing after intervals  more or  less
                                regular.
 ^ Ejulans.                    The  convulsion accompanied with
   Shrieking convulsion.        shrieks or yells, but without pain.
 e  Puerperalis.               Occurring during pregnancy  or la-
   Puerperal convulsion.       bour, usually with coma, and ster-
                               torous breathing.
 £ Infantilis.                 Occurring during infancy ;  preceded
   Infantile convulsion.         by  twitchings   or startings,  and
                               accompanied with a blueness about
                               the  eyes and upper lip.
   In the first or migratory variety, the convulsion travels, in
 some  instances, so completely from organ to organ,  and  from  one
 set of muscles to another, as to make an  entire circle.
   In the second or universal  variety, the convulsion is often
 accompanied with  a  peculiar kind of percussion or hammering of
 one  limb against another, or against some other part of the  body,
 resembling the malleation we have already had occasion to describe ,
 and  constituting the malleatio of some authors.
   In the recurrent variety, the intervals are often very irregu-
 lar ;  but the ordinary return, where any thing like a regular period
 is established, is menstrual or lunary.  To this, as also to the pre-
 ceding, many writers have applied the name of hieronosus or mor-
 bus  sacer ; which  by others, as we have  observed above,  has been
 limited to some modifications of chorea.
   In the fourth or shrieking variety, the muscles of respira-
 tion, and especially those of the larynx, appear to be chiefly affected:
 and  the shrill sounds or yelling to  which it gives rise,  proceed
 rather from  an involuntary motion of these organs than from any
 greater degree of pain that is suffered under this form than under
 any other.
   In puerperal convulsion, the irritation is supposed by Dr. Bland
 to derive no peculiar  character from the state of the body at the
 time.  But it is impossible to shut our eyes to the close and active
 sympathy which exists between the sexual organs and the sensorium,
 and which is peculiarly striking in hysteria; nor to the distinctive
 symptoms which take  place in convulsion  from this cause ;  in which
 there is a greater tendency to oppression in the head than in any
 other modification whatever, the breathing is stertorous, and the spas-
tic action peculiarly  violent; insomuch that were it not  that the head
 seemed first  affected, we might resolve  the oppression  into the
vehemence and duration of the  entastic struggle.  Convulsions of
this kind occur during pregnancy, in  the midst of labour or immc- 
GE. VII.—SP. I.]        NERVOUS FUNCTION.                347

diately afterwards:  they rarely, however, take place before the
sixth month.  Yet, if the irritation were not of a particular kind,
we might rather expect it on the first turgescence of the uterus.
But we shall have occasion to recur to this subject under the ensu-
ing class.
   In infantile convulsion, the mobility of the frame is impres-
sively conspicuous.   The clonic motions are  exquisitely rapid, and
the fingers  work and the eye-lids nictitate with  a  quiver that it is
often  difficult to follow up.  This  constitutes  the ecclampsia  of
Sauvages.   In the subsequent stage of teething, as the irritative
fibre is somewhat firmer, the clonic  vibration  is  rarely so rapid.
Antecedently to the time of teething the  usual causes of excite-
ment are retained meconium, flatulency, and acrimonious food.
   The ordinary excitements of  convulsion, however,  operate at all
periods of life.   They are often concealed, but are those of clonic
spasm generally.   They  consist not  unfrequently, as we have al-
ready observed, in pressure or  other irritation,  from  a  deformity
or some spicular node within the cranium ; and are said by Desses-
sarts* to occur most frequently in those whose sculls are peculiarly
large, or, in the language of Morgagni,! are nearly cubical in the
occipital  region.   Pressure, however, or congestion in the brain
from whatever cause, is  an occasional source  of this  complaint.
And hence  convulsion is a frequent result of severe fright, or any
other  violent  agitation  of  the  mind.   And, like several of the
species we have just noticed, it is a frequent result of some sudden-
ly suppressed natural or morbid discharge,  or suddenly repelled
complaint affecting a remote organ. It has hence appeared on sup-
pressed menstruation, suppressed flow of milk, leucorrhoea or lo-
chia ; on suppressed dysentery,^ or the suppressed discharge from
an old ulcer.§   And  it has followed,  in  like manner, on repelled
gout, exanthems, and cutaneous  eruptions ; even on a sudden cure
of the itch  where it  has been of long standing, and has formed a
chronic irritation.  The usual causes in  pregnancy and infancy we
have noticed above.
   CoRvulsions are also frequently produced by many of the narcotic
poisons in a certain degree of strength  or activity, and a  certain
state of the constitution.  For  if the dose  be  very  large, or the
system much debilitated at  the time,  the irritability will be entirely
destroyed,  and death will often  ensue instantaneously, without any
struggle  whatever.  Thus  the distilled water of the leaves  or
kernels of the prunus Lauro-cerasus,  under different circumstances,
will produce both these effects; as will  also the distilled water of
the kernels of various other fruits possessing prussic acid, as those
of the black cherry and bitter almond  tree; and hence  the  prussic
* Journ. de Med. XLVII. 114.
| De Sed. et Caus. Morb. Ep.IX. 9.
t Hoefner,  Baldinger N. Mag. B. VI. p. 323.
§ Gruellmann. Diss. Observ. de usu cicutae Goett. 1782,
  Ep. hem. Nat. Cur. Dec. III. Ann. II. Obs. 74. 
348
.NEUROTICA.
[CL. IV.—OR. IV.
acid  itself.   And we  may hereby understand the remark of Sir
Hercules Langrishe, that one ounce of laurel-water will  occasion
more violent and stronger convulsions than five or six ounces.  The
dose  of  this water given, by way of poison,  to  Sir  Theodosius
Boughton,  was a draught phial full, and, consequently, about an
ounce and a-half. The struggling fit in this case began  in a minute
and a-half, or two minutes, after it was swallowed ;* it continued
for about ten minutes,  when  he expired..
   The spasmodic action produced by these plants is chiefly clonic,
which in effect is the ordinary action with which life ceases: but
there are others that render it of a mixed character,  the entastic
alternating with the clonic ; and some in which the rigid or entastic
power considerably predominates, as in the poisonous  juice of the
upas  tiente  which, though with  occasional relaxations, fixes the
muscles  as rigidly as in tetanus, and continues the rigidity till the
patient dies.
   In ordinary cases, however, the mode of attack and the progress
of the paroxysm exhibit a considerable variation.  Sometimes the
assault is sudden and without any warning,  but more generally there
are a  few precursive indications, and especially in patients who are
subject to returns of it;  such as a coldness in the extremities with
a dizziness in the head and floating spectra before the eyes, or a
flatulent  uneasiness in the bowels, and a tenseness in the left hypo-
chondrium.   In other cases the patient complains of tremours in
different muscles, and a cold aura creeping up the back which makes
him shiver.
   The struggle itself I have  already said, varies equally in its ex-
tent and  violence, and  I may add in its duration. The muscles are
alternately rigid and  relaxed,  the  teeth gnash and often  bite the
tongue, the mouth foams, the eye-lids open and shut  in perpetual
motion, or are  stretched upon a  full stare,  while  the  protuberant
balls roll rapidly in every direction:  the  whole face is hideously
distorted.  The force exerted is enormous so as frequently to shake
the entire room, and overpower the strength  of six or eight attend-
ants.  In some instances it has been so violent as to break a tooth,
and even fracture a bone.f  When the lungs are  much oppressed
in the course of the contest, the lips, cheeks, and indeed the entire
surface, is dyed with a dark or purple hue.
   The paroxysm will sometimes cease in  a few minutes, but occa-
sionally lasts for hours, and, after  a  short and uncertain period of
rest, returns again with as much violence as before ; a  fact peculi-
arly common to puerperal and infantile convulsions. Great languor
commonly succeeds;  sometimes head-ache, vertigo, and vomiting,
occasionally delirium:  but not  unfrequently, and  especially in
infants, there are no secondary symptoms  whatever.
  The treatment of convulsion must apply to  the paroxysm itself,

  * Gurney's Trial of John Donnellan, Esq. for the wilful Murder of T. E. A.
Boughton, Bart, folio, pp. 18, 19.
  f Eph. Nat. Cur. Dec. U. Ann. 7. 
GE. VII.—SP. I.]        NERVOUS FUNCTION.                349

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

 * Dissertatio Medica de Stramonii usu in morbis convulsivis. 4to. Upsalis 
UK. VII.—SP. I.]
NERVOUS FUNCTION.
351
of the same character.   Of these the metallic salts and oxydes are
chiefly to be depended upon, and especially those of iron, copper,
arsenic, silver, and zinc.   Zinc has had by far the greatest number
of advocates, and is  generally supposed to have succeeded best in
the  form of its white  oxyde  or  flowers,  ten or  twelve  grains
of which are usually given to an adult in the course  of twenty-four
hours. Mr. Dugaud increased the proportion to fifteen grains ;* and
Mr. Bell, at length, prescribed not less than ten grains at a time, re-
peated three times a-day.f In the hands of the present author, it has
proved more salutary in the form of its sulphate, which has not un-
frequently succeeded where the oxyde has failed ; the usual propor-
tion he has employed being a grain three times a-day given in the
emulsion of bitter almonds. Where silver has been made choice of,
the usual preparation has been its nitrate, and the dose has begun
with a grain given four or five times a day  in the shape of a pill,
and  gradually increased to eight or ten grains, or as much as the
patient's stomach will bear.
  The virtue of all these, however,  seem considerably improved
by a combination with camphor which has often been found advan-
tageous even alone.  " In spasmodic or convulsive affections," says
Dr.  Cullen, " it has been of service, and  even in epilepsy it has
been useful.  I have not, indeed, known an  epilepsy entirely cured
by camphor alone;  but I have had several instances of a paroxysm,
which was expected in the course of a night, prevented by a dose
of camphor exhibited at bed time ;  and  even this when the cam-
phor was given  alone ;  but it has been especially useful when given
with a dose of cuprum ammoniacum, or  white vitriol, or of the
flowers of zinc."|
  The vegetable tonics are little to be depended upon.  The bark,
recommended by Dr. Home, Sumiere, and many other distinguished
writers, is rarely of use except where the paroxysm is periodical :
and the car dam'ine prat ens is (ladies-smock,) sempervivum tectorum,
(house-leek,) and viscus  quernus  (missletoe,) are  hardly worthy
of notice in  the present day, notwithstanding the  specific  virtues
they were supposed to  possess formerly.  The cardamine, the
c-ta-vftSpiov tTtpei of Dioscorides, is of ancient celebrity, and in modern
times has been  warmly extolled by the commending authorities of
Mr. Ray, Sir George Baker, and Dr. Home  : the second of whom,
as was noticed under the head of Chorea, declares himself to have
succeeded in its use  not only in cases of convulsion but of all clonic
spasms whatever, and this too, when almost  every other medicine
had failed.§
  The house-leek was employed in the form  of an expressed juice
intermixed with an equal quantity of spirit of wine, which  gives a
* Edin. Med. Comment. V. 89.
f Id. I. 120.
t Med. Transactions. Vol.  I. Art. XIX.
$ Auserl. Abbandlundlung. fur Pract. Aerzte. B. X. 13. 
352
NEUROTICA.
[CL. IV.—OR. IV.
 white coagulum resembling creme of fine pomatum, that has a weak
 but penetrating taste, and was supposed,from its ready evaporation,
 to contain a considerable  portion of volatile alkaline salt.  Pere-
 boom* applauds its tonic and antispasmodic virtues in this state, and
 for further instances of its fancied power the reader may consult the
 German Journals of Natural Curiosities.  The missletoe has rarely
 been employed in our  own country  except  by Dr. Home, who
 thought he found it serviceable ; though it is chiefly indebted for
 its fame as a specific in  convulsions, to the practice and  writings of
 Colbatch.f  It has been given in powder, infusion, and extract.



                         SPECIES II.

                SYSPASIA HYSTERIA.

                         lltgstm'cis.

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

 Hysteria, from un-npx " the uterus or  vulva," or more correctly
 " viscus postei ius vel inferius," evidently imported in an early pe-
 riod of medical science,  some misaffection of the womb or other
 sexual  organ ;  and hence hysteria, among the Greeks and Romans,
 was also a term by which female midwives were denominated,  or
 those who especially attended to affections of the hysteria or womb.
 The Latin term uterus, although it approaches it in sense and sound,
 is altogether of a different origin.   For this has  a direct reference
 to the use and  figure of the uterus as a  single organ, and is an im-
 mediate derivation from  uter a bag or bottle.
  With a morbid condition of this organ, indeed, hysteria is in many
 instances very  closely connected, though it is going too far  to say
 that it is always dependent  upon such condition :  for we meet with
 instances occasionally in which no possible  connexion  can be
traced between the disease and the organ ; and sometimes witness
 it in males as  decidedly  as in females.   It has  been contended by
 various  writers, that in this last case, the disease ought to be  called
hypochondrism, the hypochondrias ofthe present work ; and that
hysteria and hypochondrias are merely modifications of a common
 complaint.  Nothing however, can be more erroneous.  These two
diseases have often a few similar symptoms, and more particularly
those of dyspepsy ; but they are strictly distinct maladies, and are
characterised  by signs that are  peculiarly their own.  The con-
  * N. Act. Cur. VII. Obs. 4.
  \ See also Diss, sur la Gui de Chine, remede specifique pour les maladies
Convulsives. Paris, 1719. 
 GE. VII.—SP. II.]      NERVOUS FUNCTION.                  353

vulsive struggling paroxysms, the sense of a suffocating ball in the
throat, the fickleness of temper, and the copious and limpid urine,
which are pathognomic to  hysteria, have no necessary connexion
with hypochondrias, and are never found in this disease when strictly
simple and idiopathic.  While, on the contrary, the sad and sullen
countenance, the dejected spirits, and gloomy ideas that character-
istically mark of hypochondrias, have as little necessary connexion
with  hysteria, and are in direct opposition  to its ordinary course.
Hysteria ia s-trictly a corporeal disease, hypochondrias a mental,
though it commonly originates in corporeal organs, but organs that
have a peculiar influence upon the mental faculties, and has not es-
tablished itself till these participate in the morbid action.   Hysteria
is a disease of the irritative fibres, hypochondrias of the  sentient:
Hysteria is a disease of early life, hypochondrias of a latter period.
Both, however, are diseases of a highly nervous or  excitable  tem-
perament, and, as such  may co-exist in the same individual: but so
also may vertigo or cephalaea  with  either of them;  which would
nevertheless continue to be regarded as distinct diseases, notwith-
standing such an incidental conjunction.  And hence Mieg,* and
various other established writers! upon the subject, have not incor-
rectly, though perhaps  unnecessarily, treated of the disorder before
us under the two divisions of male and female hysteria, hysteria vi-
rorum, or masculina. and hysteria faminina.
  Hysteria, like all other clonic affections, shows itself most fre-
quently in mobile and irritable temperaments, and particularly dur-
ing that period of life in which irritability is at its highest tide, as
from the age of puberty to that of thirty-five years, seldom appear-
ing  before the former, and rarely after the latter of these terms.
The common  occasional  causes of convulsion, which we have  al-
ready described, are also those of hysteria; and hence, acrimonies
of the stomach, or other  ahdominal  organs, mental  emotions, ple-
thora, and particularly turgescence of the sexual region are among
the most frequent; on which account, we are told by Forestus,| and
Zacutus Lusitanus,§ that one ofthe most common causes of hysteria
in males is a retention of semen, as one of its surest  cures is an ex-
cretion.
  As every thing moreover, that disturbs the uniform current of
the nervous fluid, or the ordinary diameter of the  blood-vessels or
cavity of the heart becomes a powerful irritant, we may also see
why this disease should occur on debilitating, and especially sudden
evacuations, and be at no loss to account for its appearing on excessive
as well as on suppressed menstruation, and consequently in leucor-
rhcea.  And as the sexual organs lose much of their orgasm during
* Epistolx ad Hallerum scripts, No. V.
f Eph. Nat. Cur. Oec. II. Ann. IV. Obs. 18, 61.
  Traite Nouveau de Medicine, &c. Lions, 1684.
* Observ. et Curat. Medic. Libr. XXVIII. Obs. 29, 33
§ De Praxi Admiranda, Libr. II. Obs. 85.
VOL, III.—45 
354
NEUROTICA.
[CL. IV.—OR. IV.
the period of parturition, we may also see why the disease should
attack barren rather than breeding women, particularly young wi-
dows, who are cut off from the means of exhaustion they formerly
enjoyed; and, more especially still, those who are  constitutionally
inclined to that morbid salacity, which  has often been called nym-
phomania, and, in the present work, will be found under the genus
UGNf.sIS.
  I have already endeavoured to show by what means, in the habit
of great nervous irritability, both clonic and entastic or rigid spasms
are produced; and the disposition there frequently  exists for thein
to pass into each other or to alternate in rapid succession.  And wc
have also seen  that the  former is most predominant in laxer, and
more mobile, and the latter in firmer and more  vigorous constitu-
tions.  There is no frame, however, that may  not become a prey to
spasmodic action of some kind or other, and hence, there is no frame
thut may not become a prey, under particular  circumstances, to the
species of spasmodic action  we are now describing.  These circum-
stances are very generally  concealed from us;  but we  uniformly
perceive that the rule we  have  now adverted to holds true ; and
that the hysteric spasm will assume more or less of a clonic, or of a
spasric character, in proportion as the individual is of a more relaxed
or a more vigorous make.  And hence the most  violent, though the
least common, instances of hysteric struggle  that occur to us, are
in young women of the most robust and masculine constitution.
  The paroxysm often takes place without any previous warning or
manifest excitement whatever, and especially where  it has establish-
ed itself by a frequency  of recurrence.  Occasionally, however, we
have a few precursive signs which rarely show themselves in vain :
as a sense of nausea or sickness, flatulency, palpitation of the heart,
depression of spirits, and sudden  bursts of tears without any assign-
able cause, showing a disturbance in the secretion, or distribution
of the nervous power.   The fit soon succeeds with a coldness and
shivering over the whole  body, a quick fluttering pulse, and an
acute feeling of pain in the  head as though a  nail were driven into
it.  The flatulency from the stomach or colon  rises in the sensa-
tion of a suffocating ball into the throat, and forms what is known
by the name of globus hystericus.   The convulsive struggle now
commences,  which in women of very  mobile fibres is  sometimes
very feeble, the relaxant  alternations prevailing over the contractile :
but in other cases is prodigiously violent,  evincing during the
contractions a rigidity as firm as in tetanus, and a force  that over-
comes all opposition.  The trunk of the body is twisted backward
and forward, the limbs  are variously agitated, and  the fists are
closed so firmly that it is difficult, if not impossible, to open the fin-
gers ;  and the breast is  violently and  spasmodically beaten.  An
equal spasm  takes  place in the sphincter ani;  so that it is often
found impracticable to introduce a clyster pipe; and the urine dis-
charged, though copious, is colourless.  The muscles of the chest
and trachea are agitated in  every way, and hence, there is an invo-
luntary utterance of shrieks, screams, laughing, and crying, accord- 
OB. VII.—SP. II.]      NERVOUS FUNCTION.
355
 ing to the direction the spasm takes, sometimes accompanied with,
 or succeeded by a most obstinate and  distressing  fit  of hiccough.
 When the fit ceases the patient appears to be quite spent, and lies
 stupid and apparently lifeless. Yet in an hour or two, or often much
 less, she perfectly recovers her strength, and has no  other feeling
 than that of a general  soreness, and perhaps some  degree of pain
 in the head.   It is rarely, indeed, that an hysteric fit becomes dan-
 gerous ; though it has in a few instances terminated in epilepsy or
 insanity.
   The definition asserts that the temper is fickle:  this is not to be
 wondered at ; for, in the hysteric teruperarnent, the irregular and
 clonic flow of the irritative fluid is communicated, by sympathy, to
 all the sensorial fluids: and in consequence the mind is as unsteady
 as the muscles: "and from hence," observes the sagacious Burton,
 who has painted strongly, but from the life, "proceed a brutish kind
 of dotage, troublesome sleep, terrible dreams, a foolish kind of
 bashfulness in some, perverse conceits and  opinions, dejection of
 mind, much discontent, preposterous judgment.   They are apt to
 loathe, dislike,  disdain, to be weary of every object.   Each thing
 almost is tedious to  them.   They  pine away, void of counsel, apt
 to weep, and tremble, timorous,  fearful, sad, and out of all hopes of
 better fortunes.  They take delight in doing nothing  for the  time,
 but love to be alone and solitary, though that does them more harm.
 And thus they are affected so long as this vapour Iasteth; but by
 and by they are as pleasant and merry as ever they were in  their
 lives;  they sing, discourse, and laugh in any good company, upon
 all occasions.  And  so by fits it takes them now and then,  except
 the malady be inveterate, and then it is more frequent, vehement,
 and continuate.   Many of them cannot tell how to express them-
 selves in words, how it holds them, what ails them.  You cannot
 understand them, or well tell  what to make of their sayings."*
   The mode of treatment bears so close  a resemblance to that for
 the preceding species that it will be unnecessary to enlarge upon it.
 Pungent applications may be applied to the nostrils, or round the
 temples, or the  face and neck may be sprinkled  or  dashed  with
 cold water during the paroxysm, and warmth and the friction of the
 hand be applied to the feet.  The peristaltic action of the bowels
 should be increased, which can only be done by stimulant and ca-
 thartic injections,  if the contraction of the  sphincter ani will allow
them to pass.
  Our chief attention, however, should be directed to the intervals.
And here the first recommendation is, sedulously to avoid every
remote or exciting cause.  If the menstruation be in a morbid state,
this must be corrected as soon as may be, concerning which, how-
ever, we  shall have to speak in the ensuing order.  If plethora be
a striking symptom, the lancet should be applied to.  In robust and
vigorous habits, we may bleed freely and have nothing to fear, but
* Anat. of Melancholy, Part I. Sec. III. 2.4. 
356
NEUROTICA.
[CL. IV.—OR. IV.
in loose and relaxed constitutions far more caution is necessary, as
has been  already explained under convulsio.
  In this last state of body tonics should also be had recourse to, and
many of  the warmer sedatives and antispasmodics as assafoetida,
camphor, most of the verticillate plants, and cajeput, which was a
favourite  remedy with Mieg.*   Valerian has often proved service-
able, but is rarely prescribed in sufficient quantity to produce any
good effect.  " It seems," says Dr. Cullen, " to be most useful when
given in substance  and in larger doses.  I have never found much
benefit from the infusion in water."t   The ammoniated tincture of
the London College, however, is an excellent form : but even here
the quantity of the  root  employed should be double what is pre-
scribed.  The cinchona may be usefully united with valerian, but
does not seem  to be of much benefit in this disease by itself.
  Opium is a  doubtful remedy: where  the  precursive signs are
clear it will often allay the irritation, and thus prove of great value.
But it so  frequently produces head-ache, and adds to the constipa-
tion, that it is rarely trusted to in the present day.  When resorted
to it is best combined with camphor.
  Where the disease occurs in the bloom of life, and there is rea-
son to apprehend the ordinary orgasm of this age to be in excess,
the surest remedy is a happy marriage.
                       SPECIES  III.

                SYSPASIA  EPILEPSIA.

             ZSjrileiJSg.   jpaiHtifl*<Stcfcuess.

spasmodic agitation and distortion, chiefly of the muscles of
  the face, without sensation or consciousness; recurring
  at periods more or  less regular.

The Greek physicians gave the name of epilepsy, from tariXxftQxvo-
fMti, to the present disease, from its "sudden seizure or invasion,"
which is its direct import:  and as the violence of passion or mental
emotion, to which the Roman people were accustomed to be worked
up in their comitia, or popular assemblies, from the harangues of
their demagogues, was one of the most common exciting causes, it
was among the latter denominated morbus comitialis ; in the popu-
lar language of our own day " Electioneering disease," in reference
to the time and occasion  in which it most frequently occurred.
  The general pathology of the two preceding species,  and which
• Epist. ad. Haller. ut supra No. V.
t Mat. Med. Part II. Ch. VIII. 
GE. VII.—SP. III.]      NERVOUS FUNCTION.
357
has been given at some length, under the genus clonus, will apply
to the present: but it is obvious fromthe symptoms that the muscu-
lar power, commonly speaking, though not always, is affected to a
less extent,  and the sentient and  intellectual to  a much greater;
and consequently that the irritative fibres suffer in a smaller degree
than the sensific and percipient.
  Before we enter upon the history of the disease it will be con-
venient to remark that fromthe different modifications under which
it shows itself, it has been subdivided by many nosologists into very
numerous varieties, but that the whole may be reduced to the fol-
lowing :

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

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

      •  Hornung, Cista. p. 394.
        Demerehene, De  la Conseillere in Diss, de Auditu.  Ultraj. 1710.
      f  Fabr. Hildan. Cent. I. Obs. 4. 
358
NEUROTICA.          [CL. IV.—OR. IV,
 of glass :* and Widenfield another upon swallowing a needle.f Con-
 firmed drunkards are peculiarly subject to this complaint.
   Particular affections ofthe uterus are, in like manner, an  occa-
 sional source of epilepsy, as well as of hysteria: and sometimes the
 latter  has run into the  former, where the  epileptic diathesis has
 predominated; examples of which occur very numerously in all the
 medical collections of cases.I Menostation  or a suppression or re-
 tention of the menstrual flux is perhaps the most common of this
 class of causes:  and we may hence see, why  it  should occasion-
 ally be excited by a suppression of the lochial discharge.   A sud-
 den suppression, indeed, of discharges of almost every kind natural
 or morbid, of long continuance in an irritable habit, has occasionally
 proved a sufficient source of excitement.  And  hence it has fol-
 lowed upon restraining too abruptly a chronic diarrhcea,§ or an habi-
 tual hemorrhage from the nostrils,\\ or the  hemorrhoidal vessels."?
   Hence, also repelled gout has been a cause, and still  more gene-
 rally repelled eruptions, and exanthems, as  itch, various species of
 ecpyesis, small-pox, and in  one instance miliaria.**
   Yet the most frequent cause of epilepsy is seated  in the head
 itself; and has been found on post-obit examinations to consist in
 some morbid structure or  secretion, in the bones, tunics, or sub-
 stance of this organ, as tubercles, exostoses, caries, apostems, natu-
 ral misconstruction  of the whole, or of particular parts,  injuries
 from external violence,  hydatids,  pus,  ichor, and  other diseased
 fluids.  Of these some are  predisponent, others occasional causes;
 the former of which will  often continue inactive for a long period
 of time, and, as we have already observed, appertain chiefly to the
 first or cerebral variety.   It has  been  observed,  also,  that in this
 modification  the disease often makes its attack  suddenly, and with-
out any manifest exciting cause.   Yet there can be little doubt that
in every instance some occasional cause does exist, though from its
acting upon a morbid part of an organ that lies beyond our research
it entirely eludes all notice.
  The paroxysm, indeed, in most  cases occurs suddenly, and the
patient is, so to speak, cut down at once, and loses all sense of per-
ception and power of motion : so that if he be  standing he falls to
the ground with a greater or less degree of convulsion.   There are
 a few rare instances of some degree of consciousness and perception
* Hist. Anat. Cent. V. Hist. 66.
f Diss. Obs. Med. Triga. Coett. 1768.
i Moranus, Apologia de Epilepsia hysterica, Orthes. 1626. 4to.
  Schulze, Diss, casus hysterico-epileptici Resolutio.  Hal. 1736.
  Eickmeyer Diss, de Epilepsia uterina.  Ultraj.  1638.
§ Eph. Nat. Cur. Dec. I. Ann. I. Obs. 88.
|| Hagedorn, Cent. I Obs. 20.
1 Riedlin, Lin. Med. 1695. p. 454.
' * Baraillon, Hist, de l'Aead. Royale de Med. ad 1776. p. 220. 
«E. VII.—SP. Ill]      NERVOUS FUNCTION.
359
throughout the paroxysm ;* but the exceptions are few, and by no
means enough to disturb the general rule.  Commonly the limbs
on one side are more agitated than those on the other. The muscles
of the face and eyes are always much affected, and throw the coun-
tenance into various and  violent distortions.   The tongue is thrust
out of the mouth, which discharges a frothy saliva: the lower jaw
is strongly convulsed; the teeth gnash violently upon each other;
and, as this occurs while the tongue is protruded, the tongue is often
wounded most grievously.
  During the continuance of the fit there is generally an alternate
remission and exacerbation ofthe symptoms; though the whole does
not usually last  long, and is often of shorter duration than hysteria.
On the cessation of the paroxysm the patient remains for some time
motionless,  quite insensible,  and apparently in a profound sleep or
lethargy.   He recovers  from this  attack sometimes suddenly but
more generally by degrees, yet without any recollection of the suf-
ferings he has undergone.
  Under the first or cerebral variety, or where there is little or
no appearance of an occasional cause, and the predisponent cause
is supposed to exist in the head, the comatose symptoms, and indeed
the general mischief to the external as  well as to the  internal senses
is most striking.  Yet the effect is even here very different in dif-
ferent individuals.  The optic  nerve affords severe proofs of this.
Sometimes from a diseased accumulation of sensorial power in this
organ, surrounding objects appear brighter or larger than natural,
or both.f  Yet in many cases irritability of the nerve or its adjoin-
ing muscles has  been  destroyed, and a  paresis, more or less general,
has been the result.   Hence a perpetual nictitation, strabismus, or
blindness, are no unfrequent consequences.  Yet the stimulant in-
flux of accumulated power appears in one instance to have  had  a
most  fortunate  and directly opposite effect; for an  habitual  blind-
ness was hereby removed {   Where the muscles of speech  have
suffered  in  an equal degree, speechlessness has in like manner
followed ;§ and for the same reason where the joints have been vio-
lently affected with a predominancy of rigid over clonic  action they
have  sunk into an insuperable contraction.||  It is hence  not to be
wondered at that the whole system should occasionally be nearly
exhausted of its  entire stock of sensorial power, and that the pa-
roxysm should terminate in mania,  idiotcy, or even death  itself;
sometimes instantaneously, and at other times through the medium
of a fit of apoplexy.
  The warning or precursive symptoms, by which epilepsy is some-

      * Bresl. Sammlung. 1724. Band. I. p. 436.
      \ Bartholin.  Hist. Anat. Cent. HI.  Hist. 45.
       N. Saml. Med. Wahrnem. B. IV. p.  229.
      * Ephem. Nat. Cur. Cent. I. II. Obs. 130.
      § Hagedorn, Cent. I.  Obs.  14. Act. Nat. Cur. Vol. I. Obs. 7J.
      !! Horstius, II. p. 90. 
360
NEUROTICA.
[CL. IV.—OR. IV.
 times ushered, have been most common to the second or catenat-
 ing variety.  The most usual sensation is that ofthe ascent of a
 cold creeping vapour from some particular part of the body, of the
 nature and cause of which we  know nothing, but which has often
 been called an aura epilefitica.  This halitus  usually ascends from
 the extremities, but there is no organ from which it has not issued
 in different individuals, according to examples accumulated by the
 collectors of medical curiosities ; as the feet,  the hands, the fingers,
 the thumb, the great toe, the legs, the arms, the hypochondria, the
 crown of the head.   And in various instances spots on the face or
 feet have preceded, and at other times accompanied the paroxysm.
   We sometimes meet, however, with other  harbingers of quite as
 singular a character,  in the Other varieties:  as a heaviness of the
 eyes, pain, heat, and sparkling, which, by Sir Clifton Wintringham
 were regarded as signs that  peculiarly distinguish the idiopathic
 from the symptomatic disease.*   Sometimes there has been a wild
 play of phantasms or illusive objects before the sight :f and Portius
 relates a case of a woman, who was  always warned of  an approach-
 ing fit, by the appearance,  as it were, of her own image in a mir-
 ror4   On many occasions indeed, as Paulini has rightly observed,
 there is a peculiar overflow of spirits, and a tendency to merriment,
 as though the mind were entirely thrown  off its balance.§   Some-
times the patient exhibits sudden starts  of  running,|| or dancing ;"|f
occasionally he is strangely talkative ;** and in one instance exhi-
bited a new and  peculiar talent for singing.ft
  Under the ihird or complicated variety, while many of the
limbs are rigidly fixed, almost  without  relaxation, the muscles or
other parts are thrown into the most grotesque and ludicrous gesti-
culations of chorea : and, if the muscles of the chest be affected in
this  way, the patient appears  in  some cases to burst into involun-
tary  fits of laughter from their irregular and clonic action.If  At
the same time that such has been the force of the spasiic  muscles
as to break one  or more teeth, to rupture an artery,  or render a
vein varicose; and in one case at least to burst the left ventricle of
the heart itself.§§

  * Ricardi Mead Monita et Prsecepta,  permultis notationibus et observationi-
bus illustrata.  Tom. I. 8vo.
  f Bartholin. Hist. Anat. Cent. 1. Hist. 81. Cent. II. Hist. 72.
   Hagedorn, Cent. III. Obs 49.
  $ Medicae Considerationes varix.
  § Cent. II. Observ. 13. Bresl. Samml. 1724. Band. II. p.  434.
  || Boot. De Aft'ectionibus omissis. Cap. VI.
   Schenck, Obs.  I. Lib. U. p 202.
  1 Chesneau, Lib. I. Cap. IV.  Obs. 4. Eph. Nat. Cur. passim.
  ** Eph. Nat. Cur. Dec. II. Ann. VI. Obs. 229.
  ■pi; Act. Nat. Cur. Vol. V.
  *$ Eph. Nat. Cur. Dec. I. Ann. HI. Obs. 304.
  §§ Johnston, Med. Remarks, &c. Vol. U. 
GE. VII.—SP. in.]
NERVOUS FUNCTION.
361
   It has been observed that the epileptic paroxysm occurs chiefly at
irregular periods, and is for the most part of short duration. There
are, however, some instances on record  of a singular exception to
this rule in both cases.   For it has occasionally  lasted for two  or
three days with little or no remission.   It has also  returned at stated
times, and with great frequency;  with the revolution of the morn,
or even of the night; in one instance six times in a single day ;* and
in another, on the revolution ofthe birth-day of each of the patient's
parents.f   In a highly nervous temperament it is  not  difficult  to
account for such returns ; since the dread of its return alone, when
it has once established a circle of action, will form a sufficient cause
of irritation.   In a few instances it seems to have been hereditary ;
and perhaps in an equal number of congenital, appearing soon after
birth, and mostly produced by a fright of the mother during preg-
nancy,  Hildanus gives an example in which a fright  of this kind
was occasioned by  the presence of an  epileptic patient when sud-
denly attacked with a paroxysm :|and other medical records narrate
examples of a like  effect on a sudden rush of a hare, or some other
animal, against a pregnant woman.
  Many persons habitually disposed to  epilepsy are attacked imme-
diately on waking in the morning from a sound sleep, when we may
be inclined to think they  would be least  liable to such a surprize.
Dr. Cullen admits that he finds a difficulty in explaining this curious
fact.  But  when we reflect that epilepsy is a disease of irregular
action, chiefly in a  debilitated system, depending, where there is a
confirmed diathesis, upon whatever may disturb the balance  of
perhaps any ofthe circulating fluids—and that this balance may be
disturbed  either by too much as  well  as too little  excitement;—
when we reflect, moreover, that during sound sleep there is always
taking place  a considerable accumulation of sensorial power,  and
may at times be an excess of it—we shall no longer, I think, be at
a loss to account for  an adequate cause of this very singular phe-
nomenon.
  The general mode of treatment proposed for the last two diseases
will apply to the present.   The two-fold intention is to remove, as
far as we are able, the exciting cause, and to allay the habitual irri-
tation of the nervous system.
  Where plethora  manifestly exists, we  may use venesection with
great hopes of success, and,  generally  speaking,  more freely than
in hysteria.  But here also cathartics will be of considerable avail,
and in the hands of Dr. Hamilton have been found sufficient alone
to produce a cure.  To effect this they  should be used freely and
maintained steadily, so as to keep up a perpetual counter-irritation
in the bowels which may act as  a revellent against the morbid
* Tulpius, Lib. I. cap. xi.
f Eph. Nat. Cur. Dec. III. Ann. IV. App. 193.
* Cent. III. Obs. 8.
vol. ill.—46 
362
NEUROTICA,
[CL. IV.—OR. IV
irritation  in any other part, and directly carry off whatever acri-
mony may exist in the bowels themselves.
   Provided this be accomplished, the particular medicine employed
does not appear to be a matter of great moment.  Colocynth, gam-
boge, sulphate of magnesia,  and calomel seem to have been used
with almost equally good effects ; though in visceral congestion the
last should never be omitted.   If worms be suspected, and especially
the vermicular acaris, the rectified oil of turpentine  should un-
doubtedly be allowed a preference.  Even where worms are not
found to exist this has often  proved highly successful,  apparently
by the convulsive action it excites.  As a purgative it should be
given in ounce or ounce and  half doses to an adult: but as an alter-
ant in smaller doses repeated daily.*
   It was probably from its stimulant and cathartic effects alone, that
the mucus agaricus was ever in a high degree  of popularity.  It is
a reddish  mushroom, with a  white, thick, and  hollow pillar, and a
reddish or crimson cup,  nearly flat, about six  inches in diameter.
The dose was from ten to thirty grains  of the  powder to be taken
in vinegar.  Its effects, however, are sudorific  as well as purgative,
and, as the last are not wanted, it has been judiciously relinquished
for other medicines of the same  class.  It may be useful, never-
theless, to  observe, whilst upon this article, that it is employed suc-
cessfully in destroying both  flies and bugs, on which last account
it has been called bug-agaric.  The former are killed instantly on
their sipping milk in which  the  plant has been infused; and the
latter by rubbing  the juice over the holes and other places to which
they retreat in the day-time.
  De Haen often employed emetics, and chiefly for the purpose of
exciting and maintaining a new action, for which purpose he con-
tinued them daily for a week or two.  His example was followed at
one time,  but has long been  relinquished as highly inconvenient,
and in some cases injurious.!
  Externally stimulants have also been tried, and in various instan-
ces seem  to  have been attended with  good success.   The spine
has been rubbed night and morning with different preparations of
ammonia, camphor, or cantharides; and setons and issues have been
applied to  different parts of the body, as have  also both the actual
and potential cautery.J  Where the cause of the disease has been
suspected to be seated in the head, they have been chiefly confined
to this organ, but where there has been a manifest aura epileptica,
to the limb or other  part of the body from which the vapour has
seemed  to  ascend.  And there can be no question that these also
  * See Dr. Latham. Med. Trans. Vol. V. Art. XXIH. and compare with his
Treatise on Diabetes.
  f Rat. Med. Part. V. Cap. IV. § 1.
    Eph. Nat. Cur. Cent. VI. Obs. 58.
  i Ab. Heers, Observ. var.
    Locher, Observ. pract.
    Rockard, Journ. de Med. Tom. XXV. p. 46 
GE. VII.—SP. HI.]
NERVOUS FUNCTION.
363
 have  frequently proved serviceable, especially in  preventing the
 recurrence of subsequent fits, where a habit of return has been
 established.   Schenck has  examined  at considerable  length the
 successful and unsuccessful  cases which, in his day, had been pub-
 lished upon the use of cauteries.* In several instances an accidental
 burn has answered the  purpose of a surgical escharotic, and fortu-
 nately proved a radical  cure t Professor Loeffler of Altona, instead
 of cauterizing the limb from which the epileptic halitus seems to
 ascend, has ingeniously tied a light ligature above the part whence
 the vapour issues, probably  upon the ground of the success with
 which it is often attended in  the bite of the rattle snake, and other
 venomous animals, and in one or two cases the ligature seems to
 have proved quite as favourable in the present disease.
   The general irritability of the nervous system has been attempted
 to be  overcome  by sedatives and tonics.  Of the former the chief
 have been camphor, cajeput, valerian, hyoscyamus, stramonium, and
 opium.   The peculiar powers of all these we have so often had
 occasion  to  examine, and particularly under the preceding  two
 species, that it is only necessary to offer a few words on the datura
 Stramonium.  This medicine, like many others, has had a strange
 alternation of fortune.  About a century ago it was esteemed every
 thing, half a  century ago it declined greatly in its reputation,  and
 has of late been once more rising into esteem.  Fourteen epileptic
 patients in the royal hospital at Stockholm, were, many years since,
 treated with pills of stramonium.*,  Of these, eight are declared by
 Dr. Odhelius, in the official report upon this subject to have been
 entirely cured, five had  their symptoms mitigated, and only  one
 received no relief.  The greater number on first using this remedy
 were affected with confusion  in their heads,  dimness in  their eyes
 and thirst; but these symptoms gradually diminished.
   Where hyoscyamus has been given it has been employed both in
 the leaves and seeds: Dr. Parr  preferred the  latter, and usually
 combined the seeds with some aromatics, commencing with doses
 of a grain, and advancing them to four or five grains.
   The tonics employed have been both vegetable and metallic.
 Among the former the missletoe of the oak stood at one time at the
 head of the remedies for epilepsy.   It was regarded as a specific by
 Colbatsch,§ and most warmly recommended by Haller and De Haen.||
 It appears, however, of no importance from what tree it is taken,
 for, as a parasite, it flourishes equally on many, and preserves its

  * Observ. Lib. I. No. 233.
  t Eph. Nat. Cur. Dec. I.  Ann. II. Obs. 9.
  4= Mem. de l'Acad. Royale des Sciences de Stockholme traduit par M. Ke
raKo, Tom. III.
    Razoux, Diss. Epist. de Stramonio, &c.
  § See also Abhandlung von dem Missel, und dessen kraft wieder die  Epir
lepsie,  Altenb. 1776.
  H Rat. Med. Pract. Part VI. p. 317. 
I
364
NEUROTICA.
[CL. IV.—OR. IV.
 own peculiarities on all; and from every tree, so far as late  expe-
 riments have been made, it is equally inefficacious and futile.  It
 is difficult, indeed, to conceive what property could ever recom-
 mend this plant to therapeutic notice, for its sensible qualities are
 few and slight, both the leaves and roots  having little smell, and
 only a weak bitterish,  nauseating taste.
   Bark, and the leaves of the orange-tree, both of which have been
 very strongly recommended by many writers as powerful remedies
 for epilepsy, are almost as little worth a trial.   The leaves of the
 orange, popular  as  they were at one  time for the  cure of this
 disease,*  have  less sensible virtues than the peel; while it is only
 in a very  few  instances that we can indulge a reasonable hope of
 any degree of benefit from  cinchona.   In plethoric habits  it will
 generally do mischief, in the cerebral variety it  can do little  or no
 good;  and it is only in a relaxed and  mobile state of the animal
 frame in which we can expect the slightest success.
   The metallic tonics, however,  offer a  very different and more
 cheering  prospect: and all of them  seem  to have given proofs of
 a salutary result.   The metals chiefly trusted to have been mercury,
 arsenic, zinc, sulphur, and copper.
   Mercury has been tried in almost every form and to almost every
 extent; sometimes, indeed, to that of salivation, in which state some
 practitioners pretend to have found it highly useful.  As a general
 plan, however, this can never be advisable : and Muralt admits that
 in most cases where it has seemed to answer, it has only restrained
 the disease, or prolonged the interval,  but not  effected a radical
 cure.f
   Ofthe preparations of zinc we took notice under convulsion, and
 the remarks  there  offered are equally applicable  to  epilepsy.
 Such, however, has been the state of exhausted irritability produced
 by this disease in some instances, that the patient would bear almost
 any quantity of them. Mr. Johnson of Lancaster gave the sulphate
 of zinc in  doses of five grains twice a-day at first, and increased the
 dose gradually to twelve grains.  Thelenius had previously  given
 eight grains of the same daily 4  Arsenic  has of late been chiefly
 employed in the form of the common solution, and, as united with
 nickel, in  the compound of an arseniate.§   But the preparations of
 copper and silver, have met with more success  than any of the
preceding.  The best form of the first is that of the cuprum ammor
niatum; and the Edinburgh Medical Commentaries are full of cases
that afford proof of its remedial power.  The  simplest mode  of
  * Hannes (Christ. Rud.) Epist. de puero epileptico foliis aurantiorum re-
centibus servato. Leips. 1766.
    Gesner, Beobachtungen I. No. 19.  The epilepsy was here an effect of
terror.
  f Hippocr. Helvet. p. 247.
  * Mediciniche und Chirurgische Bemerkungen. Franc. 1789.
  § See a valuable article on this and similar medicines in the Edinb. Med
and Surg. Jour. No. XIX. p. 374. 
GE. VII.—SP. III.]      NERVOUS FUNCTION.
365
   exhibiting this medicine is that of pills, as the fiilula carulca ofthe
   Edinburgh Pharmacopoeia, which is nothing more than ammoniated
   copper made into a pilular consistence by means of crumbs of bread.
   The patient should  begin with half a-grain  of the metallic salt
   every night, and increase it to double  the quantity  if his stomach
   will bear it.
     The best, and indeed the common preparation of silver  for the
   purpose before us is its nitrate.  Under a more operose and unsci-
   entific form,  it was  employed as early as the beginning of  the se-
   venteenth century by  ^ngelus Sala, and afterwards by Boyle and
   Geoffrey, though for  other  complaints rather than the present.
   Dr. Badeley has observed  that the use of this  medicine, if  perse-
   vered in, gives a peculiar  darkness to the colour of the skin, which
   remains for many months  after its discontinuance,  in  some cases
   for upwards of two years.*
     Dr. Powell has tried the nitrate of silver in St.  Bartholomew's
   Hospital upon a large scale, and in two forms, that of pills and that
   of solution,  the solvent being mint-water which seems best to cover
   ils unpleasant taste.   Many of the cases seem to have been strongly
   marked, and they are  given  in  a communication to the London
   College.! They relate chiefly to young persons of both sexes from
   nine to fifteen years  of age ; in all  of  whom the medicine proved
   successful, and is said to have operated a perfect cure.   The dose
   at first consisted of not more than half a-grain  or a grain of the
   metallic salt whether in the form of pill or of solution, given usually
   every four hours, but this was gradually  increased to doses of three
   or four grains taken  at the same distance of time : and the increase
   was still continued till sickness or some other inconvenience forbad.
   It is singular  that while the earlier writers complain very generally
   of the purgative powers of this medicine, and  the  griping  it pro-
   duces, the modern preparation excites no such  effects; not even
   when it has been carried, as it has occasionally been, to the amount
   of fifteen grains to a single dose in the shape of pills;  though it
   should be remembered that few stomachs will bear  more than five
   grains in a dissolved state.
    All these tonics seem to  act by taking off the tendency to irregu-
   lar nervous  action, and, consequently, the tendency  to a  return of
   the paroxysm, where a habit of recurrence has  once been  estab-
   lished : for in many  instances such habit alone appears to  be as
   much  an adequate  stimulus  as  a  similar habit of intermittents:
   and hence, whatever has a tendency to break through such a habit
• must have a beneficial effect; fevers themselves of  various  kinds
   have often done this  ;| and especially quartans, the  most obstinate

    • On the effect of Nitrate of Silver, Trans. Medico-Chir. Soc. Vol. IX. p. 234.
    f  Med. Trans. Vol. IV. Art.  VIII.
    i Hornung, Cista Medica Norib. 1625. 4to.
     Augziige  aus dem Tagebuche eines aus'iibenden arztes, &c.  1 Samml
  Berl. 1791. 
366
NEUROTICA.
[CL. IV.—OR. rv.
of the whole tribe of fevers ; and the above  remark explains their
mode of operation in  this respect: it is that of introducing a new
circle of actions.
  But the exciting causes of epilepsy are so  numerous, and  the
disease itself so complicated, that it would be in vain to expect suc-
cess in every instance from metallic tonics, or any one description
of medicines whatever.   The remedies  must often  be varied to
meet the varying case.   And on this account it is by no means un-
common to find epilepsy  removed by  oil of  turpentine  or  some
other purgative that  had obstinately  resisted the most  powerful
doses of the metallic  salts : while in some instances the disease is
altogether irremediable.
                      GENUS  VIH.

                         CA11US.



MUSCULAR IMMOBILITY ; MENTAL OR CORPOREAL TORPITUDE OR BOTH.

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

                                       SUSPENDED ANIMATION.
1.	CARUS	ASPHYXIA.	ASPHYXY.
)p	---	ECSTASIS.	ECSTACY.
o.	---	CATALEPSIA.	CATALEPSY.
1.	---	LETHARGUS.	LETHARGY.
D.	---	APOPLEXIA.	APOPLEXY.
6.	---	PARALYSIS.	PALSY.
  Carus, therefore, will be found to embrace under the present ar-
rangement, a field somewhat more extensive than that allotted to it
by most other writers, so as. to include several of the species ar-
ranged by Sauvages under his two orders Leipopsychiae,and Coma-
ta, to be  nearly synonymous with the Defectivi and Soporosi of
Linneus, and still more so with the Adynamiae of Macbride.
  As a generic sign the author has preferred  the  term torpor  or
torpitude to stupor or sopor, which have hitherto been chiefly made
use of for the same purpose ; and this on two accounts.  First, as
being of wider  signification, since  it includes the general idea
furnished by both the others; and, secondly, because neither stupor
nor sopor have been uniformly employed in a determinate sense of
any kind.   Thus stupor  is often, perhaps usually, restrained to. 
 GE.VIIL—SP. I.]       NERVOUS FUNCTION.                3g-j

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

                  CARUS  ASPHYXIA.

            ^tejrtigKg-  jSusjiettTretr Animation.

TOTAL SUSPENSION OF ALL  THE MENTAL AND CORPOREAL FUNCTIONS.

Asphyxy, from x privative,  and o^vf's, pulsus, is here used in the
general sense of the term, though it has occasionally been employ-
ed to import mere failure or  cessation  ofthe action ofthe heart and
arteries, which, in the  present classification,  is made a species of
entasia under the name of acrotismus ; and has already passed in
review as belonging  to the second order of the present class.
  Asphyxy offers us several varieties from a difference of occasional
cause, which produces a like  diversity in a few of its  symptoms.
Sauvages, who has made the disease  a  genus, gives us no fewer
than seventeen species  or subdivisions; Dr Goodwin contents him-
self with three, and, denominating  the disease  melanama from the
black colour which the blood ordinarily assumes under its influence, 
368
NEUROTICA.          [CL. IV.—OR. IV.
 distinguishes them by the names of melanaema from hanging ; from
 drowning ; and from inspiration of fixed air.
   Of these the first arrangement is unnecessarily diffuse and com-
 plicated ; and the second too limited, and not quite correct, since it
 will presently appear that the  direct cause of asphyxy in hanging
 and drowning is one and the same.
   The author has, in consequence, been induced to  divide the spe-
 cies into the following table of varieties, forming a middle line be-
 tween the two preceding arrangements, and including, as he hopes,
 every modification with which it  is of importance  to  become ac-
 quainted :

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

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

         • See how the blood is settled in his face!
          Oft have 1 seen a timely parted ghost
          Of ashy semblance, meagre, pale and bloodless;
          Being all descended to the labouring heart.
          Who, in the conflict that it holds with death,
          Attracts the same for aidance 'gainst the enemy,
          Which, with the heart, there cools, and ne'er returneth
          To blush and beautify the cheek again.
          But see ! bis face is black and full of blood ;
          His eye-balls further out than when he lived,
          Staring full ghastly, like a strangled man.
          His hair up-rear'd, his nostrils stretched with struggling ;
          His hands abroad display'd, as one that grasp'd
          And tugg'd for life, and was by strength subdued.'*
* Henry VI. Second Part. Act III. 
GE. VIII.—SP.  L]      NERVOUS FUNCTION.
369
    This description,  however, applies more fully to asphyxy from
 hanging than to that from drowning, in which last there is more flac-
 cidity in the limbs, and consequently less of "struggle and grasp,
 and tug for life." In both cases, however, the countenance has a sem-
 blance of apoplexy, as though there was a congestion of blood in the
 head, to which the application ofthe rope to the neck, in the case
 of hanging, affords some countenance.  And hence, many eminent
 writers of  earlier times, as Boerhaave, Wapfer, and Alberti referred
 suffocation from  both  the causes before  us to  apoplexy ; while
 Cullen made it as  a subdivision of this last disease :  and M. Portal
 has, still more  lately, entered into the same view.*  But in apoplexy
 there is always oppressive, generally stertorous sleep,  which never
 exists in asphyxy, unless, indeed, the exciting c mse  has only parti-
 ally operated and produced a different disease, or  apoplexy instead
 of asphyxy; affording us a  proof of what  in fact we have noticed in
 a  thousand instances  already, that different maladies may issue from
 the same cause, according to the degree of its violence, or perhaps
 the accidental condition or constitution of the patient.  In asphyxy,
 wherever we can trace  any sign of diseased action, the  lungs  are
 chiefly affected ; in apoplexy, the brain.   In the first the irritability
 of the system is sudden and total, in the second it is progressive
 and partial. In the former the patient is often restored after  all  the
 common symptoms of death have, for some minutes,  perhaps  for
 nearly an hour, fixed  upon him : in genuine apoplexy this is never
 the case.  The appearances on the dissection of drowned animals
 are very accurately given  by  Dr. Curry, and precisely coincide
 with  the distinction here offered.   The vessels of the brain were
 found, in every instance, free from distention, or any other morbid
 condition,  while the lungs were over-loaded.
   The author has  observed that the immediate  cause  of asphyxy,
 or, in other words, an occlusion ofthe larynx, may be  partial,  and
 in such case give a tendency to apopletic symptoms.  And in  effect,
 wherever the larynx or glottis is only imperfectly closed we meet
 with  such  a tendency; and it is on this  account  that the face of
 those who die  by hanging is more generally turgid, and the muscles
 give proof  of more convulsive action than  the face of those who  die
 by drowning ; fbr  in the former case, either from  a rigidity  in the
 coats of the larynx, or from  the rope not being properly applied, a
 small current of air is often capable of moving backward and for-
 ward  for some time,  and particularly in  suicides, many of  whom
 suffer much before they die in consequence of applying  the rope
 very  bunglingly, and whose  cheeks, lips,  eyes, and  tongue  are
 peculiarly turgid and prominent.  The reason of this may be partly
 collected from the history already given, in the Physiological Proem
to  the third class,t  of the state of the heart in  the  act of dying.
  * Observations sur les effects des vapeurs mephytiques.  Nouv. Edit. Paris,
1774,.
  f Vol. II. p. 9.
  VOL. ill.—47 
310
NEUROTICA.
[CL. IV.—OR. IV.
The immediate cause of the contraction or systole of the heart, we
observed, has not  been satisfactorily  settled :* but we  may safely
affirm that a part of this cause, if not the whole,  depends on  the
change, whatever that  change consists in,  which takes place in  the
blood during its ventilation in the lungs, by which it is rendered
more active and stimulant; for as this change gradually subsides
in those who are in the act of dying, the heart contracts more fee-
bly ; and when, with the  last expiration of air, it ceases altogether,
the heart as instantly contracts no more : the consequence of which
is that the lungs, the heart, and the larger vessels in the vicinity of
the heart, are usually found filled with blood, the smaller vessels
empty, and  the general surface of the body pale.   Now whatever
has a power of instantaneously cutting off inspiration must neces-
sarily produce the  same effect:  and hence,  as we have  already
observed, the gorged state of the lungs and the livid hue of the coun-
tenance in most cases of  suffocation by drowning: and consequent-
ly the only reason  why the lungs are not quite  so full, and the coun-
tenance more turgid in most  cases of suffocation by hanging, is
that from the inexpert manner in which the rope is usually appli-
ed, and the necessary  admission of a  certain  portion of air to  the
lungs, the heart is, for some time, able to contract feebly, and to
keep up a feeble circulation, while the pressure of the rope on the
jugulars prevents  a ready return of the blood from  the head, and
consequently accumulates it in all the vessels of the face ; and hence,
the more  inexpertly this  operation is  performed  the more turgid
these vessels must become, and the  more apoplectic  the general
appearance.
   It is the same, as we  shall presently have occasion to notice more
fully, with persons who  are exposed  to the action of carbonic acid
gas or other mephytic  vapours, so far lowered or intermixed with
respirable air as to render them incapable of destroying  life  in-
stantly; in which cases there has not only been sometimes a feeble
prolongation of the circulation, but even a stertorous breathing and
many other symptoms of  apoplexy, of which we shall have to speak
further under the next variety.
   There are some of the narcotic poisons that seem to act in  the
same manner.  Given  in a full dose they destroy the life instantly,
but in an  under dose the circulation is continued feebly, and apo-
pletic symptoms ensue.   Thus, according to Mr. Brodie's experi-
ments, infusion of tobacco, when injected into the intestines, and  the
upas antiar, when  applied to a wound, have a power of rendering
the heart  insensible  to  the stimulus of the blood, and thus suddenly
stopping the circulation : while alcohol,- the juice  of the leaves of
aconite,  the woorara, essential oil  of almonds, whether applied to
wounded  surfaces or taken internally, produce death by destroy-
ing the functions of the brain, while they act only indirectly on the
circulation.
* Vol. II. p. 12. 
GE. VIII.—SP. I.]      NERVOUS FUNCTION.                 371

  In like manner, De Haen gives one instance of apoplectic signs
discovered on the dissection of a criminal who had been publicly
executed by hanging : in which the pia mater was found unusually
florid,  the vessels of the brain turgid, and some degree of serous
effusion  had taken place under the tunica arachnoides: but in this
case he found, also, that the lungs were equally overloaded, and that
the rope had  not pressed upon the trachea, but upon the part lying
between the scutiform cartilage and the os hyoides, and consequently
that the compression had been imperfect.*
  But, except in cases where the occlusion of the trachea has not
been entire, the patient, who suffers  from asphyxy  produced  by
hanging, is as void of apoplectic symptoms as he who suffers the same
disease from drowning.   In the dogs hanged by way of experiment
by De  Haen,f and cut down, as soon as they were dead, and in those
drowned by Dr. Goodwin,} there was an equal absence of apoplectic
signs:  and, in truth, wherever an executioner does his duty com-
pletely, the death is too sudden to allow of accumulation as its
cause.   By the double effect, however, of stopping the circulation,
and obstructing the passage of the air, the public punishment of
hanging, when dexterously conducted, is probably attended with very
little pain. It has been said of late that another, and indeed a chief
cause ofthe suddenness of the death hereby produced is to be found
in a luxation  of one of the  upper vertebrae.  Such an affect  may
take place at times upon our public scaffolds, on which the har-
dened  criminal jumps from the gallows to produce a rapid result,but
it is rarely met with in the  private retreat ofthe more timid suicide.
  That a total obstruction to the respiration, moreover, is the chief
cause of death on hanging  is clear from the cases in  which the as-
phyxy has been cured by inflation of the lungs after the unhappy
wretch has been cut down ; and from one or two instances in which
the individual has escaped death from an ossification of the trachea;
of which we have a few curious examples in Bonet, and Fallopius ;§
and more particularly from the case of Inettade Balsham>stated by
Dr. Plott, in his Natural History of Staffordshire : who having been
hung,  in the  reign of Henry VI., according to the due form of law,
was cut down alive,  after suspension from nine o'clock on Monday
till later than sun-rise on the ensuing Tuesday; in consequence of
which  she received the king's pardon.  Dr. Plott ascribes this ex-
traordinary escape, and  with great reason, to an ossification of the
larynx ; " She could not,"  says he, " be hanged, upon account that
the larynx or upper  part of her wind-pipe was turned to bone."||
  *  Rat. Med. continuat. Tom. I. part II 8vo.
  f  Abhandlung iiber die art. des Todes per Ertrunkenen, Ernhenkten, und
Erstikten.  Wien. 1772.
  t  Connection of Life with Respiration, or an experimental Inquiry into i\\n
effects of submersion, strangling, &c. Lond. 1778.
  §  Bonet. Lib. VII. Sec xii. Obs. II.
    Pallop. Tom-1. Obs. vi.
  it  Hist. p. 292. 
312
NEUROTICA.
LCL. IV.—OR. IV
  It has hence been occasionally proposed to save a criminal con-
demned to the gallows by introducing a silver canula, into the tra-
chea.  It is commonly reported that such an attempt was in agita-
tion among the friends of the  unfortunate Dr. Dodd, but we have
no reason to believe it was then, or ever has been actually 'lied.
   The following experiment, however, as related by Dr. Curry, is al-
most demonstrative as to the immediate organ through which the at-
tack of death is received in hanging. It was performed at Edinburgh,
many years ago, by the senior Dr. Munro, and in the language of Dr.
Curry " clearly proves that the  exclusion of air from the lungs is the
immediate cause of death.  A  dog was suspended by the neck with
a cord, an opening having been previously made in the  wind-pipe,
below the place where the cord was applied, so as to admit air in-
to the lungs.   In  this state he  was allowed to hang for three quar-
ters of an hour, during which time both the circulation and breath-
ing went on.   He was then taken down without appearing to have
suffered much from the experiment.  The cord was  now  shifted
from above to below the opening made into the wind pipe, so as to
prevent the ingress of air  into the lungs, and the animal being again
suspended he was completely dead in a few minutes."*
  Asphyxy from submersion has been very generally accounted for,
even by many  who have regarded it as an effect of suffocation, by
supposing the  suffocation produced  by a rush of water into the
cavity of the lungs which prevents the access of air and consequent-
ly of respiration.  This idea first, perhaps, advanced by Galen, has
been in modern times adopted by Hallen, Goodwin, Ponteau,  and
indeed most physiologists, and attempted  to  be  supported by va-
rious experiments on drowned cats.  It  is now well ascertained,
however, that in many cases of death from drowning not a drop of
water enters into  the lungs : that where it does enter, the quantity
is for the most part very small; and that whether small or  large,
it passes the trachea after death instead of before it, and consequent-
ly cannot be a cause of death.
  The immediate cause, as in the case of suspension is suffocation.
The glottis is extremely  irritable ; the access of the  surrounding
water produces a rigid or entastic spasm upon the muscles : and
the rima is as  completely closed against the entrance of air, as in
the case of  a  cord round the  throat.   And hence, the  suffocation
often produced by a very  small substance of  any other kind acci-
dentally thrust into or stimulating its aperture,as a minute crust of
bread, a hair or blade of grass, a peach or even a grape-stone ; to
which last Anacreon is well known to have fallen a victim.
  How long ihe living principle may, under these circumstances,
remain attached to the animal frame, and afford a chance of reco-
very, is not ascertained, with any degree of accuracy,  even in  the
present day : and  the answer to the question must, in a considera-
* Observations, p. 71. 
CJE. VIII.—SP I.]
NERVOUS FUNCTION.
3"<J
ble measure, depend upon the degree of irritability, or perhaps the
idiosyncrasy, of the individual.
   It has been known, however, from  a very early age, that torpi-
tude from drowning may be induced and continue for some minutes,
without much  danger : since this, as  we  have already  observed,
was a common practice among the Greeks and Romans for the cure
of lyssa:* and was carried by Van Helmont so far that  he would
not suffer the individual to be raised from under the water till the
psalm Miserere had been solemnly chaunted, which was the measure
of time he allowed.   If the submersion have not exceeded five mi-
nutes,  and no blow against  a stone, or other violence have coinci-
ded, persons will usually be found to recover without much difficul-
ty.  After a quarter of an hour, recovery is not common, and after
twenty minutes or half an hour, it is nearly hopeless.
   The first report of the establishment for the recovery of drown-
ed persons, at  Paris, divides  the cases that had occurred to it into
three classes, the first of which includes those that were restored to
life, and comprehends  twenty-three instances.  Of these one re-
covered after having been three quarters of an hour under water;
four after having been half an hour, and three  after a quarter of an
hour ;  the rest after a still shorter period.f   Of twelve dogs, drown-
ed by De  Haen for the purpose of experiment, not a single one was
recovered though only confined  under water for a few minutes.  It
is very possible,  however, that in these cases  the force necessary
to keep them submerged, may have considerably added  to the ex-
tent ofthe mortality.   Among mankind, where no such force is ap-
plied, this eminent physiologist conceives that one in sixteen is no
unfavourable average of the proportion that recover.|
   There are cases, indeed, on record,  of recovery from  drowning
after a submersion of some hours; but these are rare  and wonder-
ful, and some of them altogether incredible : for we have histories
of recovery after eighteen hours,§ four  and  twenty hours,|| and even
three days,H while some of the retailers of the marvellous have
stated intervals of fifteen days, and in one instance related with much
gravity, not less  than seven  weeks.**   From  all which, however,
we may at least learn the  useful lesson of the necessity of redoub-
ling our exertions when called  upon for  medical aid, and of not
despairing very early.
  Unfortunately we have no means of determining whether the vi-
tal principle lies latent in  the body or has utterly dropped its con-
  •  Vol. III. p. 243.
  -f-  Detail des succes de l'Etablissement que la Villede Paris a faite en faveur
des  Personnes noye"es, &c. Paris 1773.
  t  Rat. Med. Cont. Tom. I. Part II.
  §  Pechlin, De aeris et alimentorum defectuet vita sub aquis. Kiel, 1676. 8vo.
  ||  Lepi, Submersos per 24 horas vitam protrahere posse. Rom. 1670.
  1  Eph. Nat. Cur .Dec. I. Ann. VI. VII. Obs. 20.
  ** Id. Observ. 125. 130.192. 
374
NEUROTICA.
LCL. IV—OR. IV
nexion.  Want of heat is no more to be relied on than cessation of
the pulse or of breathing : for while in submersion, heat  in conse-
quence of its rapid absorption by the surrounding elements, is one
ofthe  first properties of life  that disappears, whether the  patient
recover or not; in death from  convulsions and various other sudden
causes, it often continues for hours, and sometimes even for  days
after the event, cheating the  by-standers with an  empty and un-
founded hope  of a restoration never to take place.  The present
author was lately sent for in haste, to a female domestic of Mr. Salmon
of Mecklenburg Square, who however died under a convulsion-fit be-
fore his arrival.   In the evening, nearly twelve  hours afterwards,
he was again requested to attend, as notwithstanding the  body had
been laid out from the first and merely covered with a sheet, it still
possessed a considerable  degree of warmth.   He was sorry to re-
press a hope which he  found fondly and highly cherished, but the
symptom was illusive, and the heat gradually  disappeared.   On the
decease of a robust and corpulent lady  whom he  lately attended in
Bedford Row,  and who died of a spasmodic  asthma, this  symptom
continued, or rather showed itself afresh, eight and forty  hours af-
ter death, so that the author was requested to attend at the time the
body was on the point of being put iyto the coffin.  In this case the
heat was produced by putrefaction, for the body was livid and offen-
sive.   Bartholine  has an example or two of the same kind ; and the
Ephemerides,  among other cases less marvellous, one in which the
heat is said  to have  continued till the fourth day after death : but
which should no doubt fall within the solution just given.*
  As heat has  occasionally maintained  itself for hours after death,
so also has perspiration.   Paullini mentions a case in which tears
flowed from the eyes ;f Riedlin another in which  the eyes them-
selves  recovered their brightness ;$  and Hagedorn a  third, in
which the face swelled and looked red.§  In  all these  cases we
have proofs of a lingering of the irritable principle in particular
parts after  the sentient principle has  totally disappeared.   And
hence, in a  few instances some of the  muscles have been  thrown
into irregular  action, the penis has become erect,|j the jaws have
opened and  shut,  as though masticating -^ and,  as is well known,
the heart when dissected from the pericardium, has leaped  from
the table.
  In attempting a cure of suffocation by submersion, the two grand
means  by which we are to operate are those of  warmth  and infla-
tion of the lungs.   The body should be quietly conveyed to a warm
and dry situation,  and rubbed all over with moderate  stimulants, as-
* Eph. Nat. Cur. Dec. II. Ann. IV. Obs. 18.
f Cent. III. Obs. 10. Franc. 1698, 8vo.
* Lin. Med. 1696. p. 203.
§ Cent. III. Obs. 46.
|| Eph. Nat. Cur. Dec. I. Ann. IX. X. Obs. 34. 158.
1 Commerc. Nor. 1732. pp. 82. 90. 173. 
GE. VIII.—SP. I.]
NERVOUS FUNCTION.
375
diluted flower of mustard, or the warmer balsams; while the nos-
trils are plied with volatile ammonia, and the eyes exposed to a
strong light.  But a restoration of the action of the lungs is chiefly
lo be aimed at:  and for this purpose, a full expiration of warm air
from the lips of a by-stander, should be repeatedly forced  into  the
patient's mouth, and his nostrils  held close to prevent its escape by
that channel.  Inflation may also be attempted by a pair of common
bellows; or, which is far better  if it can be readily procured, by a
pair of  bellows  communicating with a pipe introduced  into  the
larynx, or  as  some  have  recommended, into an  aperture  made
between the rings of the trachea.  Stimulating injections of acrid
purgatives, of camphor, ammonia, and brandy, or other spirits, have
often been  introduced with success into the rectum, and sometimes
injections of warm air alone :  and it would  be better that the air
introduced into  the  lungs  should be also moderately warm.  Be-
sides this active process, it may  be possible  to convey some warm
and cordial stimulant, as volatile alkali,  or the compound spirit of
lavender, into the stomach  by means of a canula; or what may pro-
bably in this case answer better, by a piece of sponge, impregnated
with one of these, fixed to the end of a small  rod of whalebone;  for
the sides of the  stomach may be, so to speak, mopped round by
the sponge thus charged, and stimulated in every direction.  In the
Berlin Translations is recommended the use  of a ventriculi excutia,
or stomach-brush, to produce internal friction in the same manner:
but the stomach-mop, prepared as above, will be found a more ser-
viceable contrivance.
   There is no family of diseases in which the internal use of phos-
phorus seems to promise more success.  The German physicians
have employed it very generally in the  last  ebb of typhous fevers,
in apparent death from convulsion,* and  in most cases in which  the
nervous fluid seems to be suddenly discharged as by an explosion,
or not secreted at all, and they have often employed it  with  success.
It is one of the most powerful stimulants we know, and in  asphyxy
should be given to the amount of two or three grains for a dose,
dissolved in ether.
   Venesection,  and  especially that of the jugular vein,t has been
strenuously recommended by physicians of high authority; and,
wherever there is reason to believe that  the drowning has followed
upon a sudden fit of apolexy, the recommendation is rational  enough,
provided it can be practised with effect. But commonly speaking it is
advice to no purpose, for the blood will not flow: and  in other cases
if it would, such depletion, we have reason to believe, would do
more injury by weakening, than good by removing what is errone-
ously supposed to be congestion.  It may occasionally, perhaps, be
serviceable as soon as  the living powers begin to show themselves,
but it is rarely to be tried in the first instance.

  * De Phosphori, loco Medicamenti adsumpti, virtute medica, &c. Anat. J.
Gabi, Mentz.
  ■j- Jo. Wences Nachtigal, Dissertatio de Submersis.  Vindobon. 8vo. 
376
NEUROTICA.
[CL. IV.—OR. IV.
   Returning life is first usually discoverable by  the symptoms of
 sighing, gasping, twitching, or subsultus, slight palpitation, or pul-
 sation of the heart; in effect by a weak or clonic action in most of
 the organs.  Our efforts should  here be redoubled, for the feeble
 spark still requires to be solicited and nourished into a permanent
 flame—and has often  disappeared from  a relaxation of labour.   A
 spoonful or two of warm wine, or wine and water, should now be
 given by the mouth  as  soon  as  the power of swallowing is suffi-
 ciently restored; which should  be shortly succeeded by a little
 light, warm, and nourishing food of any kind, with gentle laxative
 clysters, a well-heated bed, and perfect  tranquillity.
   I have dwelt the longer upon this subject  because the general
 principles of the remedial  treatment  here recommended, apply to
 most of the other varieties under which asphyxy or suspended ani-
 mation is to be traced:  and the reader who is desirous of following
 the operative plan into a still  minuter  detail, will do well to con-
 sult Dr. Cullen's letter to Lord Cathcart the president of the  Board
 of Police in Scotland, concerning the recovery of persons drowned
 and seemingly  dead ;  an able extract of which is given in the Medi-
 cal Commentaries of Edinburgh.*  We may observe, however, that
 in attempting the recovery of those who have been hung, and par-
 ticularly who have inexpertly hung themselves, bleeding from the
 jugulars may be more frequently found necessary than in attending
 the drowned, since in the former, as  we have very fully observed
 above, there is a greater tendency to apoplectic symptoms than in the
 latter : yet even here  the quantity abstracted needs not be large.
  In the second variety of asphyxy, or that from an inhalation of
 irrespirable auras, death  in many cases takes place instantaneously;
 and,  consequently, for reasons already advanced, the general sur-
 face of the body, and even the countenance itself, is pale.f   Yet as
 the gas is often in some degree diluted  with atmospheric air, the
 circulation and  even the  breathing are occasionally continued for
 some  time in a  feeble  and imperfect state, and the asphyxy is united
 with symptoms of apoplexy, or genuine apoplexy takes place in its
 stead.  In Cornwall and other mining regions, these gasses are vul-
 garly  called damps, from the German dampff, "a vapour or exha-
lation."
  The direct effect of such gasses, when in a concentrated state, is
 utterly and instantaneously to destroy the irritability and sensibility
of the  nervous system, of which  we  have  perpetual examples
occurring in persons who incautiously descend foul beer-casks, or
the shafts of mines.   By what means, however, such exhalations
when  they have penetrated the lungs become so rapidly communi-
cated  to the nervous system as to prove  instantly destructive, we
do not seem to  be yery well  informed.  Absorption would be the
* Vol. III. p. 243.
t Briikser von den ungewisheit der Kennzeichen des Todes. 
«E. VIII.—SP. I.]      NERVOUS FUNCTION.
377
 most ready way of accounting for it, but till the objections thrown
 out by Mr. Eilis against an absorption of oxygene or any other gas
 by  ihe  lungs,  and which  we have  noticed in the Physiological
 Proem to our second Class, are more satisfactorily replied to than
 they appear to have been, it is an hypothesis that can hardly be al-
 lowed.  In the case of hanging or drowning, it  does not seem to be
 owing to a direct want of irritability that the heart ceases instantly
 to contract, but, as we have already remarked, to its being deprived
 of the necessary stimulus which is no longer afforded by the lungs,
 however they may act, in providing it   Yet in the present  case
 there seems lo be not only a cessation of action, for want of a pro-
 per stimulus, but a total  abstraction of both sensific and motific
 power:  and this as completely in one part of  the frame as in an-
 other.
   The gasses ofthe description before us that are found most fatal,
 are the carbonic acid, hydrogene, nitrogene, and several of a more
 compound kind which are thrown forth from putrefying animal and
vegetable substances, and especially  from cemeteries, on opening
 fresh graves, in which the process of decomposition is proceeding
 rapidly,  and the  concentrated effluvium  bursts forth with an  into-
 lerable stench.  Of the powerful effects of this  last exhalation,
 Fourcroy has furnished  us with a very particular and striking ac-
 count from the  narration of grave-diggers examined for the pur-
 pose : from which it appears that those who are immediately hang-
 ing over a  corpse, whose abdomen is accidentally struck  into by a
 pick-axe, often  fall down instantly in a state of senselessness and
 apparent death, while persons who happen to be at a little distance,
 and receive the  exhalation in a form diluted with atmospheric airy
 are attacked with nausea, vertigo, faintness, and tremors, which
 continue for some hours.
  The most common of these gasses is the carbonic acid, which is
 chiefly found in the guise of a torpefying vapour in  close rooms
 where charcoal has been burnt, at the bottom of large beer-casks,
 or of wells, and in many natural caverns in the earth's surface. Its
weight prevents it from escaping readily, even when  there is an
 accession of atmospheric air: and its want of  smell, when  pure,
prevents it from being detected otherwise than  by its effects.   As
it will not support flame, the common and easiest test, where it is
 suspected to exist, is that of a lighted candle, which is well known
to be extinguished jimmediately, if this  gas be present in a quan-
tity sufficient to  be injurious to respiration.
  Nitrogene and  hydrogene, when  pure, have probably as little
 smell as carbonic acid gas ; but they are generally combined with
 other gasses, sulphur, carbone, or phosphorus.  The first formerly
denominated phlogistic air, and sometimes mofette, is thrown forth
largely during the decomposition of  animal matter,  and in a small
degree during that of vegetable matter. Combined with hydrogene
it forms ammonia; with oxygene, nitric acid.  Fourcroy asserts that
it possesses a peculiar and distinct odour, resembling that of fishes
  vol. in.—48 
375
NEUROTICA.
(CL. IV.—OR. IV
just beginning to putrefy: but this is probably at all times produc-
ed by a combination with other materials.  It seems chiefly con-
cerned in giving the greenish colour to parts, and especially mus-
cular parts, in a putrid state.  In some gases of this kind a candle
will  burn freely.
  Hydrogene issues also from  fecal malter, and,  in  combination
with sulphur, phosphorus, and carbone, produces the  chief part of
the  nauseating and putrid stench thrown forth from decomposing
animal and vegetable substances.  It is emitted in a much purer
state from the sides of coal and metallic mines, and often  exists in
considerable abundance without being perceived by the nostrils.  If
mixed with an equal proportion of oxygene, it may be breathed for
about an hour without any great inconvenience. If inhaled beyond
this  time, or in a more concentrated form, it has a great tendency to
occasion the  effects we have just noticed, lower the irritability of
the animal frame, and induce stupor or an  inclination to sleep.
  The fumes of mercury, lead, and some other metallic substances,
when highly  concentrated, seem to operate not very dissimilarly to
those of charcoal, and give a check to the mobility of the nervous
power at once.
  The fumes of charcoal are generally inhaled in a dilated form,
but they are still highly deleterious and  produce asphyxy more or
less  complete, according to  iheir degree of concentration,  and in
some cases according to the  strength or weakness of frame of those
who are exposed to them.   We have a striking illustration of this
in the case of two persons communicated by Dr. Babington to the
Medico-Chirurgical  Society, who had  gone to bed in a room in
which a charcoal fire was kept up through the whole of the night,
with whose gas the surrounding atmosphere was strongly impreg-
nated.   According to the  principle we have endeavoured to esta-
blish, we ought here, from the dilution of the vapour, to expect that
whatever tendency there might be to asphyxy would be united with
a tendency to apoplexy.   And such we find to have been  the fact:
for, of these  two persons,  the younger and less vigorous, a boy of
thirteen, died apparently during his sleep, and without commotion :
while the elder and more robust, a man of thirty-eight, was  found,
upon being called in the morning between six and seven, in an apo-
plectic slate,  with a swollen,  projecting  tongue, suffused and pro-
minent eyes,  and laborious breathing.
  The patient, if any degree of  sensibility remain, should in this
variety be freely exposed to  the open air, instead of to a heated at-
mosphere as  in the preceding :  and, if he can swallow, acidulated
liquids should be given him.  If insensible, cold water should be
dashed on his face, strong vinegar, and especially aromatic vinegar,
be rubbed about his nostrils,  and held under them, and stimulating
clysters be injected as recommended under the first variety.  The
lungs should  be inflated  with the warm breath of a healthy man,
or, which is better with oxygene gas.
  A  proper use of voltaic electricity is also in many instances foutv 
GE. VIII.—SP. 1.]      NERVOUS FUNCTION.
379
highly serviceable as a nervous stimulant.  No advantage, however,
is likely to accrue from passing the electric aura across the chest,
directly through  the heart and lungs, which is a common practice.
The fluid should be  transmitted along the channel of the nerves,
from the seat of  the  phrenic nerve in ihe neck, to the seat of the
diaphragm, or that of the par vagum and great sympathetic nerve
immediately  under the sterno-mastoid muscle, where they lie in a
common sheath, and send forth branches to the heart.*  In  Dr. Ba-
bington's case, the application  of  voltaic electricity surprizingly
increased the power  of the muscles of respiration, but  appeared
rather to diminish the action of the heart.  It was hence used alter-
nately with a forcible inhalation of oxygene gas, and various external
stimulants.   Venesection was tried, but does not seem to have been
beneficial.  The man recovered in a few days.
   M.  Portal recommends a  division ofthe jugular vein, but the
blood will rarely flow from any vein, and is still more rarely  suc-
ceeded by any advantage even where it is obtained.  And if every
other  remedy fail, he advises bronchotomy,  and a scarification  of
the feet and  hands.f
   The sprinkling or dashing of water upon the body seems to be
useful on two accounts; first, from having a tendency to  rouse the
vessels on the surface to contract;  and next as  affording an oppor-
tunity for a disengagement of oxygene.
   In the third,  or electric variety, the whole system  appears
to be not so much rendered inirritable to stimulants, as to  be  sud-
denly exhausted of its entire stock of nervous power, like a Leyden
phial upon an application of the discharging rod: in consequence of
which the limbs  are  flexible, the countenance pale, and  the blood
uncoagulable.  The mode in which the electricity is communicat-
ed is of little  importance; for, if sufficiently  powerful for the  pur-
pose, real or  apparent death is instantaneously produced, whether
the stroke flow from lightning, an  electric battery, or a  voltaic
trough ;  and every organ is equally  affected and emptied.
   Upon  plants, on the contrary, we often find a stroke of lightning
of the same  intensity occasion  very  different  effects in different
kinds of branches of the same plant, in consequence of the variety
they exhibit as conducting powers.   Upon some, it descends with-
out mischief; in others, it exhausts itself on particular parts, which
are withered, as  though  attacked by a hemiplegia.  In the betula
alba or common birch, it never runs along the stem, but confines its
stroke to the top alone, beating  off the boughs  in every direction.
   In animal life, however, there is also a difference of effect, but
only in proportion to the  degree or intensity of the electric power
that attacks the system;  and it is curious to observe the nature of
  * Greg Consp. Med. Theor.
    Hiifeland, Diss, usus vir. elect, in asphyxia.  Goet. 1783.
  f Observations sur les  effets des  vapours mephytiques sur les corps de
l'homme, &c. nouv. edit. Paris, 1774. 
 J80                     NEUROTICA.           [CL. IV.—OR. IV.

 this effect.  Small doses of electricity prove a powerful stimulus to
 the nervous function, increase the flow of sensorial fluid, and aug-
 ment the irritability of the muscles : while a violent  shock, as we
 have just seen, exhausts the nervous system instantaneously, carries
 off the entire stock from the animal fabric,  and leaves  the muscular
 fibres flaccid and flagging.  This singular  result is extended to the
 blood, and extended to it in both cases: for its coagulability, or the
 firmness of its texture, is increased by the application of small doses
 of electricity, while the shock of lightning  which renders the mus-
 cles lax and uncontracted renders the blood loose and uncoagulable.
 It is to this variety of effect that Mr. John  Hunter makes a power-
 ful, and certainly a very impressive appeal, in proof that the blood,
 though a fluid,  is actuated by the  same living principle as the mus-
 cuiar fibres.
   The general principle of medical treatment  has been laid down
 under the first  variety.  Stimulants of the most active kind should
 be resorted to  without loss of time: but of all stimulants that of
 electricity, or voltaism, seems to be especially called for in the pre-
 sent modification of asphyxy.   I do nol know that it has ever been
 tried to any great extent, in the  variety before us, on the human
 subject, but M. Abildgaard, in the Transactions ofthe Copenhagen
 Medical  Society, has related a few experiments on other  animals
 that are well worthy of attention, and were  found highly beneficial.
 The animals chiefly selected  were from the poultry-yard, and con-
 sisted of cocks  and hens.  These were first rendered  asphyctic, or
 apparently dead, by a strong shock of electricity passed through the
 head ;  and afterwards recovered by another shock passed through
 from the  chest to the back, the animal instantly  walking about as
 if nothing had happened.  M  Abildgaard does not say what inter-
 val he allowed  between the shocks  thus administered : but he ob-
 served that where no second shock was employed the apparent was
 converted into  real death, for the  animal,  in no instance, showed
 any tokens of resuscitation : and he observed farther that, if the se-
 cond shock were thrown  through the  head  like the first, instead of
 from the chest  to the back, the same lifelessness continued, and no
 benefit whatever was produced.*
  In frost-bitten asphyxy, or that produced by intense cold, the
 limbs are rigid, and the countenance pale and shrivelled.   This
 variety is always preceded by an  insurmountable  desire to sleep,
which  the  utmost exertion of the will  is  unable to overpower.
 The sleep is, in most cases, fatal and becomes the sleep of death.!
 Captain Cook, in the account he has given of his first voyage round
 the world, has strikingly exemplified this remark in the case of Dr.
 Solander  and Mr. (afterwards Sir  Joseph)  Banks.  " Dr.  Solan-
der," says he, " who had  more than once  crossed the mountains
  ♦  Societatis Med. Havniensis Collectanea, &c. Vol. II. Art. Tentamina Elec-
trica in Animalibus.
  J  Rhazes ad. Abnans. Tract. VI. Cap. V. vii. 
V.E. VIII.—SP. I.]     NERVOUS FUNCTION
381
which divide Sweden from Norway, well knew that extreme cold,
especially when joined with fatigue, produces a torpor and sleepi-
ness that are almost irresistible: he therefore conjured the company
to keep moving whatever pain it might cost them.  ' Whoever sits
down,' said he, * will sleep, and whoever sleeps will wake no more.'
Dr.  Solander himself  was the  first  who  found the inclination,
against which he had warned others, irresistible, and insisted upon
being suffered to lie down.   He  soon fell into a profound sleep,
from which, however, by the exertion of Mr. Banks he was awaken-
ed.  Several others of the party very narrowly escaped; and two of
them slept, and perished from the cold."*
   For these symptoms, and their effects, it is easy to account. Cold,
so long as the living power is capable  of producing  a reaction, is
one of the most strenuous tonics we are possessed of, and the glow
that accompanies the reaction, is felt to be peculiarly vigorous and
elastic.  But  if it  exceed this proportion and no reaction ensue,
the contraction of the vessels on the surface is converted into a rigid
spasm, the blood is driven into the interior, and the  surface  must
necessarily be pale.   In this extremity of temperature, moreover,
cold, instead of being a tonic, is one of the most formidable sedatives
in animal chemistry : it carries off  the heat of the body far more
rapidly than it can be recruited, and as effectually exhausts it of all
its irritable and sensible power.   But such exhaustion, as  we have
already shown under the genus paroniria, is a cause of stupor or
sleep, and a cause so cogent that the will is, in many cases, incapa-
ble of resisting it, and falls a  prey to its power.
  In applying remedial means to this modification of asphyxy great
caution is necessary respecting the  employment  of  warmth ; and
particularly where the limbs are  peculiarly  rigid, and  under the
influence of frost.  In this last case it  will be generally found most
advisable, in the first instance,  as in  frost bitten limbs, to plunge
the body for a few minutes into a bath of cold sea-water or salted-
water, at the same time that warm  air  may be breathed  into the
lungs, and the stomach and  rectum gently excited by moderate
stimulants :  for it does  not follow that, because the limbs  and sur-
face of the body are frozen from frost-bite, the central  parts have
suffered to the same extent.  After a short immersion in sea-water
the body should be taken out, wiped perfectly dry, laid  in flannel
in a moderately warm room, and submitted to the friction  of warm
hands,several persons being engaged in this process simultaneously.
* Hawkesworth's Account of Voyages, Vol. 11. p. 46. 
NEUROTICA
[CL.  IV.—OR. IV.
                        SPECIES II.

                  CARUS  ECSTASIS.

                          JScstasg.

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

There is so close a connexion between the present and the ensu-
ing, and in truth, most ofthe ensuing species of the order before us,
that they are occasionally apt to run into each other, or to  exhibit
a few aggregate symptoms.  And on this account they have  been
very differently arranged  by different writers.   Sauvages, and most
of the continental nosologists have regarded them as distinct genera,
Dr. Mead, and Dr. Cullen, as species or subdivisions of apoplexy,
and Dr. Cheyne as the same of  lethargy.   Dr. Cooke has treated
of them more cursorily than those  who are acquainted with  his
talents and learning, could wish : and has so far followed Dr. Cullen
as to  place them  conjointly in a chapter under the head  of apo-
plexy : while Dr. Young, coinciding with the  view  taken in the
present work, has arranged the whole as species under the  generic
name of carus.
  To understand  the nature of their distinctive symptoms, and the
reason of their occasional combination, it is necessary to bear in
mind the remarks offered in the Physiological Proem to the  present
class respecting the natural division ofthe nervous ramifications into
fibres of different sets and powers, and  the different kinds of fluids
which these several sorts are capable of secreting or conveying, as
sensific and motific fibres, and sensific  and motific  fluids;  since it
happens that some of  these diseases are  confined to  one  set, and
others to another, while other diseases again, extend equally to both.
And hence we are able to account for disorders in which the  percep.
tion or sensibility is abolished, while the irritability continues with-
out much interference : or in  which  there  is a disturbed flow or
total cessation of the irritable power, with little interference with
the percipient, and sometimes also  with the  sentient,  as in  some
cases of paralysis : or in which there is a disturbance  or cessation
of all these, wilh the exception  of a  partial supply  of irritative
power  to the involuntary organs.  It will  also be necessary  to
recollect, as we have  endeavoured to show in many of the  preced-
ing pages, and particularly under the genus clonus, that where there
is a disturbance in the flow of  the motific or irritative power, this
disturbance is of two kinds, one from excess, and one from deficien-
cy ; and that in both  cases there is a great  irregularity of action
and consequently entastic or rigid,  and clonic  or agitatory  spasms
 exhibiting, by their continuation, innumerable modifications. 
GE. VIII.—SP. II.]      NERVOUS FUNCTION.
383
   All the divisions of the nervous system, moreover, have a natural
 tendency to sympathize in the same action, however combined or
 interchanging; and  hence  in  whatever division of  it a disease
 commences, one or more of the other divisions arc peculiarly apt
 to participate in the affection : and the more  so as  it is not very
 common for abnormal actions, when once communicated, to proceed
 with much order or regularity ; for if trismus and tremor give us
 examples of  such  order, tetanus very generally, convulsion fit,
 epilepsy, and hysteria furnish proofs of the most capricious alter-
 nations of spastic and clonic action, or of their existing in different
 trains of muscles simultaneously.
   These remarks peculiarly apply to ecstasy, the species  imme-
 diately before us, compared with catalepsy or trance, the species
 that immediately follows.  In both, the nervous fluids contributory
 to sensibility or irritability are disturbed in their flow or regularity
 of action, but not equally, nor in the same manner: for while the
 flow of the former seems to be totally suspended, that of the latter
 continues, though with a striking deviation fromthe uniform  tenour
 of health.  Thus far the  two diseases agree.  They differ  in the
 nature of the disturbance of the  motific fluid.   In ecstasy,  this
 seems to be secreted in  excess  and irregularly accumulated; in
 consequence of which the muscles are thrown into a rigid and per-
 manent spasm,  not incurvating the body,  as in the different modi-
 fications of tetanus,  but maintaining it erect from an equal excess
 of supply to the extensor and flexor muscles.   In catalepsy, on
 the contrary, the motific  fluid seems to be secreted in deficiency
 rather than in  excess,  though it  is often irregularly distributed ;
 and hence, while some  muscles appear sufficiently supplied, the
 action of others, and even the involuntary ones is often peculiarly
 weak. Whence also, the limbs, instead of resisting external force,
 yield to it with readiness, and assume any position that may be given
 to them.
   In both cases the torpitude of the  external senses, appears to
 extend to those of the mind ; for the patient, on returning to him-
 self, has no recollection of any train of ideas that occurred to him
 during the fit.  Yet, we shall find presently that, in a few instances,
 the power of sight and of judging, and perhaps some other powers,
 do not seem completely to have failed.
   It deserves,  however, to be specially remarked, that both these
 diseases are most common to persons constitutionally disposed to
 some  mental  estrangement,  as melancholy  or revery, hypochon-
 drism, or morbid elevation of mind; thus pointing  out  to us  the
 outlet at which  the sensorial  power is  often  carried off: for we
 have already seen that under intense revery the external senses are,
 for the most part, inactive  or torpid  to the  impressions of sur-
 rounding objects during wakefulness: while the mind is alike dead
 to every thing but the train of ideas which immediately constitute
the subject of the revery.  The same tendency to abstraction, though
 not carried so completely into effect, is often found in melancholy. 
384
NEUROTICA,
[CL. IV.—OR. IV
 and still more so in that species of alusia which, in the present
 work, is  denominated elatio, mental elevation or extravagance,
 and particularly the variety called elatio ecstatica, false inspi-
 ration, visionary  conceits.   If  the  person labouring under any of
 these be attacked at the same time  with  a general entasia,  or rigid
 tetanus, erecting instead of incurvating the body, he will be thrown
 into an ecstasy, constituting the present  species. And if, instead of
 an excessive there be a deficient supply of irritable power, and con-
 sequently a flaccidity or flexibility of the muscles instead of a rigi-
 dity, his disease  will be a catalepsy, constituiing the ensuing spe-
 cies, with this difference alone, that in most cases of the two dis-
 eases before us, the faculties of the mind unite in the torpitude of
 the senses,  instead of giving rise to it.
   I  say, in most cases, and have kept to  the same limitation in the
 specific definition : for if it be true that one of the causes of both
 these affections is profound contemplation or attention of mind, or
 some overwhelming passion, as we are told by many writers, the
 mind does not seem, in such cases, to be without ideas, nor without
 them in a very energetic degree.   And it is to- ecstasis under this
 modification that I am inclined tothink we should refer the catochus
 of most of the nosologists, which they arrange in the same order as,
 and next to  tetanus, and define  a " general spastic rigidity  without
 sensibility."
   Ecstasis is of rare occurrence, its predisponent cause is unques-
 tionably a  highly nervous or irritable temperament: the exciting or
 occasional causes it is not easy, at all times, to  determine. For the
 greater part they seem to be of a mental character, as profound and
 long continued meditation upon  subjects of great interest and excile-
 ment; and terror or other violent emotions of the mind. It seems
 also to have proceeded, like most ofthe spasmodic affections already
 treated of, from various corporeal irritations, and particularly those
 of the stomach,  suppressed menstruation, repelled chronic erup-
 tions, and plethora.   The  duration of the fit  varies, from a few
 hours to two or three days.  The patient rouses as from a sleep,
 seems languid, and complains of nausea and vertigo :—evidently
 showing that the  morbid supply of sensorial povvor is exhausted,
 and that the spasm has ceased in consequence of such exhaustion.
  As the disease evidently consists in a disturbance ofthe balance of
 the sensorial power, or in an excessive secretion of irritable, but a
 deficient or  suspended secretion of sensific fluid, the curative inten-
 tion should lead us to aim at a restoration of this balance : and hence
the remedial process will run so nearly parallel with that for  tetanus
that it is only necessary to refer the  reader to the treatment already
laid down  for that disease. 
GE. VIII.—SP. m.]      NERVOUS FUNCTION                 385


                         SPECIES III.

                CARUS  CATALEPSIA.

                    <£atalej)sg.   France.

total suspension  of sensibility and voluntary motion ; MOSTLY
   of mental power ; pulsation and breathing continuing ; mus-
   cles FLEXIBLE :  BODY YIELDING  TO, AND RETAINING ANY GIVEN
   POSITION.

This species is chiefly distinguished from the preceding by the
flexibility instead of inflexibility of the muscles.  The cause of this
difference  has been explained  under  the  preceding species, and
needs not to be repeated in the present place.  The specific term
common to the Greek writers is derived from xxrxXx(K%xtopxi, "de-
prehendor" " to be seized or laid hold of," and alludes to the sud-
denness of its attack.
   The predisponent and exciting causes are the same as those of
ecstasis : and the state of the habit or idiosyncrasy alone produces
the difference of effect.   The countenance  is commonly florid, and
the eyes open, and apparently fixed intently upon an object, but in
most cases  without perception.  Yet here,  as in ecstasis,  we some-
times  meet with examples in which  one  or more ofthe  senses,
mental as well as corporeal, do not associate in the general torpi-
tude.  So,  in paroniria, the sight or hearing continues awake, while
the other external senses are  plunged into a  deep  sleep, and in
some cases of paralysis, the sentient fibres retain their activity while
those of motion are torpid.
   The paroxysm commonly attacks without any previous warning,
and closes  with sighing or a clonic effort of the nervous power to
re-establish its regular flow.   Its duration  is from a  few hours, or
minutes, to two or three days;  and, according to well established
authorities, sometimes for a much longer period. And so complete-
ly exhausted of irritable power or  some of the organs,  and even
those of involuntary action, that we have one example in a foreign
journal of forty grains of emetic tartar having been given without
any effect.*
   The disease, like the last, is not  common.   Dr. Cullen  affirms
that he never  saw an instance of it,  except  where it was altogether
counterfeited, and asserts the same of other practitioners: which,
in fact, he offers as an apology  for not knowing exactly where to
arrange it.   " Therefore," says he, " from the disease being seldom,
differently described, and almost always feigned, I can scarcely tell
where to place it with certainty : but I am well persuaded that it
does not at all differ from the genus apoplexy, and I have  hence
         • Behrends, Baldingers, N. Magazine. B, IX. 199.
VOL. III.—49 
386
NEUROTICA.
[CL. IV.—OR. IV.
arranged it as a species of this division."  Plethora or pressure of
the brain may, perhaps, be an occasional cause of this, as of most
other nervous diseases, in some habits; but the  greater number of
cases that have occurred  show very clearly that this disease, in its
genuine form, is as distinct from apoplexy as from  epilepsy.
  We have said that both catalepsy and ecstacy are most frequent-
ly found  in constitutions  disposed to mental estrangements.  Dr.
Gooch has given a very  interesting case in illustration of this re-
mark in his paper on puerperal insanity published in the Medical
Transactions.  The patient was twenty-nine years of age, had been
often pregnant,  but had only  borne one living child; and was now
confined  after delivery of a dead child in her seventh month  of
gestation.  " A few days  after our first visit,'  says Dr. Gooch," we
were summoned to observe a remarkable change in her symptoms.
The attendants  said she  was  dying or in a trance.   She was lying
in bed motionless, and apparently  senseless.  It had been said that
the pupils were dilated and motionless, and some apprehensions of
effusion on the brain had  been entertained.  But, on coming to ex-
amine them closely, it was found that they readily contracted when
the light fell  upon them; her eyes were open,  but  no rising of the
chest, no movement of the nostrils, no appearance of  respiration
could be seen ;  the  only signs of  life were her warmth and pulse;
the latter was, as we had hitherto observed it, weak, and about  120 ;
her feces and urine were voided in bed.
  " The  trunk of the body was now lifted so as to form rather  an
obtuse angle  with the  limbs  (a most uncomfortable posture,) and
there left with nothing to support it.  Thus she continued sitting
while  we were asking questions and  conversing, so  that  many
minutes must have passed.
  " One arm was now raised, then the other, and where they were
left, there they remained  ; it was  now a curious sight to see her,
sitting up in bed, her eyes open, staring  lifelessly, her  arms out-
stretched, yet without  any visible sign  of animation; she was very
thin and pallid, and looked like a corpse that had been propped up,
and had stiffened in this attitude.   We  now took  her out of bed,
placed her upright, and endeavoured to rouse her by calling loudly
in her ears, but in vain ; she stood up, but as inanimate as a statue ;
the slightest  push put her off her balance ; no exertion was made to
regain it; she would have fallen if I had not caught her.
  She went into this state three several times, the first time it lasted
fourteen  hours, the second time tweive hours, and the third time
nine hours, with waking intervals  of two days after  the first fit, and
one  day  after the second.    After this, the disease resumed the
ordinary form of melancholia, and three months from the time of
her delivery, she was well enough to resume her domestic duties."
  From the rarity of the complaint and the singularity of many of
its symptoms, many physicians who have never witnessed an exam-
ple of it, are too much disposed, like Dr. Cullen, to regard it  in
every case as an imposture.  The instance just given is sufficient 
RE. VIII.—SP. III.]     NERVOUS FUNCTION.
387
 to clear it from this charge;  yet the following from Bonet is added
 in confirmation. George Grokatski, a Polish soldier, deserted from
 his regiment in the harvest ofthe year 1677.   He was  discovered
 a few days afterwards, drinking and making merry in a common ale-
 house.  The moment he was apprehended he was so much terrified
 that he gave a  loud shriek and was immediately deprived  of the
 power of  speech.  When brought to a court-martial, it was impos-
 sible to make him articulate a word ; he was as immoveable as a
 statue, and appeared not to be conscious of any thing that was going
 forward.  In the prison to which he was conducted, he neither ate
 nor drank, nor  emptied the  bowels or the bladder.  The officers
 and the priest at first threatened him, but afterwards endeavoured
 to soothe  and calm him ; but all their efforts were in vain.   He re-
 mained senseless and  immoveable.  His irons were struck off, and
 he was taken out  of the prison, bul he did not move.  Twenty days
 and nights were passed in this way, during which  he  took no kind
 of nourishment, nor had any natural evacuation.  He then gradually
 sunk and  died.*
  The pliability of the muscles to any stimulus that acts upon them
 is sufficiently evident from both these cases :  but  it has not been
 generally  observed by pathologists, that the force  of the  stimulus
 which is acting upon them at the time of the attack continues after-
 wards, so  that the same state of motion or rest is  still maintained.
 In the case of a school-boy aged eleven years, related by Mr. Stearns
 in the American Medical  Register,f the paroxysms returned ten
 times in twenty-four hours, and never exceeded three  minutes at
 a time.  And if it commenced whiie the patient was walking,  the
 same pace was maintained, though without the direction the of mind.
 The present author was consulted a few years ago on a similar case
 by a student of Gray's Inn, about  nineteen years of age.   Having
 been attacked with a fit of catalepsy v/hile walking, within a  few
 minutes after having left  his chambers, he continued his pace in-
 sensibly, and without the slightest knowledge of the course he took.
 As far as  he could judge,  the paroxysm  continued for nearly an
 hour, through  the whole  of  which time his involuntary walking
 continued ;  at the end of this period he began a little to recover
 his recollection, and the general use of his external senses.  He
 then found himself  in a large street, but did not know how  he got
 there, nor what was its name.  Upon inquiry he  learned  that he
 was  at the further end of Piccadilly near Hyde Park  corner, to
 which, when he left his chambers, he  had no intention of going.
He was extremely frightened, very much exhausted, and returned
home in a coach.  He was not conscious of any particular train of
 ideas that  had passed  in his mind during the fit; but if such there
had been,  there can  be little doubt that, like the visions of a dream,
the recollection of them would have been completely banished by
• Medic. Septentrion. Lib. I. Sect. XVI. Cap. 6.
t Vol. I. Art. VIIL 
388
NEUROTICA.          [CL. IV.—OR. IV.
the terror he felt on first recovering his recollection and  finding
himself in a strange place, to which he had been irregularly wander-
ing through a great number of streets without consciousness.  He
had several slighter attacks antecedently, shorter in duration, and,
from his being at rest at the time, unaccompanied with a tendency
to perambulate.
   In this case, and in all of a similar kind, from the power which
the patient seems to possess of avoiding danger, the faculty of the
will and of sight, must be in some degree  of activity, however ob-
tunded; bearing a near resemblance to paroniria ambulans, or sleep-
walking, with the exception of the suddenness of the attack. Some
pathologists, indeed, have  noticed  a modification in  which  the
powers  of deglutition and digestion continue,  as well as those of
pulsation and breathing, provided the food be thrust into the mouth.
If we were right in ascribing the catochus of the ancients to vhat
form of ecstacy  in which the mind retains  some  train of ideas, we
shall probably be right also in referring their catoche to this mo-
dification of catalepsy ;  though Galen seems to have regarded the
term as a mere synonym of catalepsy, and JLtius adopted  his opi-
nion.
   Instead, however, of most of  the  involuntary organs being in a
joint state of  activity, instances have occasionally occurred  of  an
apparent cessation of activity in  all of them, from the scanty as well
as irregular flow of the sensorial current.   A critical  examination
of the region of the heart, will mostly, indeed, give proof of a very
feeble  flutter, and if a  clear mirror  be applied to the mouth and
nostrils it wiil generally be found to have a thin vapour on its face.
But even these signs have not always been  given : insomuch that
the disease  has been mistaken  for real death: and,  in countries
where the rite of sepulture takes place  speedily, it is  much to be
feared that the unfortunate  sufferer has,  in a  few instances, been
buried alive.*  In a case of asphyxy of a singular kind, related  by
M. Pew, the patient, a female, was peculiarly  fortunate in having
had her  interment  postponed for the purpose of ascertaining the
cause of her supposed death by dissection :  for  on being submitted
to the scalpel, its first touch brought her to her senses, and threw
her into a state of violent agitation, the  anatomists being almost as
much frightened as herself, f  So Diemerbroeck relates the case of
a rustic, who was supposed to be dead of the plague, and was laid
out for  interment.  It was by accident three days before he  could
be carried to the grave, when in the act of being buried, he show-
ed signs of life, recovered, and lived many years.!  Mathaeus, Hil-
danus, and the collectors of medical curiosities are full of stories of
  * Pineau, Sur le danger des Inhumations preciptees.  Paris, 1776.
  ■J- Practique des Accouchemens, &c.
   Tozzett's Raccolta de Teorie, Osservationi e  Regole per distinguere e
promptemente dissipare le Asphyssie, a Morte apparente. Fiorenza. 8vo 1772
  $ Tractat de  Peste. Lib. IV. Hist. 85. 
GE. Vm.—SP. III.]      NERVOUS FUNCTION.
389
this kind: many of them,  indeed,  loosely related; but many also
possessing every requisite authority for belief: and urging the ne-
cessity of waiting for signs of  putrefaction  before the lid of the
coffin is screwed down, or, I should  rather say, before the body is
removed from its death-bed.
  We have  already observed, that the predisposing and exciting
causes are the same as those of ecstasy, and that the state of the
habit or idiosyncrasy alone produces the difference of effect.  This
distinction has not been sufficiently attended to by  pathologists  in
their mode of treatment: and hence one common plan has been too
generally laid down and pursued in ecstasy, catalepsy, lethargy, and
even apoplexy, the general treatment being as much confounded
as the diseases themselves.
  Commonly speaking, copious bleedings and purgings have been
chiefly trusted to in all of them :  and as the present disease, in some
cases, arises from plethora, or obstruction or some irritation of the
stomach, it is not to be wondered at that this process should some-
times succeed here also.  But, if we have been correct in our pa-
thology, if catalepsy be not only a nervous disease, but a disease  of
nervous debility, in which the sensorial power flows with enfeebled
and clonic irregularity, and consequently with a necessary disturb-
ance of the balance of the nervous system, it is perfectly clear, that
a reducent treatment,  however serviceable in a few cases,  cannot
be laid down as the proper plan to be pursued in general, nor even
in any case as an advisable practice,  further than it may be called
for by the contingency of the exciting cause.   Stimulants of most
kinds will usually be found far more serviceable, particularly in the
form of blisters to the head and heart, sinapisms and other rubefa-
cients to the extremities, and injections to the rectum.
  It is now well known that the simplest substances, as a solution
of gum arabic, or merely warm-water infused, to the amount of not
more than an ounce or two, into the  current of the blood by open-
ing a. vein, will  not only excite the heart to a more  violent action,
but affect the stomach and intestinal canal with a like increased ac-
tion  by sympathy, producing sickness in the former, and looseness
in the latter : and hence, Dr. Regnaudot, in an ingenious inaugural
dissertation, has thrown out a hint well  worthy of being followed
up,  that such a stimulus may probably succeed in rousing the sys-
tem generally in the present and most of the preceding species.
   Electricity or voltaism, in the  manner  already recommended
may also be tried with a hope of success;  and if it be possible to
introduce any thing into the stomach by means of a canula, brandy,
ether,ammonia, camphor, or even phosphorus, in the form and  dose
already recommended, may be attempted in rotation.  The body  in
the mean-while should be kept warm, with a free influx of pure air,
and general and persevering friction should often be had recourse
to.   A steady use of  the metallic tonics should be chiefly confided
in after the paroxysm is over. 
390                      NEUROTICA           [CL. IV.—OR. IV.


                        SPECIES IV.


                CARUS  LETHARGUS.


                         acthatfli).

   MENTAL AND CORPOREAL TORPITUDE WITH DEEP O.UIET SLEEP.

Lethargy, from the Greek terms Ajj0jj and xgyes, " oblivio pigra,'*
is distinguished from all the preceding species of  the present ge-
nus, by the apparent ease and quietism of  the  entire system; the
limbs retaining that gentle and placid flexion which  they are wont
to exhibit  in natural  sleep, and  the eye-lids  being  consequently
closed :  by both which signs it is  also distinguished from apoplexy.
  Lethargy is sometimes produced by congestion or effusion in the
brain, by violent mental commotion, as  that of fright or furious
anger ; by retrocedent gout, or repelled exanthems ;  but more ge-
nerally by  long-continued labour of body, or  severe exertion of
mind.
  The common causes of sleep, therefore, whether natural or mor-
bid, are  in many cases causes of lethargy.  The proximate cause,
however, of idiopathic lethargy does not seem to have been suffici-
ently pointed out, and on this account it is that it has too frequent-
ly, like the preceding species, been confounded with apoplexy, and
regarded as a mere modification of it.
  We had occasion  to take  a glance at  the general  physiology of
sleep, under the genus ephialtes, or night-mare, andobserved that
its proximate cause is  to be sought for in a torpitude  or exhaustion
of sensorial power from the ordinary stimulants of the day.   Now
it is possible that  the  same effect may be  produced by a defective
supply of sensorial power as well as by its exhaustion; and conse-
quently  that the torpitude of sleep may ensue whenever such defi-
cient action or energy exisls, even where  there is no exposure to
its ordinary exciting causes.   And this it is,  as it appears to me,
which constitutes the real difference between genuine lethargy and
sound healthy sleep : in which sense the former becomes a strictly
nervous affection dependent upon  a weak and irregular action  of the
sensorial organ, accompanied with a diminished secretion of senso-
rial power, and this power so  diminished, irregularly distributed
over its different  departments or ramifications, being altogether
withheld from the external senses and the voluntary organs,  while
the  current to the involuntary organs is little interfered with,  as in
the case of common  sleep.   The faculties of the mind seem also in
most cases to partake of the  torpitude of the external  senses:
though as the whole is a  disease of debility, and  consequently of
irregular action, we can readily  account for a  few singular  cases 
<iE. VIII.—SP. IV.]      NERVOUS FUNCTION.
391
that have been met with, in which the lethargy has been broken in
upon by short returns of sensation, or even of speech, or by an irre-
gular flow  of ideas, which the patient is sometimes apt to mistake
for sensations.   And hence, lethargy has been observed under the
following varieties:

« Absolutus.                    Without intervals of sensation,
  Genuine Lethargy.              waking or consciousness.
b Cataphora.                    With short remissions or  inter-
  Remissive Lethargy.            vals of imperfect waking, sen-
                                  sation and speech.
y Vigil-                        Perfect  lethargy of body,  but
  Imperfect Lethargy.             imperfect  lethargy of  mind ;
                                  wandering ideas, and belief of
                                  wakefulness during sleep.
  The  first variety has, in some instances, been considerably
protracted.  We have examples of its continuance for forty days,*
and even for seven weeks.f   In one instance it is said to have re-
sulted from insolation, or exposure to the direct rays of the sun;  and
at length, with great singularity, to have yielded to a large flow of
urine loaded with pus that fell to the bottom-!  In this case,  the
cause must have been congestion, and the inflammation have passed
off by a secretion of pus, probably without  any abscess whatever.
  The second variety, or cataphora, is the coma somnolentum
of many writers:  and  is also a frequent accompaniment of many
fevers and  other  diseases of great  debility.  It  occurs at times,
however, as an idiopathic affection ;  and I was some years ago ac-
quainted with a very singular example, that continued for five years.
The patient was a young lady of delicate constitution, in her eigh-
teenth year at the time of the attack:  her mind  had been previously
in a state of great anxiety: the remissions recurred irregularly twice
or three times a week, and rarely exceeded  an hour or two: during
these periods she sighed, ate reluctantly what was offered to her,
had occasional egestions. and instantly relapsed into sleep.   Her
recovery was sudden, for she seemed  to awake as from a night's
rest, by a more perfect termination of the paroxysm, not followed
by a relapse.
  A less fortunate case of the same kind is related by Mr. Brews-
ter, in the Edinburgh Philosophical Transactions, and was connected
with depressed animal spirits, and probably congestion or plethora.
The patient was  a female servant about the middle of life.   The
first paroxysm was preceded by a hemorrhage from the nose, and
lasted three days; the next continued six weeks; during which
she occasionally swallowed food and had alvine evacuations.  She
* Plott, Natural Hist, of Staffordshire.
f Bang, Collect. Soc. Med. Havn. n. 17.
t Morgagni, de Sed. et Caus. Morb. Ep. V. 13,14.  Albertino. 
392
NEUROTICA.
[CL.  IV.—OR. IV.
had two subsequent fits, neither of which lasted above a few days.
Not long afterwards she hung herself*
  The third variety, or imperfect lethargy,  is the typho-
mania of the Greek writers; the coma vigil of many later patholo-
gists.  It is a frequent sequel upon fevers, or other causes of great
nervous debility, in circumstances on which the sensorial  power
has not recovered its regularity of current, or stability of balance :
during which the patient uniformly assures  his  physician and his
friends, from morning to morning, that he has passed a restless and
hurried night, without a moment's sleep,  while the nurse has been
a witness to his having been asleep the whole night  long.
  The mode of treatment must depend upon the nature of the cause,
as far as we are able to ascertain it.  If this have consisted in any
suppressed discharge or eruption, we should endeavour to repro-
duce it by all possible means  If we have reason to suspect com-
pression on the brain, copious bleedings, purgatives, and other re-
ducents are imperative.   And if, as is more commonly the case, it
be a strictly nervous affection, and depend on atony and a disturbed
secretion or balance of the sensorial power,  the warm nervine irri-
tants, as musk, camphor, valerian, with blisters, sternutatories, and
other stimulants are the means we should have recourse to.
  These different  processes have been pursued in most ages, but
unfortunately they have been pursued indiscriminately; and bleed-
ing, purgatives, and ethers and other diffusable excitants have been
employed on like occasions, or even at the  same time.  Forestus
and Dr. Cheyne, who regarded lethargy as chiefly dependent upon
plethora or congestion, seem uniformly  to  have adhered to a re-
ducent plan: and Celsus who contemplated it as a nervous affection,
equally confines  himself  to external and internal pungents,  and
advises pepper, euphorbium, castor, and vinegar,  with the fumes
of burning galbanum or hartshorn applied to the nostrils: as  also
shaving the head, fomenting it with a decoction of laurel leaves, or
rue,  and afterwards applying sinapisms or some other rubefacient
epithegm.
  All these are consistent with themselves how much soever they
may differ in their  view of the proximate cause.  Yet both lines of
conduct cannot be right as a general practice; and hence it is  that
other practitioners have  incongruously  intermixed the two,  and
consequently have  sometimes done less mischief, as at other times
they have done less good.
  That genuine  lethargy is, not unfrequently, a strictly  nervous
affection, and even closely connected with an irregular or debilitated
state of the mind ; and that a reducent plan is not always calculated
to afford it radical relief, however it may give a temporary pi omise,
must, I apprehend, be obvious to most practitioners who have paid
a due attention to  their  own circle  of cases; but  the following
example from Dr.  Cooke, bearing a close resemblance in its termi-
* Edin. Phil. Trans. 1817. 
GE. VIII.—8P. IV.3     NERVOUS FUNCTION.
393
 nation to that already quoted from Mr. Brewster, is peculiarly in
 point,  and ought not to be omitted on the  pre&ent  occasion : "A
 lady about twenty years of age, who had usually enjoyed very good
 health, was one morning found in a state of profound but quiet sleep,
 from which she could not be awakened, although the preceding eve-
 ning she had gone to bed apparently  quite well.   Various means
 had been tried with a view of exciting her from this state, but in vain.
 Under these circumstances I recommended cupping in  the neck;
 and after she  had lost a few ounces of blood in  this way, she opened
 her eyes perfectly recovered, and remained through the  day, quite
 free from all  symptoms of disorder.   The  next morning, and for
 several successive mornings, she was found in a similar state, from
 which she was recovered by the same remedy, no stimulating ex-
 ternal applications producing any good effect.   As she was consi-
 derably weakened by repeated depletions, it was determined that,
 on the  next occurrence ofthe paroxysm, the case should be left to
 the effects of nature  as long as was consistent  with safety.  The
 experiment was tried; and at the end of about thirty hours she
 spontaneously awoke, apparently refreshed, and wholly unconscious
 of her protracted sleep.  On the future returns of these paroxysms,
 which were frequent, the same plan was adopted, and she awoke
 after intervals of thirty-six, forty-eight, and,  on one occasion, sixty-
 three hours, without  seeming to have  suffered from want of food,
 or otherwise.   In the early part of the disease, various means were
 employed without the smallest advantage, except that while under
 the influence of mercury, which produced a very severe  salivation
 that lasted more  than a  month, she was free  from the complaint.
 For a considerable length of time these paroxysms recurred ; but
 at length they gradually left her; and soon afterwards she became
 deranged in mind, in  which state I believe she  still remains."*
   When, therefore, there are no symptoms leading  to a peculiar
 cause, it will be advisable to  bleed by  cupping, once or twice, but
 not oftener, to open the  bowels and keep them in a state of slight
 irritation; to employ blisters or other external stimulants occasion-
ally, and to have  recourse to  a repeated use of the voltaic trough,
sending the line of action from the  occiput down the spine, and
varying it to the extremities.  In the mean time, if the patient can
be made to swallow, we  should try the effect of mush, or camphor,
with free doses of the  metallic tonics, of which the sulphate of zinc,
in doses of a grain, three or four times  a day, offers the best pros-
pect of success.
          * Treatise on Nervous Diseases, Vol. I. p. 372.

vol. lli.-»-50 
394
NEUROTICA.
[CL. IV.—OR. IV
                         SPECIES V.

                 CARUS  APOPLEXIA.



mental and corporeal torpitude with pulsation and oppressive,
                  mostly stertorous, sleep.

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

                * Lib. X. Obs. 73.
               f Comment, p. 16.
               t On Nervous Diseases, Vol. I. p. 166. 
GE. VIII.—SP. V.]
NERVOUS FUNCTION.
396
action of the latter being supposed to be entirely dependent on that
of the former, and, consequently, only a secondary affection.
   This view of the  subject, however, is by far  too limited: for
although in most cases the more prominent symptoms concur with
the appearances on dissection in leading us to compression of the
brain as the primary cause of the disease, yet we  shall find pre-
sently that it has sometimes taken place where no such compres-
sion seems to have existed, whilst we have already had occasion to
notice a variety of affections ofthe head attended  with forcible and
severe compression, as inflammation and dropsy of the brain, that
have  run their entire  course  without any sign of apoplexy what-
ever : to which should be added that, while in most other diseases
or lesions accompanied with compression ofthe brain, and a suspen-
sion of sentient and motory power as a consequence hereof,  such
suspension ceases almost the moment the compression is removed,
when the nerves of feeling and motion, together with the faculties
of the mind, resume their wonted activity, and evince no tendency
to a relapse ; in apoplexy, on the contrary, the result is always
doubtful; for a palsy of some part or other is a frequent and perma-
nent effect, or the mind suffers in some of its faculties, and a relapse
is generally to be apprehended.  So that though compression ofthe
brain, and particularly from a morbid state of the  sanguineous and
respiratory functions, may be justly regarded as the  ordinary effi-
cient cause, there seems to be at the same  time some peculiar
debility or  other diseased condition of the sensorial system to which
apoplexy is to be primarily referred,  and without which it might
not take place; and which has not been sufficiently  adverted to by
practitioners.   Though there can be no difficulty in our affirming
that wherever such a morbid condition exists, compression, from
whatever cause, will be sure to produce the disease.
   We may hence see why advancing age should prove a predispos-
ing cause ; and account for the statement of Morgagni, who tells
that, of thirty cases of apoplectic patients that fell within the reach
of his observation, seventeen were above the age of sixty, and only
five below that of forty.  Hippocrates, on a more general estimate,
calculated that apoplexies are chiefly (paXta-vx)  produced between
the fortieth and sixtieth year.*   This, indeed, is somewhat earlier
than we should expect on the ground of advancing age ; but when
we take into  consideration that it is the precise period in which the
mind  is most agitated and exhausted with the violent and contend-
ing passions of interest, and ambition, and worldly honours, and the
blood  most frequently determined to the head by this impulse of
sudden and irresistible emotions, we shall, perhaps,  readily accede
to the Hippocratic aphorism as a general rule.
  How far  apoplexy is occasionally the result  of  an hereditary in-
fluence on the frame  it is not easy to ascertain.   Forestus, Portal,
and Wepffer refer to  decided instances  of  such facts within their
* Aph. Sect. VI. 57. 
S96
NEUROTICA.
[CL. IV.—OR. IV.
 own knowledge ;  the first, indeed, relates to the history of a father
 and his three sons, all of whom died in succession of this disease ;
 but as the chronology drops with the second generation, it docs not
 descend quite far enough for the purpose.   There is great reason,
 however, for believing tint  an hereditary tendency does sometimes
 show itself; and as this  exists without  external or  manifest signs,
 it is probably seated in the sensorial system-and constitutes another
 of the morbid conditions of this system, to which we have referred
 above, as often giving effect to subordinate causes.
   There is no difficulty  in conceiving how heat may become a pre-
 disponent cause, since nothing tends more effectually to quicken the
 action of the heart, drive the blood forcibly into the ascending trunk
 of the aorta, and, consequently, overload the vessels of the brain.
 But cold is said to be a predisponent  cause  as well, and one that
 operates quite as extensively, while the reason of this has not been
 at all  times very clearly explained.   Now  as a hot temperature
 acts chiefly upon the sanguiferous system, extreme cold act9 chiefly
 upon the sensorial, benumbs  the  feeling, weakens  the  muscular
 fibres, diminishes the sensorial secretion, and  consequently induces,
 as we have already seen  under one of the varieties  of asphyxy, an
 unconquerable propensity to sleep.  And hence again,in apoplexies
 produced by severe cold, the primary or predisponent cause is to
 be sought for in a debilitated  state of the  nervous system.  The
 Greek physicians are perpetually alluding to this cause as one of
 great frequency, and the explanation now given, does not essentially
 vary from that offered by Galen.*  If, indeed, the cold be exquisite-
 ly intense, carus Aspyxia is more likely to be produced than carus
 Apoplexia ; for we have already observed  under  the preceding
 species that the  very same cause which, operating  in a vehement
 degree, excites  the former,  operating less powerfully  has  often a
 tendency to excite the latter.
  The other predisponent causes, so far  as they have been traced
 out,  are more obvious to the senses, and for the most part, more
 directly referable to the state of the sanguineous function ;  as  ple-
 thora, corpulency, and grossness of habit, a short thick neck, and an
 inordinate indulgence in  wines and heavy fermented liquors.   Dr.
 Chcyne, indeed, believes the last  to be so common a cause as even
to produce the disease when employed without any inordinate in-
dulgence  whatever : « the daily use," says he, " of wine or spirits
will  lead  a man of a certain  age  and constitution to apoplexy, as
certainly  as habitual  intoxication."t  This may  be true as here
limited, but then the limitation must be attended to; in  which case
we are only told in other  words, that wherever such  a kind  of sen-
sorial debility exists as that  which we have  already adverted  to,
the result of age,  or habit, or constitution, one  man will be as rea-
dily led to apoplexy under a moderate use of wine, as another man
* De Loc. Aff. Lib. III. cap. vi.
t Cheyne, p. 146. 
tiE. VIII.—SP. V.]      NERVOUS FUNCTION.
397
destitute of such predisposition will be under a state of habitual in-
toxication.  Under this explanation,  however, a moderate use of
wine becomes only an accessory, and not a primary cause.
   How far there may be any other efficient or exciting causes of
apoplexy and  compression of some kind or other, it is difficult to
determine, though various cases on record should induce us to sup-
pose there are.   Hydatids, humours  of almost every consistency,
gelatinous, steatomatous, and bony, pus and polypous caruncles and
indurations of the membranes, have, in various cases, been disco-
vered on dissection.and are generally supposed to operate by com-
pression,^ the same manner as an accumulation of blood or serum.
But in many instances these appearances  seem to have  been too
minute for any such  effect; and, if causes of any kind, can only
fairly be regarded as  concomitants or allied powers—as local irri-
tants, stimulating and exhausting the sensorium, and preparing it for
attacks of apoplexy against the accession  of some superinduced and
occasional cause.  Though  where there exists  already  a strong
predisposition to the  disease from hereditary or any other affection,
it is not improbable that such local irritants may alone be sufficient
to perfect the  complaint.  And we may hence account for that form
of apoplexy which is said to proceed from intestinal worms, or some
other acrimony of the stomach, or from teething; and which, con-
sequently, occurs at an early instead of at a late  period of life,  and
has been specially denominated apoplexia infantum.  Other organs,
however, besides the teeth and the stomach, seem not unfrequently
to have given occasion to apoplectic  attacks from irritation, disten-
sion, or organic lesion. Thus, according  to M. Portal, superinduc-
ing tumours and congestions have been found  in the neck, in  the
breast, or in the abdomen; ossifications in the thoracic  and ventral
aorta, as well as in the arteries of the  upper and  lower extremities,
in the superior vena cava, and in the  right  ventricle and  valves of
the heart which has also indicated various other  changes."*
   Most of these morbid actions and appearances, however, are as
common to various other  affections of the sensorial  system as to
apoplexy.  We have already noticed  them in lethargy,  convulsion,
epilepsy, various species of cephalaea, and some  forms of insanity :
and, hence, wherever they become causes at all, it is most proba-
ble that the disease they immediately produce, is regulated by the
predisposition of the  individual to one rather  than to any other of
the above sensorial affections, resulting from family  taint, idiosyn-
crasy, habit, or period of life : and, consequently, that the same ex-
citing or occasional cause, which, in one person,  would produce
apoplexy, in a second, would form epilepsy, in a third, convulsion,
and in a fourth, madness.
   It is highly singular that this view of the subject should scarcely
ever have been attended to by physicians; and that, whilst  all  the
writers  have pretended to  regard  apoplexy as  a disorder of the
* Porta], ch. Resultats de l'overture des Corps, p. 329. 
398
NEUROTICA.
[CL. IV.—OR. IV.
 nervous system, none of them have  suffered such  ideas to enter
 fairly into their pathology, or in any way whatever into their prac-
 tice : the  nervous organ being  supposed by all of them to be in a
 state of soundness at the lime of the attack ; and whatever mischief
 it suffers to be merely secondary and consequent upon a morbid
 state of the blood-vessels, or of some other cause that as suddenly
 and effectually interrupts the secretion  or flow  of the sensorial
 power, as retrocedent gout, mephitic vapours, or narcotic poisons.
   Now all these accidental or effective causes of apoplexy are well
 known to be causes, also, of  the other nervous affections we have
 just referred to.   But if this  be the case, how comes  it that they
 should thus  vary in their result, and that what in one person, and at
 one period of life, should produce apoplexy, should in another per-
 son, and in another period of life, produce lethargy, palsy, convul-
 sions, or epilepsy ? or that some of them should exist without pro-
 ducing any of  these diseases  or any other disease  whatever? It  is
 not, perhaps, possible, for us to  develop the precise  condition of
 the sensorium  that leads to any one of these effects,  rather than  to
 any other ; but that there is such a condition, forming a predispo-
 nent or remote cause of the specific disease that shows itself, must,
 I think, be allowed by every one who seriously  considers the sub-
 ject.
   Nor is there, in  effect, any other means of reconciling the dis-
 crepant and  opposite opinions that have been held concerning the
 proximate cause of the disease. This we have stated to be, for the
 most part,  compression, and especially sanguineous  compression.
 Mr. John Hunter was so strenuously attached to this cause that he
 would allow of no other; and if a man died of apoplexy from  atonic
 gout,and without effusion, he distinguished it as a disease similar to
 apoplexy.  He  regarded apoplexy and palsy as one and the same
 disease, merely differing in degree : and he gives us his sentiments
 very forcibly, in the following words :  " For  many years," says he,
 " I have been particularly attentive to those who have been attack-
 ed with a paralytic stroke forming a hemiplegia.   I  have watched
 them  while alive that I might have an opportunity  to open them
 when dead : and in all I found an injury done to the brain in conse-
 quence ofthe extravasation of blood.—I must own I never saw  one
 of them which  had not an extravasation of blood in the brain, ex-
 cept in one who died of a gouty affection in the brain with symp-
toms similar to apoplexy "*
  In direct hostility to this hypothesis, many other writers of great
eminence and experience h/ive contended that compression  is no
cause whatever, and that an accumulation of  blood in the head as  a
prominent symptom in apoplexy,  is a doctrine rather than a fact.
Of this sentiment is Dr. Abercrombie, who, after examining  the
question with much ingenuity,  brings himself to the following
conclusion :  " Upon all these grounds," says he, " I think we must
• Treatise on Blood, &c. p. 213. 
GE. VIU.—SP. V.]     NERVOUS FUNCTION.
399
admit that the doctrine of determination to the head i3 not supported
by the principles of pathology, and does not accord with the phe-
nomena of apoplexy."*  M. Serres, however, a physician ofconsi-
perable distinction in France, and who followed up this subject for
many years by a careful examination of the bodies of persons  who
died of apoplexy and paralysis, both at the Hotel Dieu, and the Hos-
pital de la Pitie, has  carried his inroad  upon the popular doctrine
of the day still  farther; for he has not  only, in his own opinion,
completely  subverted it, but has endeavoured to establish another
doctrine, of a very different character, upon its ruins.f  To deter-
mine the question he has gone through a long series of experiments
upon the brains of dogs, pigeons, rabbits, and other animals, whose
crania were  trepanned, their  lateral, or longitudinal sinuses  laid
open, and their brains lacerated and excavated in various ways, so
as to be gorged with effused blood, yet in none of them did  somno-
lency or any other apoplectic symptom take place.  And he hence
triumphantly concludes that extravasation  of blood  does not  pro-
duce apoplexy, whether lodged between the cranium and the dura
mater, or  between the dura mater and the brain : whether the blood
occupy  the great interlobular scissure, and thus  lies upon the
corpus callosum ; whether cavities be made in the fore, the back,
or the middle part  ofthe hemispheres, or run from the one  into
the other; or, lastly, whether piercing through the corpus callosum
we reach and fill up  the ventricles of the  brain.  " On whatever
animal," says he, "we try these experiments, whether on birds,
rabbits, or dogs, the result is the same, and hence apoplexy in'man
ought not to be ascribed to such effusions."
   How  are these discrepancies to  be reconciled ? by what means
are we to account for it, that pressure may  be a cause, and may not
be a  cause?  and that apoplexy is  sometimes found  with  it,  and
sometimes without  it ? It is the peculiar state of the sensorium or
nervous system at the time that makes all the difference__it is the
morbid predisposition or debility, or whatever other deviation from
perfect health it may labour under at the  moment of the application
ofthe exciting cause,  that  gives an effect which  would not other-
wise take place : and something of which, in many cases, often dis-
covers itself  by precursive signs  for a considerable period before
the apoplectic incursion.   The facts stated  by Mr. John Hunter no
one can call in question : and we have as little right to question the
experiments of M. Serres: the error consists in taking an unsound
and a sound state of brain for like premises, and reasoning from the
effects produced on the one, to those that are found to follow on the
other.  This, in truth, is an error too often committed; and heca-
tombs of quadrupeds and other animals in  a condition of  perfect
health are tortured  in  a  thousand ways  for the  purpose of deter-
mining what they never could determine,  though the trials were
* Treatise on Apoplexy, &c. p. 19.
f Animaire Medico-Chirurgicale, avril, 1820. 
400
NEUROTICA.
[CL. IV.—OR. IV-
 to be repeated to the end of time ; I mean  the  effects of certain
 causes on a diseased state of body in man, from  their influence on
 a sound state of body in brutes.
    M. Serres's actual examinations of apoplectic patients after death,
 however, though conducted also upon a large scale, do not seem to
 afford much countenance to his hypothesis,  nor, in effect, to offer
 any thing  out of the common  way.   In a considerable number of
 subjects there was serous effusion, sanguineous  effusion, or both;
 sometimes in  the circumvolutions ofthe brain,  sometimes in the
 ventricles, sometimes in all these; and not unfrequently the vessels
 ofthe minenges appeared distended with blood, and the membranes
 themselves thickened.  Such  appearances seem to furnish some-
 thing of a  stumbling-block to M. Serres's  new dectrine,  yet he
 readily gets o\er the difficulty by  satisfying himself that, in all
 these cases, the effusion did not produce the apoplexy,  but  the
 apoplexy the effusion.  In other dissections he found some mate-
 rial alterations  in the structure ofthe brain, but  without effusion:
 and,  as the  last class of individuals had evinced  palsy rather than
 apoplexy, he is inclined to think that apoplexy, or that state ofthe
 disease in which the stupor is greater and more general,  is occa-
 sioned  by a morbid irritation of the  membranes of the brain ; and
 palsy, or that state in which the stupor  is less by a morbid change
 in  its substance ; in  consequence of which he proposes to call  the
 first menivgic, and the second cerebral apoplexy.   In this conclusion,
 however, there seems to be a striking mistake, and the very reverse
 is what we  should have expected ; for if there be one  pathological
 principle more established than another, it is that stupor and dull-
 ness  of pain appertain to the parenchymatous irritation or inflam-
 mation  of an  organ, and rousing, restless, and acute pain to  its
 membraneous irritation ; a principle we have already explained at
 some length ; and whence, indeed, the lancinating pain of pleuritis
 compared with pneumonitis,  and of meningic or  brain-fever, com-
 pared with acute dropsy ofthe head.*
   We hold then, after all, that the grand exciting cause of apoplexy,
 is compression; and this shows itself in various ways, which are
 well  enumerated by Dr. Cheyne in the  following  passage:  "I
 mention first," says he, "the remains of an excited state  of the
 minute  arteries of the brain and its membranes, this probably being
 the most important, as it is the most unvarying appearance : then
 the extravasation of blood, probably the consequence of the excited
 state  ofthe vessels; the turgescence of the venous  system; the
 enlargement of the  ventricles, partial or general; and lastly, the
 serous effusion which is generally found in various parts of the
 brain, and which would seem to imply  previous absorption ofthe
brain."f
   It is singular that the congestive fluid, instead of proving a mate-
• See Vol. 1L Empresma Cephalitis, p. 214.
f Cheyne, p. 24. 
CE. VIII.—SP. V.]      NERVOUS FUNCTION.
401
rial elaborated by the animal frame itself, should sometimes consist
of a foreign material recently received  into the  stomach.   Dr.
Cooke has given a case strikingly in proof of this, which I shall
offer in his own words:  " I am informed by Mr. Carlisle that, a few
years ago, a man was brought  dead into the Westminster Hospital,
who had just drank a quart of gin for a wager.  The evidences of
death being quite conclusive,  he was immediately  examined; and
within the lateral ventricles of the brain  was found a considerable
quantity of a limpid fluid distinctly impregnated with gin, both to
the sense of smell and taste, and even to the test of inflammability.
' The liquid,' says Mr. Carlisle, < appeared to the senses of the ex-
amining students as strong as one third gin to two-thirds water.' "*
It is curious, and seems to baffle all explanation, to see how readily
substances foreign to the blood, when they once enter into its cur-
rent, are often carried  from one organ to another, undiluted and
undissolved, and deposited in an entire, or nearly an entire state, in
a remote quarter.   Absorbed  pus affords us frequent examples of
this  and morbid poisons,  as they are called, still  more frequent.
It is hence that various medicines are enabled to act by a specific
power; that mercury travels chiefly to the salivary glands, and per-
haps several of the demulcents to the lungs.
   On examining the different  sources of a compressed brain, as we
have just enumerated them, it will be obvious that they bespeak a
very different, and, indeed, opposite state of vascular action in dif-
ferent cases; and that while some of them necessarily imply a vehe-
ment and entonic power, others as necessarily imply an infirm and
atonic condition. The external symptoms, from the first, speak to
the same effect; and hence, from an early period of lime, apoplexy
has been contemplated under two distinct forms or  varieties, which
have  commonly been denominated sanguineous, and pituitous, or
serous; as though the former proceeded  from an overflow of blood
highly elaborated by a vigorous and robust constitution, and rushing
forward  with great impetuosity; and  the latter from  thin dilute
blood, or a leucophlegmatic habit, from the relaxed mouths of whose
vessels a serous effusion is perpetually flowing forth.  Morgagni
has endeavoured to show, but without success, that this distinction
was in existence among the Greek writers.  It is a distinction, how-
ever, that runs, not  only through his own  works, but through those
of Boerhaave, Sennert, Mead, Sauvages and Cullen, and is acknow-
ledged by most practitioners of the present day.
   The term pituitous or serous, however, has been objected to as
not always expressing  the actual state of the brain in atonic apo-
plexy ;  since no serum has been found at times in  cases where the
symptoms of debility have peculiarly led those pathologists to ex-
pect it who have employed the distinctive term; while the cavities
* On Nervous Diseases, Vol. I.p. 221.
 Schrader has a similar case, Observ. Anat. Med. Decad. IV. Amst. 1674,
 As also Wepffer, Observ. Medico-pract. p. 7. Scaph. 1722.
VOL. IH:—51 
402
NEUROTICA.
[CL. IV.—OR. IV.
 and interstitial parts of the brain, have, on the contrary, been some-
 times found as much loaded with blood, as in what they denominate
 sanguineous apoplexy.   And hence, Forestus and a few other wri-
 ters have been disposed  to exchange the terms sanguineous and
 serous, for strong or perfect, and weak or imperfect apoplexy.  How
 far a modification  of this disease, strictly serous, may be said to
 exist, we shall examine presently ; but that apoplexy is continually
 showing itself under the two forms of entonic, and atonic action
 seems to be admitted by all.   And, as the terms sanguineous and
 serous do not  sufficiently express this change of condition in every
 instance, the author, in proceeding to treat of these two varieties,
 will, for  the future, distinguish them as follows :

 *  Entonica.                      With a hard full pulse, flushed
   Entonic apoplexy.                countenance,  and  stertorous
                                   breathing.
 /3  Atonica.                       With a feeble pulse, and pale
   Atonic apoplexy.                 countenance.

   In entonic apoplexy the  fit is, for the most part, sudden and
 without warning; though a dull pain in the head occasionally pre-
 cedes the attack, accompanied with a sense of weight or heaviness,
 somnolency and vertigo.  The inspirations are deeper than natural  ;
 the face  and eyes are red and turgid, and blood bursts from the
 nostrils.   On  the incursion of the paroxysm,  the  patient falls to
 the giound, and lies as in a heavy sleep from  which he cannot be
 roused.  The  breathing  is strikingly oppressive : though at  first,
 perhaps, slow  and regular, increasing in frequency, weakness, and
 irregularity with the progress of the fit, till at length it becomes,
in  many  cases, intermitting and convulsive.
   It is in  this form of the disease  that we chiefly  meet, and are
 almost always  sure to meet, with a snoring or stertorous breathing;
 nor is this d'fficult to be  accounted for, since the vessels of the tra-
 chea, and particularly those of tlie larynx and fauces, labouring under
 the same augmented action as those of the head, a larger portion of
mucus is secreted by their excretories, than is carried off by the
 corresponding absorbents; in consequence of which it accumulates,
 and impedes the free flux and  reflux of the air in respiration.  And
 hence, stertor, though not a symptom to apoplexy, as a species, may
 be ranked as a pathognomic character ofthe particular form before
 us.  And to the same effect Dr. Cooke and the most celebrated pa-
 thologists who have preceded him.  " Boerhaave," says he, " mea-
 sures the strength of the disease  by  the  degree of stertor;  and
 Portal agrees  with him in opinion on this  subject;  observing that
 respiration in  apoplexy is greatly impeded, and the  motions of the
 breast are very apparent. We hear a noise of snoring or stertor,"
 he says,  "which is great in proportion as the apoplexy is strong. In
 all the cases of strong apoplexy which I have seen, the respiration
 in the beginning of the paroxysm was laborious, slow, and sterto- 
«E. VIA.—SP.V.]      NERVOUS FUNCTION.
403
rous: and in those which proved fatal, this symptom, as far as I can
recollect, remained, even when the breathing  had became weak
and irregular."*
  The author has witnessed it in the same manner, continuing to
the last gasp of life : the reason of which is, that, although  in con-
sequence of the  debility which has  now, perhaps, succeeded to
morbid strength of action, there is less mucus secreted in the larynx
and fauces than on the commencement ofthe disease, the absorbents
of these organs participating  in the  growing  weakness, are only
capable of carrying off the finer and more attenuate part of the fluid,
and thus leave the more viscid in a state of accumulation.  And it is
for the same reason that from first to last there is often, also, an ac-
cumulation of frothy saliva or foam, which, as it becomes trouble-
some by its increase, is occasionally blown away from the lips with
considerable force.
   The skin is about the ordinary temperature,  and covered with a
copious perspiration, or a clammy sweat:  the pulse is full and hard,
the face flushed,  the eyes blood-shot and prominent, and generally
closed   The cornea is dull and glassy, and the pupil for the most
part dilated.   In  a few cases, however, there is  a tendency to either
spastic or convulsive action, spreading sometimes over  the limbs,
but more generally confined to the  muscles ofthe face : insomuch
that, under the first, the teeth are  firmly closed, and deglutition is
impeded.  And where this state exists the pupil is contracted, as in
a synizenis, sometimes, indeed, almost to a point.  This last feature
has been rarely dwelt upon by pathologists whether of ancient or
modern times; but it has not escaped the observant eye of my accu-
rate and learned  friend Dr. Cooke : " In some instances," says he,
" I have seen the  pupil contracted almost to a point, and a physician
of eminence of my acquaintance has likewise observed this  appear-
ance of the eyes  in apoplexy :  yet although all  writers on the sub-
ject mention the  dilated pupils, I  do not find any  one, Aretaeus
among the ancients, and Dr. Cheyne among the moderns excepted,
who has noticed  the contracted pupil in these cases."t
   The paroxysm varies in its duration, from eight to eight  and for-
ty hours, and sometimes exceeds this period.   Dr. Cooke  quotes
from Forestus the case of a woman, who being seized with an apo-
plexy, which he  calls fortissima, lay in the fit  for three  days, and
afterwards recovered.   We  have   already observed that where it
does not prove fatal it predisposes to a relapse, and often terminates
in a lesion of some of the mental  faculties, or  in a paralysis more
or less general:  commonly, indeed, in a hemiplegia, which usually
takes place on the opposite side of the body  from that of the brain
in  which  the  congestion  or  effusion is found, on examination, to
have taken place, " This," says Dv. Baillie, " would seem  to show
that the right side of the body derives its nervous influence from

             * On Nervous Diseases, Vol. 1.  p. 171.
             t Ibid. p.  174. 
404                     NEUROTICA.           [CL. IV.—OR. IV

the left side of the brain, and the left side of the body its nervous
influence from the right side ofthe brain.  It is rarely, indeed, if
ever, that some ofthe turgid vessels ofthe brain are not ruptured
in this form of the disease, and consequently produce an effusion of
blood into some part of the organ of the brain."  And,  according
to the same distinguished writer, the part where the rupture most
commonly takes place is its  medullary substance near the  lateral
ventricles,  some  portion of  the  extravasated fluid often escaping
into these cavities."*
   Atonic apoplexy is the disease of a constitution infirm by nature
or enfeebled by age, intemperance, or over-exertion of body or
mind.   It has more of a purely nervous character, as we have al-
ready observed, than the preceding  variety, and is more a result
of vascular debility than of vascular surcharge, and consequently
where effusion  of blood is found, as  it often is, in the present form,
the vessels have been ruptured, not from habitual distension or vi-
gorous plethora, but from accidental, often, indeed,  slight causes,
that have produced a sudden  excitement and  determination to the
head beyond what  the vascular walls are capable  of sustaining.
Hence,  a sudden fit of coughing or vomiting,  a sudden fright, or fit
of joy, an immoderate fit of laughter,! the jar occasioned by a stum-
ble in  walking, or a severe jolt in  riding,  have  brought on the
present form  of  apoplexy, and  with so much the more danger as
the system possesses less of a remedial or rallying power in itself.
   In most of the cases the effusion detected after death has, there-
fore, been as truly sanguineous as in entonic apoplexy;  and hence
a valid objection to the use of the term sanguineous as descriptive
ofthe entonic form alone.  " It is," says M. Portal, "an error to
believe  that the apoplexy to  which old men are so much subject is
not sanguineous."  Daubenton and Le Roy, Members of the Insti-
tute, died of this precise kind of the disease at an advanced age :
and Zulianus describes a case marked by a pale countenance, and a
pulse so weak as scarcely to be  felt, which, on  examination after
death, was found to be an apoplexia vere sanguinea:  and another in
which, after all the symptoms of what is ordinarily called serous apo-
plexy had showed themselves, extravasated blood was discovered
in the brain without any effusion of serum, or the smallest moisture
in the ventricles.^
   It is nevertheless true that atonic apoplexy  is often found with an
effusion of serum instead of an  infusion  of blood, and apparently-
produced by such serous effusion : and hence, notwithstanding the
objections of Dr. Abercrombie, and, in the latter years of his prac-
tice of M. Portal, to serous effusion as a cause at all, the experience
and reasoning of Boerhaave and Hoffman, and Mead, and  Sauvages,

         *  Morbid Anat. p. 227.
         f Aretacus de Sign, et Caus. Diut. Morb. Lib. I.  Cap. 7.
         t  See also Burser. De Apoplex. p. 82.
           Cooke ut sup. 
GE. VIII.—SP. V.]       NERVOUS FUNCTION.
405
and Cullen, must not be abruptly relinquished without far graver
proofs than have hitherto been offered:  for if it be a question, as
Stoll has made it, whether effused serum, when discovered in the
brain of those who have died of apoplexy, be a cause of the disease
or an effect,* we may apply the same question to effusion of blood.
It is possible, indeed, for effused serum to become occasionally a
cause even of entonic apoplexy,  or that which, from its symptoms
is ordinarily denominated sanguineous apoplexy ; for it is possible
for the exhalants of the brain to  participate so largely in the high
vascular excitement by which this form of the disease is character-
ised, as to secrete an undue proportion of effused fluid into any of
its jcavities, and thus become as  direct a cause of apoplexy as ex-
travasated blood.
   This, however, is not what is generally understood by the term
serous apoplexy as  distinguished from sanguineous, and,  indeed,
ought only to be regarded as an effect of sanguineous distention.
Serous apoplexy, properly so called, is strictly the result of a debili-
tated  constitution, and especially  of  debility  existing in  the ex-
cernent vessels of the brain, whether exhalants or absorbents.  I
say absorbents, because although lymphatics have not yet been
discovered in  this organ, there  must be vessels of some kind or
other to answer their purpose,  and  the  extremities of the veins
have been  supposed thus to act; a supposition which has  derived
countenance from various experiments of M. Magendie, to which
we shall  have to advert in  the Proem to  the sixth class, and
which may at least stand as an hypothesis till the proper system of
vessels is detected.
   A  serous effusion, under  these circumstances, may take place
from three causes.  The mouths of the exhalants may be relaxed,
and consequently let loose  a larger portion of fluid than they are
accustomed to do in a state of health, and a larger portion than can
be carried off by the absorbents.   Or the extremities of the absor-
bents may be torpid and inactive,  and not imbibe the fluid that is thus
thrown forth, and the balance may be disturbed in this as well as in
the preceding way.  Or the blood itself, may be of too watery a
crasis,and too large an effusion take place from this cause; whence,
indeed, we frequently meet with apoplexy as the result of general
dropsy.
   Hence, atonic  apoplexy rarely makes its attack  altogether  so
incontinently as entonic; and is commonly preceded by a few warn-
ing symptoms.  These  are often, however, nothing more than the
ordinary precursors of other nervous affections, as vertigo,  cepha-
laea, imaginary sounds,  a  faltering in the speech, a failure in the
memory or some other mental  faculty, and  at length a sense  of
drowsiness, and a tendency to clonic spasms. On the attack of the
paroxysm the patient is as completely prostrated as in the entonic
variety,  but the  symptoms are  less  violent,  though not  on this
account less alarming, in consequence of  the greater debility of the
• Prslect. p. 367. 
 406                     NEUROTICA.          [CL. IV.—OR. IV.

 system.  The countenance is here pale or sallow, instead of being
 flushed,  but at the same time full  and bloated ; the pulse is weak
 and yielding,  sometimes,  indeed,  not easy to be  felt;  and the
 breathing though always  heavy and laborious, not  always, as  we
 have already observed, noisy or stertorous.  If spasms occur, they
 are uniformly of the convulsive  or clonic kind.  The duration ofthe
 fit varies as in the preceding variety, and if the patient recover, he
 is more liable  to a relapse, and more  in  danger of  hemiplegia or
 some other form of paralysis than in  the  stronger modification of
 the disease.
   From  these remarks on the two varieties of apoplexy, we may
 readily see why the complaint, and its ordinary associate or sequel
 palsy, should be about equally common to the poor and to the rich :
 for frequent exposure to cold and wet, severe and long protracted
 exercise, and a diet below what is called for will often  be found to
 produce  the same debilitating effects  as ease, indolence, luxury,
 and indulgence at too sumptuous a table.  And hence, contrary to
 what many would expect, Sir Gilbert Blane  has observed from
 accurate  tables kept with minute attention and derivedfrom a prac-
 tice of ten years in St Thomas's Hospital, and  his private consulta-
 tions, that "there is  a considerably greater proportion of apoplexies
 and palsies" among the former than among the latter: or, in other
 words, that these  disorders bear  a  larger  proportion to other
 diseases  among  the  lower classes than  among those in high life.
 "Some cases of hemiplegia," says he, " occur in fuil habits; some
 in spare  and exhausted habits   The former being most incident to
 the luxurious and indolent, most frequently  occur in private prac-
 tice, and among the upper ranks of life.  The latter  occur more
 among the laborious classes, and among  such of the  rich as  are
 addicted  to exhausting pleasures."*
   In forming our prognostic, a special regard must be  had to the
 peculiar  character of  the disease.    Generally speaking, atonic
apoplexy is more dangerous than entonic, for we have here a more
barren field to work upon, and  nature herself, or the instinctive
 power of the living frame, has less ability  lo assist us.  As to the
 rest in either modification, the degree of danger will be generally
measured by the violence ofthe symptoms. Where, under the first
 variety,  the breathing is not much disturbed, the pupil is relaxed,
 and there is no appearance of spastic action; where the perspiration
 is easy, the skin warm rather than hot, the bowels are readily kept
 in a due  state of evacuat;on, and more especially where there is any
 spontaneous hemorrhage, as from ihe nose or hemorrhoidal vessels,
 and of sufficient abundance, we  may fairly venture  to auger favour-
 ably.  But where the symptoms are directly  opposed to these; where
 the stertor is  deep and  very loud,f and  particularly where it is
* Trans. Medico-Chir. Soc. Vol. IV. p. 124.
f Dolxus, p. 144. 
GE. VIII.—SP. V.]     NERVOUS FUNCTION.
407
accompanied with much foaming at the mouth ;* where the  teeth
are firmly clenched, or a spasm has fixed rigidly on the muscles of
deglutition, and the  pupil instead of being  dilated, is contracted to
a point, we have little reason to expect a favourable termination
   The great hazard resulting from this tendency to spastic action,
and particularly as evidenced in a strongly  contracted pupil, is thus
forcibly pointed out by  Dr. Cooke.   " Among the dangerous  signs
in apoplexy, many authors mention a dilated state ofthe pupil of
the eye: but the contracted  pupil, which  I consider to be a still
more dangerous appearance, has been scarcely noticed.  I am of
opinion that this ought to be reckoned among the very worst symp-
toms ofthe disease.   I never knew a person recover from apoplexy
when the pupil was greatly contracted.  My opinion on this subject
is confirmed by that of  Sir Gilbert lilane and Dr. Temple."f
   Dr. Cheyne, in  like manner, regards convulsions as a source of
great danger: while M. Portal, on the contrary, thinks they some-
times announce a diminution ofthe morbid cause.   The latter rea-
sons from the fact  that when, in living animals, a slight pressure
has been made on the exposed brain, convulsions have taken place ;
while, if the pressure be increased in power, general  stupor with
stertor and difficult respiration have followed instead of convulsions :
an ingenious  conclusion but not exactly applicable, since, in  the
one case the brain is in a morbid and in the other in a sound  state,
whence the premises on which the  reasoning is  founded are  not
parallel.
   In the treatment of apoplexy, if we be timely consulted during
the existence of the precursive signs which have been noticed as
occasionally taking place, we shall often find it in our  power  com-
pletely to ward off a paroxysm by bleeding, purgatives, perfect quiet,
and, in  the entonic variety, a reducent regimen.  Where, however,
the pulse, and other symptoms give proof of weak vascular action,
and  nervous debility, the depleting plan should  be pursued with
caution, and it wiil be better to employ cupping-glasses than  vene-
section, and, in some instances,  to  limit ourselves  to purgatives
alone.   Yet, whatever be the degree of general debility, if the proofs
of compression or distention be clear as those of drowsiness,  verti-
go, and a dull pain in the head, it will be as necessary to have re-
course to bleeding either locally or generally, as in entonic apoplexy;
for such symptoms  will assuredly lead to a fit unless timely  coun-
teracted and subdued.
   " In the  actual  paroxysm of apoplexy," says Dr.  Cooke, and  I
quote his words because it is impossible to exchange them for better,
" the patient should, if possible, be immediately carried into a spa-
cious apartment, into which cool air  may be freely admitted.    He
should be placed in a posture which the least favours  determination
of blood to the head: all ligatures, especially those about" the  neck,
* Burser p. 97.
f lb. p. 280. 
408
NEUROTICA.
[CL. IV.—OR. IV.
 should be speedily removed, and the legs and feet should be placed
 in warm water,  or rubbed with stimulating applications.   These
 means may be employed in all cases of apoplexy :"* and are conse-
 quently equally  applicable to both the forms under which we have
 contemplated the disease   The collateral means to be had recourse
 to require discrimination, and it will be most convenient to consider
 them in relation to the actual form under which the apoplexy pre-
 sents itself.
   In entonic apoplexy, copious and repeated bleeding seems pri-
 ma, facie, to offer the most rapid and effectual remedy we can have
 recourse to:  yet the opinions of the best  practitioners, as well in
 ancient as in modern times, have been strangely  at variance upon
 this subject.   Hippocrates, who regarded apoplexy as chiefly de-
 pendent upon a  weak and pituitous habit, discountenanced the use
 of the lancet, as adding to the  general debility :  and even where
 it is accompanied with symptoms of strong vascular action, he dis-
 countenanced it  equally, from an idea that the case was utterly hope-
 less when it assumed this form,  and that to have recourse to bleed-
 ing would only bring a reproach upon the art of medicine.  The
 authority of Hippocrates has had too much influence with physicians
 in all ages, and has extended its baneful effects to recent times, and
 in some instances even lo our own day.  Hence Forestus tells us,
 that in strong or entonic apoplexy no courageous  plan ought to be
 attempted, no  venesection, no pills : we may, indeed, to please the
 by-standers have recourse to the remedia  leviora  of frictions, and
 injections, and ligatures round the arms and thighs; " and where,"
 says he, " we have not found these succeed in rationem sacerdotibus
 commisserimus."
  In our own country, the same timid  feeling has been particularly
 manifested by  Dr. Heberden and Dr. Fothergill,  but  on  grounds
 somewhat different.  Those excellent pathologists have chiefly re-
 garded apoplexy as a disease of nervous rather than of general de-
bility, and have been fearful of adding to this debility by abstracting
blood, and hereby  of almost ensuring hemiplegia or some other
form of paralysis.  Hence Dr. Heberden speaks with great hesita-
 tion concerning  the practice rather than with an absolute  and ge-
neral condemnation of it:  he observes, which is true enough, that
many persons have been injured by large and repeated bleedings,
and then lays down his rule, not to bleed either in  an attack of apo-
plexy or palsy if there would have been just objections to taking
away blood before the incursion of either.f
  Dr. Fothergill, however, expresses  himself still more decidedly
against bleeding than Dr.  Heberden.   He suspects that the weak-
ness it occasions checks the natural effort to produce absorption •
and that even the hard and full and irregular pulse, which seems
imperatively to call for a  very free use of the lancet, " is often an
* Burser, p. 288.
f Medical Transactions, I. p. 472. 
GE. VIO.—SP. V.]      NERVOUS FUNCTION.
409
insufficient guide ;" since "it may be that  struggle  which arises
from an exertion of the vires vita to restore health."  And hence,
he adds in another place,  " I am of opinion that bleeding in apo-
plexy is, for the most part, injurious, and that we should probably
render the most effectual aid by endeavouring, in all cases, to pro-
cure a plentiful discharge from the bowels :  as by these revulsions,
the head is, perhaps, much more effectually relieved from plenitude,
and that without weakening or interrupting  any other effort of na-
ture to relieve herself by venesection."*
  Itis singular that in drawing such conclusions from the instinctive
efforts or remedial power of nature, where a cure has been effected
spontaneously, these distinguished writers have not felt more deeply
impressed by the salutary efforts of spontaneous and copious hemor-
rhages, as from the nose, the lungs, and the hemorrhoidal vessels,
which have never  perhaps poured forth blood freely, without ope-
rating a cure ; and that they have not endeavoured to  follow these
footsteps as far as  they might have done, by substituting an artifi-
cial discharge of blood where  a  natural discharge has not  taken
place.
  Other physicians, however, both  in  ancient and modern times,
have not  been equally insensible to this important  fact.  Galen,
though he always hesitated in  departing from the  practice of Hip-
pocrates, ventured to deviate from him upon the point before us.
Aretaeus, Paulus of jEgina, and Ccelius Aurelianus carried the re-
medy of bleeding to a still  further extent, and Celsus regarded it
as the only means  of effecting a cure.f.
  " The Arabians  adopted the practice  of the ancients,  so  far as
relates to the  employment of  blood-letting  in a strong apoplexy,
and by far the greater number of  modern physicians  have, in this
respect, followed their example.  In support of this  practice we
might adduce the opinions of all who have written on the disease :
we  might quote from the works of Sydenham, Wepffer, Boerhaave,
Van Swieten,  Morgagni, Baglivi,  Sauvages,  Tissot, Mead, Friend,
Pitcairn, Hoffman, Cullen, Portal, Cheyne, and many other eminent
modern writers."! As  this paragraph  is quoted from Dr. Cooke,
it is almost superfluous to add his own name to the list  of  those
who strenuously recommend blood-letting.
  A question has  been made as to the side from which it may be
most advantageous to take blood.  Aretaeus drew it from the sound
side, wherever this could be distinguished. Valsalvi and  Morgagni
recommend the same;  as does also Cullen, observing that " dissec-
tions show that congestions  producing  apoplexy are always on the
side not affected."§ Baglivi recommends bleeding from  the dis-
        * Works, Vol. III. p. 208.
        f De Medicin. Lib. III. cap. XXVIT
        $ Cooke, ut supra, 292.
        §Pract.ofPhys. Vol. III.  p. 184.
vol. ill.—52 
410                      NEUROTICA.          [CL. IV.—OR. IV.

eased side, except where blood is abstracted locally.  The question
appears to be of no great importance : the grand object in  general
bleeding is to diminish the quantity and momentum of the circulat-
ing fluid, to enable the ruptured vessels  to contract with  greater
facility, and to aflbrd time  for an absorption of  whatever may have
been effused.
  In entonic apoplexy, general and local  bleeding should go hand
in hand ; and the quantity  drawn should in every instance  depend
upon the urgency ofthe symptoms.  Dr. Cheyne advises us to be-
gin with abstracting  two pounds, and tells us that it will often re-
quire a loss of six or eight pounds before the disease will give way.
  Dr.  Cullen and many other  writers, as  Morgagni, Valsalva, and
Portal, have recommended that the opening should be made in the
temporal artery or the jugular veins. " In all cases of a full habit,"
says Dr. Cullen, " and where  the  disease  has  been preceded  by
marks of a plethoric  state, blood-letting is  to be immediately em-
ployed, and very  largely.  In my opinion it will be most effectual
when the blood is taken from the jugular vein ; but if lhat cannot
be done it may be taken from the arm.  The opening of the  tem-
poral artery, when a large branch can be  opened sa as suddenly to
pour out a considerable quantity of blood, may also be an effectual
remedy ; but, in  execution, it  is more uncertain and may be incon-
venient.  It may in some  measure be supplied by cupping and sca-
rifying on the temples or hind-head.   This, indeed, should seldom
be  omitted, and these scarifications are  always preferable to the
application of leeches."*
   In bleeding from  the  temporal artery we  may safely  let the
stream flow as long as it will,  for in common  it will cease before
we have obtained enough, and all tight ligatures about the head,
or indeed any other  part of  the body, should be avoided  as much
as possible.  For the same reason  Heister advises that, on opening
the jugular vein, no ligature should be made use of, as the smallest
pressure on the part may  do harm by interrupting the circulation
of the blood on the external veins of the  neck.
   M.  Dejean, of Caen, proposed, not long ago, to the Academy of
 Sciences, to open the superior longitudinal sinus after raising the
bone which covers it, and asserted that he had employed this mode
 with great success on strangled dogs.  M. Portal,  and M. Tenon,
 however, who were  appointed commissioners  to report on M. De-
 jean's memoir, agreed that bleeding from the  jugular vein is  pre-
 ferable to that from  the sinus, as producing the same effect  more
 speedily, and  with more facility of restraint when  a sufficiency of
 blood has been taken away.
   What seems to be the fair result, the  author will give in  the
 words of Dr.  Cooke.  " General  opinion, then, as well as reason-
 ing,  appears  to  be  very  much in favour of tree and repeated eva-
 cuations of blood, both general and topical, in the strong apoplexy ;
 and I am persuaded  that  greater advantage may be reasonably ex-
tract, of Phys. Vol. III. p. 182. 
GE. VIII.—SP. V.]      NERVOUS FUNCTION.
411
  pected from this than from any other practice : yet I am very much
  inclined to think that it may be, and  actually sometimes has been,
  carried too  far.   I  have  seen several  cases, and heard of many
  others, in which very large  quantities  of blood have  been drawn
  without the smallest perceptible advantage, and  with an evident
  and considerable diminution  of the strength of the patient."*
    The next important means to be pursued is that of exciting the
  bowels by active purgatives, and  then  endeavouring to lessen the
  pressure  on the  brain by revulsion.  The particular purgative  is
  of no importance :  whatever will operate most speedily and most
  effectively is what  should be preferred in the first instance :  and
  hence a combination of calomel and extract  of jalap will be found
  among the best:  though a free action  may afterwards be more con-
  veniently  maintained by colocynth or sulphate of magnesia.  Do-
  laeus employed calomel so as to excite  salivation,  from an opinion
  that all evacuations are useful; and he gives  an account of several
  cures he was hereby enabled to effect, and particularly relates the
  case of a  woman who  was in this  manner considerably relieved,
  and died on the cessation  of the ptyalism.f
   The collateral  remedies are of less importance  though some of
 them may add to  the general  effect.   Emetics are of a very doubt-
 ful  character in  the form of the disease before us,  though often
 highly useful in atonic apoplexy.   They have been given upon the
 principle of their producing a sudden prostration of strength, and
 faintness :  but this is  a result of nausea rather than of vomiting : and
 the  languor hereby occasioned is not exactly  of the kind we stand
 in need of; regard being had to the disease as a nervous affection,
 and the danger of inducing  hemiplegia.  Full vomiting may, indeed,
 determine from the head to the surface of the  body, but we cannot
 answer that the straining will  not renew  the extravasation, or even
 rupture a vessel where no  rupture has existed.  It is true the same
 plan has at times  been  employed in haemoptysis, apparently with
 success ; bui it has in other instances been so  decidedly productive
 of mischief, as to urge  those  who have made  choice of it to aban-
 don  it abruptly, with a determination  never to return to it in  any
 other case, as we have already observed  when treating of haemop-
 tysis under Class  III. Order IV. in the preceding volume.J  The
 only instance in which it may be prudent to  prescribe  an emetic,
 is where the disease  has evidently  proceeded from a surcharged
 stomach.
  Blisters and sinapisms promise but little in  this form of the dis-
 ease : they tease and irritate to no purpose when applied lo the ex-
 tremities, and are still more injurious when they are made to cover
the  scalp; for they effectually  prevent  the use of epithems of cold
water, or vinegar, or pounded  ice, which afford a rational chance of
producing benefit.

                        •  Ut supra, p. oil.
                       f  Dolaeus, p. 149.
                        * Vol. II. p. 464. 
412
NEUROTICA.
[CL. IV— OR. IV
   Cordials were in high reputation among the Greek practitioners,
 from a belief that apoplexy is in alniost every case the result of a
 debilitated and pituitous habit:  and the custom has too generally
 descended to the present d«y, even where the ground on which it
 was founded has been relinquished.  Stimulants and cordials of all
 kinds should  be sedulously abstained from :  and the  neutral salts
 with small doses of the antimonial powder, or any other cutaneous
 relaxant be employed in their stead: cooling dilute drinks should
 be freely recommended ; and if we should hereby be enabled to ex-
 cite a gentle moisture on the  skin, it may prove of incalculable
 advantage.
   The curative process under our second variety ofthe disease, or
 atonic apoplexy, must vary in many points from  the preceding.
 It is here, if at any time, we should pause,  before we employ bleed-
 ing.   Yet as dissections show us that even here also compression,
 and  that too from an efflux of blood, is very general, and either from
 blood or serum, almost constant,—whatever be the degree of con-
 stitutional debility, I can hardly  conceive  of any  case in which we
 should be justified in withholding the lancet or the use of cupping-
 glasses.   The argument stands  precisely upon the ground of the
 expediency of bleeding in typhus accompanied with congestion : itis
 in itself an evil; but it is only employed as a less evil to fight against
 a greater.   With it we may succeed : without it, in either instance,
 the case is hopeless.
   Generally speaking, however, the local bleeding will here be pre-
 ferable to that ofthe lancet; but cupping should always be  preferred
 to leeches  whose operation  is far too slow for the urgency of the
 occasion.   The last, however, are recommended by Burserius, and
 Forestus quotes an instance in which they succeeded by a formida-
 ble application over the entire body.*  Aretaeus  after abstracting
 blood by cupping-glasses, recommends also the use of dry-cupping
 between the shoulders, and the recommendation is highly ingenious
 and worth attending to t
   Purgatives, though  less violent than in entonic apoplexy, should
 in like manner be had recourse to: and as we have  less danger to
 apprehend from the use of emetics, they may be given more freely.
 They are strongly recommended by Sauvages, and were regarded
by Grubeiius almost as a specific.  They have the triple advantage
 of freeing the stomach from morbid acrimony, rousing the system
 generally, and determining from the head to the  surface of the
body.
   Here also  we may use both external and internal stimulants in
 many cases with considerable success.  Of the former, volatile al-
 kali, rubefacients, and  blisters may be made choice of in succession,
 and applied alternately to different parts ofthe body.   Of the latter
we should  chiefly confine  ourselves to  the  warmer  verticillatc
* Lib. X. Obs. 76.
f De Cur. Morb. Acut. I. 4. 
GE. VIII.—SP. V.]
NERVOUS FUNCTION.
413
plants, as lavender, marjoram, and peppermint, or the warmer sili-
quose, as horse-radish and mustard, or the different forms of am-
monia; and even of these we are debarred by Dr. Cullen, at least
in that particular modification of atonic apoplexy, which we have
described under the name of serous, though he does not enter into
a consideration of any other.
   In that peculiar kind of apoplexy which is sometimes produced
by taking immoderate doses of spirits or some narcotic, and espe-
cially opium, in which we meet with  an almost instantaneous  ex-
haustion of the nervous power, or an  instantaneous stop put to its
secretion or flow, making a near approach to asphyxy, though with
a heavy drowsiness and stertorous breathing, the patient should first
have his stomach thoroughly emptied  by an emetic of  sulphate of
copper; he should be generally stimulated by blisters, and kept in
a state of perpetual motion  by walking or other exercise, so as to
prevent sleep till the narcotic effect is over.   An interesting case
of this  kind will be found  related by Dr. Marcet in the Medico-
Chirurgical Transactions.*
   After all it should not be  forgotten  that apoplexy is in most, per-
haps in all cases, not secondarily alone, but primarily a nervous af-
fection, and dependent upon a predisposition to this disorder in the
sensorium  itself, if not upon  a morbid condition of it: and that hence
the patient, though we should recover him from the actual fit, will
be subject to a recurrence of it. In this view the interval becomes
a period of great importance, and should be as much submitted to
a course of remedial treatment as the paroxysm itself.
   After entonic apoplexy, the patient should habitually accustom
himself to a plain diet, regular exercise, early hours of meals and
retirement, and uniform tranquillity of mind : and the  state of the
bowels should particularly claim his  attention.   After the atonic
variety the same  general plan  may be followed with a like good
effect, but  the diet may be upon a more liberal allowance; and a
course of tonic medicines should form a part of the remedial system.
If it were true, as suspected by Dr. Cullen, that all bitters contain
in the bitter principle itself a narcotic  and mischievous power, these
ought to be carefully abstained from,  but we have already observed
that this does not seem to be the fact.  And hence much of the
treatment  laid down  under limosis  Dyspepsia,! may  be pursued
here: together with a use of the waters of Bath, Buxton,  and
Leamington.
* Vol. I. p. 77.
t Vol. I. p. 111. 
 414                      NEUROTICA.          [CL. IV.—OR. IV.


                         SPECIES VI.

                  CARUS  PARALYSIS.



   CORPOREAL TORPITUDE AND MUSCULAR IMMOBILITY MORE OK
           LESS GENERAL,  BUT WITHOUT SOMNOLENCY.

 Palsy is a disease which makes a near approach to apoplexy in its
 general nature and symptoms, and is very frequently a result of it.
 It is, however, still more strictly a nervous affection, and less con-
 nected with a morbid state of the sanguiferous or the respiratory
 organs.  In examining it more in detail, we shall find that  some-
 times the motory fibres alone are affected in any considerable  de-
 gree, while the sentient are only rendered a little  more  obtuse,
 sometimes both kinds are equally torpid, and sometimes  several of
 the faculties of the mind participate in the debility, though they are
 never so completely lost as in apoplexy.
   The Greek writers contemplated the two diseases under the same
 view, considering them as closely  related  to each other, or, in
 other words, as species of the same genus.   " The ancients," says
 Dr. Cooke, who has accurately gone over the entire ground and
 taken nothing upon trust,  ' very generally considered apoplexy and
 palsy as diseases of the same nature,, but different in degree ; apo-
 plexy being an universal palsy, and palsy a partial apoplexy.  Are-
 taeus says,apoplexy, paraplegia, paresis, and paralysis, are all of the
 same kind; consisting in a loss of sensation, of mind, and of mo-
 tion.  Apoplexy is a palsy of the whole  body, of sensation, of mind,
 and of motion.  And on this subject Galen, Alexander Trallianus,
 JLtius, and Paulus ^Egineta, agree in opinion with  Aretaeus.  Hip-
 pocrates who, in various parts of his works speaks of apoplexy, no
 where, as far as I know, mentions paralysis; and when he refers to
 this disease  he employs the term apoplexia.  Both  Aretaeus and
 Paulus ^gineta represent him as speaking of apoplexy in the leg.
 Celsus describes palsy and apoplexy by the general terms resoluti o
 nervorum."*  It is only necessary to add  that paresis and  palsy
 were  used sometimes synonymously; and that, when a distinction
was made between them, paresis was regarded as only a very slight
or imperfect palsy.
  Palsy and apoplexy, however, are something more than the  same
disease merely varied in degree ;  the one, indeed, may lead to and
terminate in  the other, but they very often exist separately and
without any interference ; and,  notwithstanding  iheir general re-
semblance, are distinguishable by clear and specific symptoms. But
* Treatise on Nervous Diseases, Vol. II. p. 1. 
tiE. Vm.—SP. VI.]    NERVOUS FUNCTION.
415
if the Greeks approximated them too closely, the  greater part  of
the nosologists of modern times as Sauvages, Linneus, Vogel, Sagar,
Cullen, and Young,  have placed them too remotely,  by regarding
each as a distinct genus : the proper nosological arrangement seems
to be that of co-species, as they are ranked by Dr.  Parr, as well  as
under  the system before  us.
  The common causes of apoplexy are usually asserted to be those
of palsy: and considering how frequently palsy occurs as a sequel
of apoplexy, the assertion has  much to support it:  for compression
is here also as well as in apoplexy a very frequent  cause.  Yet  as
compression  does not seem to be the only cause of apoplexy, it  is
still less of palsy in all  its modifications, and we  shall still more
frequently have to resolve  the disease into some of those causes of
general and especially of nervous debility which we have already
noticed as  occasionally giving rise to apoplexy, and which we have
more particularly illustrated under the genus clonus of the pre-
ceding order.
   Palsy is often preceded by many of the precursive  signs we have
already noticed as forewarning us of apoplexy; and it commonly
commences slowly and insidiously;  a single limb,  or a part of the
body being at first troubled with an occasional sense of weakness or
numbness, which continues for a short time and then disappears.
A single finger is often subject to this token, as is  one of the eyes,
the tongue, or one side of the face.
   The nerves chiefly affected are those subservient to voluntary
motion, but the accompanying nerves of feeling in most cases par-
ticipate in the torpitude  though not  in an equal degree, and some-
times  not at  all. " I  never," says Dr. Cooke, " saw a case of palsy
in  which  sensation  was entirely lost:" though such  cases seem
sometimes to have occurred.  The action ofthe involuntary organs,
and especially of the heart and lungs, are but little  interfered with,
though in  a few instances something more languid  than in a state of
ordinary health.   And in this respect we perceive a considerable
difference between paralysis and apoplexy, in which last the heart
appears  to be always oppressed, and the breathing  laborious.  The
faculties of the mind,  however, rarely escape without injury, and
especially the memory ;  insomuch that not only half the vocabulary
the patient has been in the  habit of  using is sometimes forgotten,
but the exact meaning of those that are remembered, so that a sense-
less succession of words is made use of instead of intelligible speech,
the patient perpetually misusing one word for another, of which  we
have  given various  examples under moria imbecilis,  or mental
imbecility.*  And it is hence not to  be wondered at that palsy
should occasionally impair all the  mental faculties  by degrees, and
terminate  in fatuity  or childishness.
   We have frequently had occasion to observe and to prove by ex-
amples, that where any one of the external senses  is peculiarly ob-
* See Vol. III. pp. 125, 126. 
416
NEUROTICA.
|CL. IV.—OR. IV .
 tuse or deficient, the rest are often found in a more  than ordinary
 degree of vigour and acuteness, " as though the sensorial  power
 were primarily derived from a common source, and the proportions
 belonging  to the organ whose outlet  is invalid, were  distributed
 among the other organs."* Something of this law seems to operate
 in many cases of palsy, and is more and more conspicuous in pro-
 portion to the extent of the disease : for in hemiplegia and paraple-
 gia, the half of the body that is unaffected has not  unfrequently
 evinced a morbid increase of feeling.   Dr. Heberden  attended a
 paralytic person whose sense of smell became so exquisite as  to
 furnish perpetual occasions of disgust and uneasiness; and he men-
 tions one case in which all the senses were exceedingly acute.
   It is to this principle we are to resolve it that where the disease
 confines itself to the motory nerves of an organ alone, and the sen-
 sific are not interfered with, the feeling of the palsied  limb itself,
 is sometimes greatly increased,  and sometimes exacerbated into a
 sense of formication, or some other troublesome itching.  " I have
 seen several instances," says Dr. Cooke,  " in which paralytic per-
 sons have felt very violent pain in the parts affected, particularly in
 the shoulder and arm ;"f  and the remark, if necessary, might be
 confirmed from numerous authorities.
   Palsy, however,  is  strictly a disease  of nervous debility, and
 where  it shows itself extensively, the whole nervous system is af-
 fected  by it.   The  consequence of which is,  as we have already
 shown  in treating of enta3tic, and particularly clonic spasm, that the
 sensorial fluid in all its modifications is secreted or communicated
 irregularly, and its balance perpetually disturbed, so as to operate
 upon the mind as well as upon the body:  whence some  parts are
 too hot and others too cold, and even the affected limb  itself, accord-
 ing to  the nature ofthe affection, and its limitation or extension to
 different sets of nerves, will be warmer or colder than in  its natural
 temperature, and will waste away, or retain its  ordinary  bulk ;
 while the passions of the mind will participate in the  same morbid
 irritability, and evince a change from  their constitutional tenour.
 Persons of the mildest and most  placid tempers will often discover
 gusts of peevishness and irascibility;  and men of the strongest men-
 tal powers have been known  to weep like children on the slightest
 occasions.   In a few instances, however, an opposite and far more
 desirable alteration has been effected.   " I had several years ago,"
 says Dr. Cooke, " an  opportunity of seeing an illustration of this
 remark in the case of  a  much respected  friend.  The person to
 whom  I allude had always, up to an advanced  age, shown an iras-
 cible and irritable disposition :  but after an attack  of  palsy his
temper became perfectly placid and remained so until his death
about two years afterwards-"^
* See Vol. III. p. 196. 256., and compare with p. 27
| Ut supra, p. 5.
t See Vol. III. p. 12. 
 GE. VIII.—SP. VI.]     NERVOUS FUNCTION.                 417

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

« Hemiplegia.                    The disease affecting and con-
   Hemiplegic Palsy.                fined to one side of ihe body.
£ Paraplegia.                     The disease affecting and con-
* Medico-Chirur. Trans. Vol. VII.
f Acad. Nat. Cur. Soc. Oe Paralysi. 8vo. Hornx,
\ Class IV. Ord. II. Gen. V. see supra, p. 189.
vol. hi.—-53 
118
NEUROTICA.
[CL. IV.—OR. IV.
   Paraplegic Palsy.                 fined to the lower part of the
                                    body on  both sides, or  any
                                    part below the head.
 y Particulars.                    The disease affecting and  con-
   Local Palsy.                      find to particular limbs.

   Some nosologists have transferred to this division the  local in-
 sensibilities and atonies of the external senses or parts of them, as
 though they  were idiopathic affections.  It is rarely, however,  or
 never, as Aretxus has justly remarked, that they are not connected
 with other symptoms and other derangements  of such organs and
 their respective functions: and hence, they rather belong to the se-
 cond order of the present class, than to paralysis in the strict sense
 ofthe term.  They are anaesthesiae,—voc-oi tx^xXvtixoi, or tx% envoi,
 rather than TrxgxXvo-is; and  in the  system before  vis are arranged
 accordingly.
   Hemiplegia, the first of the above  varieties of palsy, is far most
 frequently met with as a sequel of apoplexy, and especially of atonic
 apoplexy,  or that in  which the energy of the nervous system is
 peculiarly  diminished, and irregular.  The usual exciting causes of
 apoplexy are in consequence those of palsy, and need not be enume-
 rated in the present place   In a few instances, however, hemiplegia
 occurs without preceding apoplexy ; and hence, distinctly proves
 that pressure, or at least such a pressure as is demanded to produce
 somnolency, is not essentially necessary.   Mr.  John Hunter, as we
 have already  observed, was inclined to think that pressure from ef-
 fused blood,  was, in every instance, the cause both of this disease
 and of apoplexy: but in allowing, as he has done, that on one occa-
 sion at least he was called to a patient who died of a gouty affection
 of the brain " with symptoms similar to apoplexy,"  and without any
 extiavasation whatever, he directly  concedes the point of compres-
 sion as  an  universal cause :  for if atonic or  retrocedent gout  may
 produce apoplexy or palsy without  pressure on  the brain, so  may
 m.uiy other atonic powers, operating as effectively on the sensorium.
 One ofthe most frequent of these  powers is a debilitated and paretic
 state ofthe liver;  and hence those persons  are  peculiarly subject
 to ihis variety of palsy, who have spent  the earlier part  of their
 lives in an  habitual course of intemperance.   Hoffman has particu-
 larly noticed this cause ; and Morgagni describes the case of a man
 advanced in years who was attacked with jaundice and hemiplegia
 simultaneously; the jaundice afiecting the hemiplegic side alone,
 which was  the right, and that with so much  precision, that the nose
 was of a deep yellow on the one  side,  and of its proper colour on
 the other,  which were divided from each other as by a ruled line.
 Other causes are exposure to the rays of the sun, drinking cold
 water and bathing in it when heated, repelled eruptions, and chronic
rheumatism.
  As apoplexy has its precursivc symptoms occasionally, so  also
lias hemiplegia, and  particularly when  it  is  connected with a 
GE. VIll.—SP. VI.]    NERVOUS FUNCTION.
419
plethoric  habit:  for in this case the veins  of the neck and face
often appear turgid, there is an obtuse pain in the head, the tongue
moves with some difficulty, and particularly on one side, the per-
ception and memory become impaired, and the patient feels a ten-
dency to drivel at one corner of the mouth rather than at the otrcr.
The onset, like that of apoplexy,  is at last sudden ; and if the pa-
tient be standing  he drops down abruptly on the affected side.
   The progress of the disease is uncertain ; and depends very much
upon the  state  of the nervous system at the time of the attack.
If there be no chronic debility,  or other  morbid  condition of the
sensorium, the patient will sometimes recover entirely in a week
or even less ; but if his system, or some particular part of it, be in
an infirm state, he  recovers only imperfectly ; and obtains, perhaps,
a thorough or a limited use  of  the  lower limb,  while the  upper
remains  immovable; or  he is compelled  to pass through  the
remainder of a wretched and precarious  existence with only  one
half of his body subservient to his will, the other half being more
dead than alive, and withering,  perhaps,  with a mildew-mortifica-
tion.*
   We have stated  that in  this  disease, as,  indeed, in all others
accompanied with  an atonic disturbance of the nervous energy,
there is not only a  great irregularity in the flow,  but a great and
confused disproportion in its distribution  to  different  parts of the
body ; so that the stock, whether of sensific or motific fluid, which
is altogether deficient in some parts, seems to be sent  in a hurried
and tumultuous accumulation to others, which are in consequence
irritated with an undue degree of sensation or motivity, in the most
capricious manner.  Dr. Cookef  and Dr. Abercrombie^: have col-
lected numerous and highly  interesting examples of these curious
anomalies, and may be consulted with great advantage by those who
are desirous of following up the subject more minutely.
   Sauvages gives  a case from Conrad Fabricius,  of what  he calls
transverse hemiplegia, in which the disease was confined to the arm
on one side, and the foot on the other :§  and Ramazzini speaks of
a patient whose leg, on one side, had lost its feeling, but retained its
power of motion, while the other leg had lost its  power of motion
but retained its feeling.||   In some instances, indeed, the entire
feeling of one side  is said to have been lost, and the entire motivity
on the other side ;1 and in a few rare examples persons during the
paroxysms, and even for some time afterwards,  have  felt on the
affected side, a sensation of pungent heat from cold, and especially
* See Vol. II. p. 608.
f On Nervous Diseases, Vol. II. Part I.
t Treatise on Apoplexy and Palsy.
§ Spec. Gen. XIX.  Or. III. Cl. VI.
H De Morb. Artif. 286.  See also Heister, Wahrnemungen. I. 205.
* Eph. Nat. Cur. passim. 
420
NEUROTICA.
[CL. IV.—OR. IV.
polished bodies, and  of  painful cold from  an application of hot
bodies.
  It is not, perhaps, very difficult to account for this last singularity.
Where the sensibility is morbidly accumulated in a weak  limb, as
it often is in hemiplegia, sometimes so much as to give a painful
sense of formication,  cold  not only excites action but becomes
almost as pungent an  irritant as an actual cautery ; in the  correct
language of the poet

                —Bores penelrabile frigus adurat.*

And hence in climbing lofty mountains, as the Alps and the Ande6,
the traveller frequently finds his skin  more completely blistered
from the sharp cold by which he is surrounded than by an exposure
to an equinoctial  sun.   On the  contrary,  the morbid halitus or
perspiration into which the application of hot bodies often throws
a limb, in  the  same  relaxed  and  debilitated state,  produces an
unusual sense of coldness in consequence of the evaporation. And
we may hence explain the singular case recorded by Dr. Falconer,
of a  gentleman who after a  paralytic attack,  felt his shoes  very hot
when he first put them on,  and gradually become  cool,  as they
acquired the warmth of his  feet; the reaction, and consequent "
increase of moisture  thrown forth  from the  surface of  the  feet
producing the difference of sensation.
  In the Transactions of the Medico Chirurgical Societyt there is a
very singular case of Dr. Viesseux, who was  gradually  attacked
with an imperfect hemiplegia which at  first showed its approach by
perturbed  sensations, and vertigo, with a feeling of sea-sickness, a
sight of objects reversed, a difficulty in swallowing liquids, and a
total loss of voice, while the powers of the  mind  remained unim-
paired so that he could watch all  his symptoms.  Shortly after this
the whole  ofthe right side  became utterly insensible, the insensible
part being divided from the sensible by a geometrical line running
down the body in a vertical direction :  and in about three  months
more the insensibility of the right side of the head, accompanied
with a debility of all the voluntary muscles,  was transferred to the
left, the right re-acquiring its antecedent powers ; but all the right
side below the head still  continuing to  possess its former torpitude.
Here, also, there was  a very different sense of heat and cold on the
opposite sides; for whilst  the left  was influenced naturally, the
right had the falsified sensation just noticed  in Dr. Falconer's case,
so that in getting into a cold bath or a  cold bed, the right side had
a feeling  of heat,  while the  left side felt cold, as it should do.
Hot bodies in like manner,  felt cold to the diseased side, apparently
from the cause just stated.   And that this was the real cause seems
manifest from the patient's  having often a feeling of a cold dew, or
* Virg. Georg. I. 93-
t Vol. VII. p. 216. 
GE. Vni.—SP. VI.]    NERVOUS FUNCTION.
421
of cold water on the surface, and especially over his face, which
induced him lo wipe himself as if he had been wet.   It is, perhaps,
more singular, that though plunging his right or affected hand into
cold water, gave him a sense of lukewarmness, plunging  it into
boiling water gave him a disagreeable sensation, but very different
from that of either heat or cold.  This sensation  seems to have
been that of numbness, and was probably produced  in consequence
of  the accumulated  sensibility  being rapidly carried  off  by the
extreme heat of the  water, as a like torpitude is produced by the
opposite effect of extreme cold, and the rapid exhaustion of sensi-
bility which is  so well known to follow on its application.
  This morbid disturbance and irregular distribution of sensorial
power is sometimes productive of the most alarming consequence:
for  in a hemiplegic state of the bowels  some parts are, in certain
cases,  so  acutely sensible, and  others so utterly  insensible, that
while ordinary purgatives are incapable of exciting evacuations from
the torpitude  and irresponsibility of the palsied  parts, they are
sufficient to occasion inflammation, and have actually  occasioned it
in  the  parts exacerbated by accumulated  sensibility,  as certain
experiments of M. Magendie have sufficiently established.
  It is owing to the same irregular distribution of sensorial power,
where every department of the nervous system participates in the
diseased state of the sensorium, that we sometimes behold hemiple-
gia, and particularly imperfect hemiplegia united with other affec-
tions of the same system.  The symptoms of hypochondrism are
peculiarly apt to associate with it, in which case the bravest hero
will often lose all his magnanimity and  sit down and weep like a
child : and in the celebrated  geologist M. de Saussure, we find a
still more complicated instance of hemiplegia, hypochondrism, and
chorea.  The disorder crept on by imperceptible degrees, and was
accompanied with various anomalies.  Both sides were weakened,
but  the left suffered chiefly :  yet, by the aid of a stick, he could
still drag forward the  left  leg.  By some unknown means he had
taken up a morbid notion, very common to hypochondriac patients,
of the difficulty of passing through a door-way when wide open
without being squeezed  to death ; and hence, at the very time in
which he could cross his room with a tolerably firm step, the mo-
ment he  reached the door,  which was of capacious breadth and
thrown open for his passage, he tottered and precipitated his mo-
tions with the jerk of a St. Vitus's dance, as though he were prepar-
ing for the most perilous leap: yet as soon as he had accomplish-
ed  the arduous undertaking, he again became collected, and passed
on  with comparative ease till he had  to encounter another adven-
ture of the same  kind,  which was sure to try him in the same
manner.*  Tulpius gives a somewhat similar case  in which hemi-
plegia was united with beribery.f
* Medico-Chir. Trans. Vol. VII. p. 214.
■■ Lib. IV. Cap. 5. 
422
NEUROTICA.
[CL. IV.—OR. IV,
   Paraplegia, or the second variety of palsy, has generally been
 conceived to depend  altogether upon a diseased affection of the
 spine in its bones, ligaments, or interior,  most  frequently in the
 region  of  the loins; in consequence of which the spinal  marrow
 becomes pressed upon, or otherwise injured, independently of any
 complaint of the brain.  That this is a common cause is unquestion-
 able, and a cause that  often operates long  without external signs:
 for the  vertebral extension of the dura mater may be thickened,
 or a serous fluid effused, or blood be extravasated within the verte-
 bral cavity; or a tumour may be formed in some part of it, or the
 spinal marrow itself may  undergo some morbid change.   But the
 best practical observers of the present day concur in opinion that
 paraplegia, like hemiplegia,  is produced still more frequently by
 causes  operating on the brain than confined to the spine.   Of this
 opinion is Dr. Baillie, who ascribes it chiefly to pressure on the
 brain,*  Sir Henry Halford, Sir James Earle,  and Mr. Copeland.f
 Some kind of affection ofthe head, indeed, will commonly be dis-
 covered from the first, if we accurately attend to all the symptoms;
 some degree ol  pain, or giddiness, or sense of weight, or undue
 drowsiness, or imperfection in the sight.   And hence, many of the
 causes  of  paraplegia are evidently those of hemiplegia, operating
 probably upon a different  part of the brain.
   This form of paralysis may take place at any age, but it  is more
 frequent as we advance beyond the middle  of life; and  Dr. Baillie
 has  observed that  it occurs  oftener in  men  than  in women ; for
 which it is by no means difficult lo account, considering the greater
 hurry and  activity of life pursued by the former.  The disease, in
 many instances, makes an insidious approach.  There is  at first
 nothing more than a slight numbness in the lower limbs with an ap-
 pearance of stiffness or awkwardness in the  motion of the muscles :
 these symptoms increase  by  degrees ; there is great  difficulty in
 walking, and an  inability in preserving a balance; the aid of a staff
 or the arm of an assistant is next demanded: and the urine is found
 to flow  in a feeble stream, or  perhaps involuntarily.  The  bowels
 are at first always costive; but as the sphincter  loses its power of
 constriction, the motions at length pass off involuntarily.  The dis-
 ease may continue for years, and the patient at last sink from general
 exhaustion.  It  sometimes, but rarely, terminates in a recovery.
   When an injured or diseased state of the spine is the origin of
 paraplegia, the complaint shows itself suddenly, or makes  its ad-
 vances insidiously, according  to the nature of the cause : and for a
knowledge of  this  form of the malady we are chiefly indebted to
Mr. Pott,}, who, however,  does not think that  it properly belongs
to the species paralysis, though there seems  no sufficient  reason
  * Trans. Med  Vol. VI. Art. II.
  f Treatise upon the Symptoms and Treatment of Diseased Spine.
  % Remarks on that kind of Palsy of the lower limbs which is frequently
found to accompany a curvature of the spine. 8vo. 1788. 
GE. VIII.—SP. VI.]    NERVOUS FUNCTION.
423
why it should not be so arranged, as in truth it has been by most
pathologists from the time of Galen, who seems not only to have
understood its nature, but to have contemplated it in this view.* It
sometimes happens that one or more vertebrae have been pushed,
by sudden force, a little way  out of their proper position ; and in
this  case  a considerable degree of numbness, together with less
motion in one or both the lower limbs, is almost sure to follow, too
often succeeded with a paralysis ofthe sphincters ofthe rectum and
bladder, and  consequently an involuntary  discharge of feces and
urine : and if the luxation should take place in the dorsal or cervical
vertebrae, the organs of digesion may all, more or less, suffer, the
respiration become affected, and the spine itself exhibit a conside-
rable degree of curvature.  And  the same effects  are still  more
likely to follow,  and even to  greater extent  and  with still  more
serious mischief, from  an idiopathic affection of some part of the
spinal chain, arising from scrophula, inflammation, or caries; from
compression  of some effused  fluid, or  a thickening of its external
tunic, or even of the substance of the spine itself; of which last M.
Portal has given a singular example.f
  In the last case the disease,  for the most part, makes its approach
slowly, and is often  found in  weakly, and  ill-nursed infants.  Its
precursive symptoms are commonly languor, listlessness, weakness
in the knees  and pale and shrivelled skin.  As it advances, there
is a  difficulty in  directing the feet aright when walking, the legs
involuntarily  cross each other, and  the little  patient is perpetually
stumbling upon level ground, till at length he is incapable of walk-
ing at all.  In adults the progress ofthe disease is more rapid than
in childhood.
  Like hemiplegia, this variety is sometimes connected with a mor-
bid state of the mental powers,  and particularly with hypochondrism,
and  this too where the disease proceeds from an organic lesion of
the spine.  Dr. Cooke has an  instructive case in illustration of this,
in an officer ofthe army, aged forty-five, who had for many years been
exposed to the hardships of a military life, particularly to extremes
of heat and cold in  various climates.   " For two  or three  years
previous to the paralytic attack, he had complained that his state of
health  was deteriorated, although no precise symptoms of disease
could be pointed out either by himself or by  his medical friends.
His  appetite was good, his bowels regular, though inclined to cos-
tiveness, and his usual robust  appearance was  not diminished. He
entertained some fanciful notions  respecting the state of his health :
and from some uneasy sensations about the sacrum he supposed that
he had internal hemorrhoids, though no evidence of their existence
could be perceived by his physicians, by whom he was considered
as hypochondriacal."   After having suffered for two or three years
he gradually lost the power of walking without some support for
• De Locis affectis, Lib. IV. cap. vi.
| Anatomie Medicaje, p. 117. 
424
NEUROTICA.
[CL. IV.—OR. IV.
 one of his hands.  He went to Bath and had the hot water pumped
 upon his loins: soon after which he complained of pain in the lum-
 bar region, which was followed by a  collection  of fluid behind the
 great trochanter on the left side, which burst  externally, and was
 discharged daily, in considerable quantity.   The  paraplegia was
 now complete :  the lower extremities  being quite useless : the feces
 and urine, which, for a considerable time, the patient had with some
 difficulty retained,  came  away involuntarily:  his strength rapidly
 wasted; he  became much emaciated;  and, at the end  of three
 months after his return from Bath he  died ; retaining the use of his
 senses and his intellectual faculties to almost the last instant of his
 life."*
   Local palsy is often produced by the general causes of the other
 varieties, probably operating in a less degree or more partially on
 the brain.  We have already seen that it frequently takes the  lead,
 and appears for some days or  weeks antecedently, in an imperfect
 movement of the tongue, or of one eye, or of one side ofthe mouth,
 sometimes of one or more of the fingers, or of an entire arm.  And
 if, in this incipient state of the disease, proper evacuants, or other
 means, be instantly had recourse to, the paralytic tendency may be
 subdued, and the complaint be limited to these local affections, and
 in a few days be entirely removed.
  This variety,  however, is often the  effect of other causes tending
 to destroy the irritability  of the nervous system, such as exposure
 to certain metallic fumes, or other  means of absorbing metallic
 particles, especially  those of mercury, and lead: and above all ex-
 posure to keen blasts  of cold and damp air.  This  last is perhaps
 the most common and effective cause of local palsy, and is peculiarly
 operative where the limb or organ so exposed  is in a state of re-
 laxation and perspirable moisture, whether from previous exercise,
 or great heat ofthe atmosphere.   A palsy on one side ofthe mouth,
 of the  muscles of one eye, of one of the cheeks, of an arm  or a leg,
 is in this manner frequently produced, and becomes, at times, of
 very great obstinacy.   Occasionally, indeed, the torpitude extends
 much further than to a single limb, and various organs are involved
 in its mischief.  "A watchman," says Dr. Powell,! "on quitting
 his duty after a  night of severe cold,  was attacked  by  sudden and
 violent  general pains, in his limbs, which soon departed,  and left
 him in a state of universal palsy of the muscles of voluntary  mo-
 tion.   He had lost all command over the  muscles of his limbs or
 trunk ; but the joints were unaltered in their external appearance  :
 they were perfectly flexible ; and it gave him no  pain if you moved
 them in any  direction.  The  sphincters also  of the rectum  and
 bladder had lost their usual powers of retention, and he passed both
 stools and urine involuntarily and unconsciously.  His circulation
was not affected  in any cognizable degree, and his mind retained its
* On Nervous Diseases, Vol. II. Part 1. p. 43.
t Med. Trans. Vol. V. p. 105. 
GE. VIIi.—SP. VI.]     NERVOUS FUNCTION.
425
usual powers.   His voice was not lost: the hot bath and other reme-
dies were tried in vain ; he died : but, on  examination there was
no congestion, or effusion, or alteration of structure of any kind dis-
coverable."
   In the  treatment of palsy, it. is necessary to distinguish between
its attack and its confirmation, and as much as possible to ascertain
the nature of its predisponent and exciting cause.
   Generally speaking, in hemiplegia, and very frequently in para-
plegia, and even in local palsy, the causes of apoplexy are those of
the present affection.   And as of these causes, compression of the
brain has appeared to be  by far the most frequent in  the  former
disease, so we  ought to regard it, and shall generally find it, in the
latter.   And hence, copious  bleeding,  and purgatives,  not  only
recommend themselves to us from the good effects we have already
seen them produce in apoplexy, but from the actual and general
advantage which has been derived from them in  palsy itself.  Mr.
John Hunter was so fully convinced of the benefit of sanguineous
depletion, that  he made it hisunicum remedium, though he allowed
of cathartics subordinately.  Upon this subject, however, he writes
with more force than discrimination.   Referring to  the stimulant
plan pursued by some practitioners, he observes, "this is even car-
ried further than blistering," to which he also objects : " We hardly
see a man taken with all the signs of an  apoplexy, where a paralysis
in some part takes place, or hemiplegia, but he is immediately at-
tacked with cordials, stimulants, electricity, &c.   Upon a supposi-
tion that it is nervous debility, &c; the poor body is also tortured
because it cannot act, the brain not being in a condition to influence
the voluntary muscles.  We might, with exactly the same propriety,
stimulate  the fingers when  their muscles are  torn to pieces.  We
ought to bleed  at once very largely, especially from the temporal
artery, till the  patient  begins to  show signs of recovery,  and to
continue it till  he may begin to become faintish.   We should give
saline purges freely to diminish impetus, and promote absorption;
then quietness  should be enjoined, and  as little exercise of body as
possible,  and especially to avoid  coughing and  sneezing.   Plain
food should be directed, and but little of it."*
   All this is excellent, as a general rule; but, the rule must admit
of exceptions.   In  treating of apoplexy we have  noticed it as  de-
pendent on two very different and opposite states ofthe constitution,
an entonic and  an atonic.  And the same diversities of constitution
are to be  found in  paralysis.  Now  under the entonic  state there
can be no question, and  there ought to be no exception: and
the boldness of the practice should be regulated by  the nature of
the exciting cause.  Where  this  is over eating or intoxication,.
eighteen or twenty ounces of blood may be taken, away, with  ad-
vantage,  at once ;  in a few hours after, twelve or fifteen ounces-
more ; and the venesection may be repeated a third or even a fourth
               * On Blood and Inflammation, p. 213.
vol. in.—54 
42G
NEUROTICA.
[CL. IV.—OR. IV
time, if necessary.  Dr. Cross pursued this active plan, in the case
of a man thirty-five years old who became hemiplegic from excess
of drinking, and at the same time gave calomel to the amount of
twenty-five grains to a dose, and in a few days effected a  complete
cure.*   And similar instances of success are to be found  in all the
writers upon the  subject.
   Even in atonic apoplexy, it has been  observed that venesection
is occasionally necessary ;  and it may be equally necessary in atonic
paralysis; for here  also effusion may take place both of blood and
serum  : of serum,  indeed, more frequently from  deficiency than
from excess of vigour ; and of blood, from a debilitated state of the
vessels, and their greater facility to be ruptured from slight causes,
as a violent fit of coughing or sneezing, of joy or terror.  Absorp-
tion may not easily take place in this state of constitution, but emp-
tying the vessels alone will gain space by stimulating them to con-
tract their diameter.
   I  cannot better illustrate  this, than by  the following case from
Dr Abercrombie:  " An old and very poor woman, aged  about se-
venty,  thin, pale, and withered, having gone out to bring water from
one ofthe public wells, on the morning of the second of July, 1818»
fell down in the street speechless, and completely  paralytic on the
right side.  Nothing was done till about two p m., when she was
found stupid, but not comatose, yet completely speechless and para-
lytic :  her pulse of good strength, and about  ninety-six.   She was
bled to fifteen ounces.  Purgative medicine was ordered, and cold
applications to  the head: on the third she was considerably improv-
ed both in speech and  motion: but having become rather worse  at
night,  the bleeding was repeated, and the purgative medicine con-
tinued.  From  this time  she improved  gradually :  at the end of a
week she was able to walk with a little assistance, and speak pretty
distinctly, and by the end of another week she had entirely recover-
ed her former  health."!   Nothing  could be more judicious than
this treatment,  and the result corresponded with ihe views of the
enlightened practitioner.  There can be no doubt  that in this case
a  ve&sel had suddenly  been ruptured : the labour in which the pa-
tient was occupied  was violent, the season was that of the summer,
and the temperature probably very hot; the stupor  and state ol the
pulse equally indicated compression of ;he brain.
   Thus far bleeding may  be allowed, and indeed, ought  to be im-
peratively enjoined..  But there are some cases in  which it is alto-
gether a venture, and others in which it is allowed on ali hands  to
be injurious.   Even Mr.  Hunter himself recoils from the practice
where hemiplegia  is apparently a result of retrocedent gout: and
if we follow up the spirit of this forbearance, we shall be induced to
abstain equally in all instances  where there is a like diminution  of
sensorial power—in all instances of atonic paralysis, let the exciting

          * Thomson's Annals of Philosophy, No. XLIV. p. 1*1.
         t Treatises, &c.p,  15. 
6E.VIIL—SP. VI.]      NERVOUS FUNCTION.
427
cause be what it may, where there is no stertor, no stupor, or ver-
tigo, no convulsion or other irregular nervous action, and the pulse,
instead of being firm, is feeble  and  intermittent.   For it should
never  be forgotten  that, if many patients  have recovered  after
bleeding in  suspicious circumstances, others have died after it, and
probably in  consequence of it, while great numbers have derived
no benefit whatever.  The advice of Dr. Cooke upon this subject
is therefore founded in the truest wisdom, and cannot be too exten-
sively  committed  to memory : " Each  individual  case must be
viewed in all its circumstances, and by a careful  consideration of
them our practice  should be regulated. Before we prescribe blood-
letting in hemiplegia, we must investigate the  age, strength, gene-
ral constitution and habits of  the patient, and above all the actual
symptoms of the disease.  In  early or  even  in somewhat advanced
life,  if plethora and the various symptoms tending to apoplexy be
present I should not scruple  to bleed freely  both  generally and
topically.  On the contrary, in great age, debilitated, leucophleg-
matic habit, dropsical tendency, &c.   I should think it right to ab-
stain altogether from this and  from every other powerful mode of
depletion, unless there  be  an evident determination  to the  head,
marked by flushing in the countenance, throbbing of the arteries,
redness of the eyes."*
  In purging we may proceed with less restraint: for even in de-
bilitated  and dropsical habits  stimulating the bowels is almost uni-
formly found useful: should there be  serous or even sanguineous
effusion, absorption is hereby  powerfully promoted ;  and if there
be none, a beneficial revulsion will often be produced, and the sti-
mulus will always be one of  the most useful  we can adopt.   In a
very debilitated state of the constitution, however, we should choose
the warmer in preference to the colder purgatives;  and hence ja-
lap, colocynth, and even aloes in preference to neutral salts:  and it
will also be serviceable to combine them with  some distilled  water
impregnated with  an essential oil, as mint, penny-royal, juniper, or
rosemary.
   The next reducent remedy worthy of notice is emetics.   If we
have strong reason to apprehend a sanguineous effusion, this class
of medicines ought not to be employed for a  few  days, and will
hence always be doubtful in the first attack of entonic hemiplegia,
as we  have  already observed they are in entonic apoplexy.  But if
we have no ground of such suspicion, they cannot be had recourse
to too  soon.   In a certain sense they weaken, but they are  at the
same time among the most powerful indirect tonics that can  enter
into our practice.   They  rouse the system generally, solicit the
torpid fibres to a resumption of activity, stimulate all the  excreto-
ries, and especially those of the surface of the body, and thus pro-
mote absorption in every quarter and in every  way.
   In low or atonic hemiplegia the practice of Stoll was founded on

             * On Nervous Diseases, Vol.  II. Par. I. p. 141, 
428
NEUROTICA.
[CL. IV.—OR. IV.
  the most  rational principles.  He first checked the hemiplegia by
  emetics, and then carried it off by external and local stimulants, as
  cantharides, in conjunction with pills of gum ammonia, myrrh, and
  aloes.*
    Such, under different  modifications, is  the reducent course it
  seems proper  to pursue in the general train of paralytic attacks
  when they first make their appearance.  If this  course succeed,
  the patient will soon recover,  and with a view  of preventing  a
  relapse, a further reducent or tonic regimen, according to the na-
  ture of the case as we have already noticed in the treatment of
  apoplexy is all that we shall have  further to prescribe.
   But this course may not succeed : the disease may prove obsti-
 nate and become confirmed ; and  the  practitioner be called upon
 to proceed further.
   Having removed, as far as we maybe able, all pressure upon the
 sensorium, and so far given  an opportunity  of healthful  play to its
 function, our  next business is to re-invigorate  its general energy,
 and extend it to the parts which  it has ceased in a greater or less
 degree to actuate.
   Stimulants, external or internal, or both,  have  been almost uni-
 formly had recourse to for this purpose: but I cannot avoid  think-
 ing that the  practice has been too indiscriminate,  and, in many
 cases, far too  precipitate.  We have observed that  in many cases of
 hemiplegia there is not only great local inactivity, but great irre-
 gularity of action ;  a tumultuous hurry of sensorial power to some
 parts, with an equal withdrawment of  it from others.  In all such
 cases we should proceed gently and palliatively rather than rapidly
 and forcibly :  and to  do nothing is better  than to do too  much.
 We should endeavour to allay the nervous commotion, and restore
 the agitated system to order  by internal and external quiet of every
 kind.  The patient should be kept as still as  possible in a  warm
 commodious bed and a well ventilated  room.  His diet  should be
 plain, with  the allowance of  a moderate quantity of wine, or wine
 and water.  Camphor, musk, valerian, and other warm sedatives, as
 ammonia, neutralized with citric acid, are here to be chiefly resort-
 ed to, if, indeed, we  resort to medicines of any kind, and to  these
 may be added the less stimulant metallic salts, and especially those
 of zinc and bismuth.   The warm bath may be allowed two or three
 times a week, and if  the nights  be restless the inquietude may be
 subdued by hyoscyamus.  And as this form of the disease is often
 connected with great  general debility and a tendency to hypochon-
 drism or lowness of spirits, cheerful and exhilarating conversation,
 and such occasional exercise  in  a carriage  as may be indulged in
without fatigue, will form very serviceable auxiliaries.  In Pechlinf
is to be found  the case of a person called Peyreske, who  is said to
have been cured of  a palsy accompanied with aphonia, by reading

                    * Rat. Med. Part II. p. 92.
                    t Lib. HI. Obs. 27. 
GE. VIII.—SP. VI.]      NERVOUS FUNCTION.
429
some favourite  and agreeable  authors.  This  may  be an  over-
statement, or too much stress may be laid on this particular part of
the general plan of treatment: but there can be no doubt  that,  in
the form  of the disease we are now contemplating, a gentle and
insinuating amusement of this kind will not be without its  effect.
   This tranquillizing and unostentatious plan I have found to answer
wonderfully in many cases  of that tumultuous and irregular action
described in the preceding history of the disease before us.   But
where the case seems altogether confirmed and  chronic, and an
entire side, or some other extensive part of the body, shows a fixed
loss  of sense and voluntary motion,  while every  other part has
resumed its healthy function, we may then, with safety, have  re-
course to the stimulant practice.
   This will consist of external and internal irritants, and Dr. Cullen
has given a long and useful table of both.  Ofthe former, the chief
are friction by the hand or a flesh brush ; stimulating liniments pre-
pared of the concentrated acids, or the caustic alkalies inviscated in
oil or lard to render them less acrid and corrosive ; brine or a strong
solution of sea-salt; the essential oils of turpentine, or other tere-
binthinate  substances;  and  various vegetable acrids as mustard,
garlic, and cantharides, or other blistering insects.  The object of
all these is the same :  it is that of acting upon  the origin of the
nervous chain by stimulating it at its extreme end, and as we have
numerous  instances of the production  of such  an effect in a great
variety of  cases, particularly those of  trismus and lyssa, or canine
madness, the principles of which we have endeavoured to elucidate
under these diseases, we have reason to expect a like influence, and
of a beneficial instead of a morbid kind, in the applications before
us.  Generally speaking, however, the irritation produced by a use
of many of the siliquose and aliaceous  or  alkalescent plants, as
mustard, horse-radish, and garlic, is more uniformly efficacious than
that of cantharides; as the irritation excited is more  considerable
and of longer duration.  Dr. Cullen tells us that he has reason to
believe the use of liquid styrax in  the  proportion of one  part  to
two of the old black basilicon, a favourite empirical  composition
"has been of remarkable service  in paralytic cases, and particularly
in a debility ofthe limbs following rickets."*
  Many practitioners have, for the same purpose, been in the habit
of burning moxa or cotton on different parts of  the affected  side.
Dupuytren employed the former, and Pascalf the latter; and both,
as they tell us, with great advantage.   Others have thought they
derived great service from a repeated use of sting-nettles.   Some
again have employed issues, others setons, and others the potential
or even the actual cautery.   This last mode of treatment, however,
is best calculated for that form of hemiplegia produced by a diseased
spine. Mr. Pott found the use of caustics applied on each side of
• Mat. Med. Vol. II. Part II. Cap. V.
f Journ. de Med. Tom. LXVI, 
430
NEUROTICA.
[CL. IV.—OU. IV.
 the spine peculiarly serviceable, and they have been in  common
 employment ever since.
   In the rank of external stimulants we are  to  arrange electricity
 andvoltaism.   From the approach which these subtile fluids seem
 to make to the nature of the nervous power, as we have already
 observed in the Physiological  Proem to the present class, and more
 particularly from their well known and extraordinary power of
 re-exciting irritability in the muscular fibres of animals that have
 been for some time dead, it was very reasonable to suppose  that
 either of these stimuli might be employed with  very great advan-
 tage : and  accordingly we  meet with them in very extensive  and
 popular use from  the earliest  periods of their having been, if not
 discovered, at  least reduced to scientific management; and  have
 numerous  reports of cases in which  the former  was tried, and in
 many instances with advantage, rather before  the middle of the last
 century.*   In various experiments, there can be no doubt that both
 have been  found highly beneficial, but  in  various cases also both
 have been  made use of in vain, and in a few instances, with appa-
 rent disadvantage.  To run over the list of those who have chiefly
 espoused, and those who have chiefly opposed their employment,
 would be useless.   It is of more importance to know that a very
 great number of physiologists and pathologists who employed them
 most  extensively, and particularly in  the form of electricity, for the
 fluids are most probably one and the  same, and  who were at  first
 most sanguine of success, gradually  lost their confidence  as they
 proceeded, and confessed their general failure; and candidly owned
that, where for a time they promised fair and  seemed to be of  use,
 the benefit was delusive and merely  temporary   And the author
now alludes to the distinguished  names of Franklin, Percival, Ca-
 vallo, Falconer, Quarin, Stoll, and Saus.
  The fact seems to be that, even at  this late period of trial, we are
 greatly in the dark upon the subject, and have not learned to  dis-
criminate the exact modifications of the disease,  or the exact  mo-
 difications  of electric  power  in  which alone this active stimulus
may be employed with advantage : for that in both forms it has
been occasionally of very high benefit  is by no means to be disputed :
and even at times when communicated by the gymnotus electricus or
electric eel itself, of which  a  singular  example is given in the
 Haerlem Transactions ;t the patient having recovered the use of
 the affected side after a hundred strokes from the fish.  Upon the
 whole, as it is a direct stimulus,  it appears belter  adapted to the
 atonic than the entonic character of paralysis.
  Hot and  cold bathing are the next  external stimulants we are to
 notice as applicable to the disease before us.  The stimulus of hot
  *  Memoires de PAcademie des Sciences, 1749, p. 40.
    Jallabert, Experience sur l'Electricite.  Genev. 1749.
  f  Abhandlungen aus den Scriften der Harlemer und anderer Hollandischen
Gesellschaften.  Band. I. p. 109. 
GE. VIIL—SP. VI.]      NERVOUS FUNCTION.
431
 water alone is often serviceable in local palsy, and especially when
 produced by  cold or damp; and in conjunction with the rubefa-
 cients and vesicatories we have just enumerated, or with friction to
 the part affected by the means of the hand or a flesh-brush, and parti-
 cularly when aided by terebinthinate or other  essential  oils, will
 usually succeed  in restoring to the  affected  muscles their wonted
 power.  But  where the palsy is more extensive, as in hemiplegia
 and  many cases of paraplegia, it has been more usual to recommend
 the stimulus of hot water in conjunction with  various active mineral
 corpuscles held in solution by it;  and hence  the common  resort of
 paralytic patients in our own country to the waters at Bath, Buxton,
 and Leamington.  Hot baths of this kind are also a direct stimulus ;
 and as such are found more  efficacious in paralytics of atonic or di-
 lapidated constitutions, than in those who have suffered from ple-
 thoric or entonic fulness, or at least till they have been lower-
 ed to the proper standard by a long course  of  some reducent re-
 gimen.
  Cold bathing is also a stimulant as well as hot balhing,  but a sti-
 mulant of a different kind, for it acts indirectly  instead of directly.
 The intention with which it is used is that of forcibly urging  the
 mouths of the cutaneous  vessels  into a general entastic or rigid
 spasm in order hereby to excite a general re-action, as in the case
 of the first and second stages of an  ague-fit,  and thus to draw  the
 torpid muscles into ihe common range of association.  Dr. Cullen
 seems favourable to this  practice under a prudent management.
 " Cold," says  he, " applied to the body for any length of time is al-
 ways hurtful to paralytic persons : but if it be not very intense, nor
 the application long  continued, and  if at the same time the body be
 capable of a brisk re-action, such an application of cold is  a power-
 ful stimulant of the whole system, and has often been useful in cur-
 ing palsy.   But if the power of re-action in the  body be weak,  any
 application of cold may prove hurtful."*  It  is hence only necessa-
 ry to add that while  the  hot mineral baths appear best adapted to
 cases of atonic paralysis, cold affusion or the cold bath may be em-
 ployed with most promise of success in accidental  palsies of  the
 plethoric and the vigorous.
  The ordinary  internal stimulants are the mineral waters we have
 just adverted to, camphor and other terebinthinate substances, many
 of the siliquose and alliaceous plants, as mustard, horse-radish, gar-
 lic, and onions, and a temperate use of wine : the whole of which,
 however, are proscribed in all cases by many  writers ot great emi-
 nence, and  particularly Dr. Cullen and Mr. John  Hunter: and,
 which,  if allowed at all, should be confined  to the atonic  form of
 paralysis, or never be commenced in any instance of entonic palsy,
till the system has been sufficiently reduced for the purpose.  And
where this has been  accomplished,  such a class of remedies has
often been found of essential service.
* Pract. of Phy. Vol. IV. MCLXVI. p. 190. 
432
NEUROTICA.
[CL. IV.—OR. IV.
    Independently of these, there is a tribe of medicines entitled al-
 so to the name of stimulants, though operating in a very different
 manner, which have long been  boldly ventured upon by some phy-
 sicians ; and after having for many years sunk into disrepute, have
 again been brought into  favour, and are now in a pretty extensive
 scale of employment.   I mean several ofthe acrid poisons, as arnica
 montana or leopard's bane, rhus  vernix, varnish-sumach, and strych-
 nos nux vomica.
   All these excite the nervous  system to great agitation and spas-
 modic action ; and if the dose be increased, violent convulsions, al-
 ternating with tetanus, are sure to ensue :  and hence  it  has been
 supposed that they  may be rendered effectual in a restoration of
 motivity to paralytic limbs.  The flowers of the arnica, or doroni-
 cum, as it was once called, were  chiefly  employed, though some-
 times the leaves were preferred.  Dr Collin was much attached to
 the former in palsies of all kinds, and affirms that he has found them
 very generally successful.   He  gave them in an effusion or decoc-
 tion, in the proportion of from a drachm to half an ounce,  to a pint
 of the liquid :* and, from his recommendation, they were, at one
 time, very generally adopted, were countenanced by Plenck, and
 Quarin, and experimented upon by Dr.  Home.f   The last  tried
 them in  six cases but without  much success: and they  have not
 been  able to maintain their reputation : nor, from the violence and
 uncertainty of  their  effects, it  is  hardly worth  while to revive
 them.
  The rhus vernix, or varnish-sumach, is chiefly indebted for what-
 ever degree of fame it has acquired in paralysis to the experiments
 and recommendation of Dr. Fresnoi. The milky juice of this plant
 is so acrid as to blister the hands of those who gather its leaves, so
 that they are obliged  to wear gloves.  The leaves are employed in
 decoction, and  in extract:  and appear not only to act  powerfully
 upon  the nervous system, but by  urine and perspiration; and hence
 the plant has a claim to be considered as  an active promoter of ab-
 sorption as well as revellent, which may, perhaps, render it service-
 able in some cases of paralysis from serous compression ofthe brain.
 Of its benefit in  some other diseases of  a spasmodic or  nervous
 character, and  especially  in  hooping cough, we have  already
spoken4
  Most of the species ofthe rhus or sumach, contain a like pungent
 acridity in their milky juices, and hence several others of them have
 occasionally been employed for the  same purpose.   Dr. Alderson,
 of Hull, has of late preferred the  leaves of the  rhus Toxicodendrum,
 poison-sumach, or poison oak, as it is sometimes, but improperly
 called : and, in many cases, of trial, he has  thought it of considera-
* Observ. circa morbos acutos et clironicos. Tom. V. p. 108.
f Clinical Experiments, Histories, &c. Edin. 8yo. 1780.
* Vol. I. p. 358. 
GE. VIII.—SP. VI.]     NERVOUS FUNCTION.
433
 ble  benefit.   He commences with half a  grain of the powdered
 leaves which he gives three times a-day, and  gradually increases
 the dose to four or five grains till he finds  a sense of tingling pro-
 duced in the paralytic part, accompanied with some degree of sub-
 sultus or a twitching or convulsive motion,
  , The effect,  therefore, produced on the nervous system by the poi-
 son-sumach is weak or clonic spasm: but there  are other acrid poi-
 sons which have a  tendency to  produce strong, entastic or rigid
 spasm, most of which  possess an  intensely bitter principle, and, per-
 haps derive this difference of effect from  the  tonic power of this
 very quality.  Of these the chief are the stychnos JVux  Vomica, and
 the ignatia amara.   Both have hence been employed in paralysis,
 and the virtues of both seem to  be nearly  alike, the former, how-
 ever, has of late taken the lead  upon  the  recommendation of Dr.
 Fouquier, of the Hospital de la Charite, at Paris, who has tried it upon
 a very extensive scale, and apparently with a perfect restoration of
 health in many cases.   He gives it in the form  of powder, or alco-
 holic extract:  four grains  ofthe  first, and two ofthe last are a dose,
 and maybe taken from two to six times  a-day.  He  also employs it
in injections.   In half an  hour  after administration the paralyzed
 muscles have, in various  cases,  begun to evince contraction : and
 what is peculiarly singular, while a spastic contraction is determin-
 ed to these, the sound parts remain unimplicated in the action.  A
 frequent effect, unquestionably dependent on the bitter principle of
 the plant, is that of increasing the appetite, and diminishing the
 number of the alvine evacuations when in  excess.   Sometimes it
 produces a temulent effect, and occasions stupor and a sense of in-
toxication,  and, when  rashly administered, general tetanus with all
 its train of distressing and frightful symptoms.
  Like all other powerful medicines in their first and indiscriminate
 use, the nux vomica appears sometimes  to have been highly bene-
 ficial, sometimes mischievous, and sometimes to  have produced
 violent effects on the nervous system without an important change
 of any kind.  Dr. Cooke has collected a variety of  cases in which
 it has been tried in our own country as well as  in France, and this
 seems to be the general result.   The present author has tried it in
 various instances, but has  never been able, from  its  tendency to
 temulency  to  proceed much more than  half as far  as some practi-
 tioners have gone, who have gradually advanced it from four grains
 of the powder to twenty-four three or four times  a-day.  In  the
 case of  the late E. Sheffield,  Esq., of the Polygon, Somers-Town,
 Mineralogist to the estates of the Duke  of Devonshire, and who is
 well known to have been one of the best practical geologists of his
 day, the author commenced with two grains alone of  the powder
 given three times daily, as this was a hemiplegia following upon a
 second  fit  of  atonic  apoplexy,  with a general debility both of
 the mental  and corporeal  powers,  the patient  being, at the time,
 rather upwards of sixty  years  of age.  This  dose   occasioned
 no manifest effect, and on the third day, August 21, 1819, it was
  vol. in,—55 
434
NEUROTICA.
[CL. IV.—OR. IV.
gradually increased  to six grains.   It now produced  a  powerful
sense of intoxication, but with clonic  agitation instead of a tetanic
spasm of the paralyzed leg and arm, and great heat down the whole
of the affected side.  The powder was continued in this proportion
for three or four days, but the stupor and vertigo were so consider-
able and afflictive that the patient could not be persuaded to proceed
with it any longer, and it was in consequence suspended.  On the
ensuing September 1, he  was evidently getting  weaker, and re-
commenced the medicine at his own desire; the dose was gradually
raised from four to six grains  three times a-day: the same clonic
effect was produced  with the same  sensation of heat  through the
whole of the affected side, but without a sense of intoxication.  The
dose was advanced to eight grains,  when the  head again became
affected, but without any permanent  return of muscular  power or
sensation in the palsied limbs, or any  other effect than a few occa-
sional twitches and involuntary movements.  Mr. Sheffield could
not be persuaded to persevere any farther, and the medicine  was
abandoned.   He continued in the same feeble state for about three
months,  when he fell a sacrifice to a third apoplectic attack appa-
rently of a much slighter kind.
  I have stated that  this was a case of atonic affection, and hence,
there was no opportunity of giving full play to the power of the
nux  vomica.   But so far as I have seen,  I think we may come to
the following conclusious :  First, that  when only small doses can be
given without seriously affecting the head, as  in  cases  of great
general, or nervous  debility, the  effect is a clonic instead of an
entastic or tetanic  spasm.  Secondly, that under this effect it is not
calculated to do any  permanent good, and often produces  mischief.
And thirdly,  that it is most serviceable in  entonic hemiplegia, after
the patient has been  sufficiently reduced from a state of high ener-
getic health, and especially energetic plethora, to a subdued and
temperate state of pulse ;  in which state it may very frequently be
employed in doses sufficient to excite strong or entonic instead of
weak or clonic spasm.     *
  From this history of treatment, it is obvious that nervous agitation..
proportioned to the  mode  of the disease and the strength of the
patient, has often been of peculiar advantage ;  and hence, we are
the more easily prepared  for hearing that  palsy has occasionally
been carried off suddenly  and spontaneously by a violent fit of
mental emotion, as of anger* or fright,f of both which the examples
are very numerous; by a stroke of lightning \\ and by fe vers.§  Nor
* Camerar. Memorab. Cent. V. No. 30.
  Paulini. Cent. 111. Obs. 89.
  Schenck, Observ. Lib. I. No. 182.
f Diemerbroeck, Observ. ut Cur. Med.
  Locffter, Beytrage zur Wundarzneykunst. Band. I.
% Wilkinson's Case of Mrs. Winder, 8vo. 1765.
§ Act. Nat. Cur. Vol. V. Obs. 64.
  Samml. Medicinischen Wabrneroungen. Band. VI. p. 152. 
GE. VIII.—SP. VI.]    NERVOUS FUNCTION.
435
 can I do otherwise than think that one of the most rational and
 etncacious  means  of cure in  many instances of paralysis, and
 especially where no great inroad has been made upon the general
 strength of the constitution, would be a journey into the Hundreds
 ol fissex or some other marshy district, for the purpose of obtaining*
 a sharp  attack of a tertian ague, which would most effectually, and
 1 apprehend at the least expense, give as all the advantage of en-
 tastic spasm and reaction in regular and repeated tides, that we
 could wish for, and which have already appeared to be so desirable.
 In treating of the tertian intermittent, we observed from Dr. Fordyce,
 that it has often a tendency to carry off  a variety of obstinate and
 chronic  diseases to which the constitution has been long  subject,
 and to restore it to the possession of  a better and firmer degree of
 health.  And where paralysis is capable of removal, there seems to
 be few complaints on which it is likely  to  operate with a more
 favourable issue.  The author has for some time been waiting for
 an opportunity of making the experiment, and at present merely
 throws out  the  hint with much deference to the medical world af
 large.
   In a few  cases hemiplegia is said to have ceased spontaneously
 by the mere remedial energy of nature, and without any apparent
 cause of cure; in one instance after ten years standing, and accom-
 panied with a loss of voice.* And in a few cases of paraplegia from
 external  injury to the spine, where  only one or two vertebrae have
 in a small degree  been displaced from their proper position, the
 same instinctive or remedial power has also  produced a cure or
 greatly alleviated  the mischief by so  far thickening the  growth of
the bones immediately above and below that the chasm  has been
filled up, and a line of support restored.
   It is only  necessary to add further, that where the local palsy has
been produced by the fumes or minute  divisions  of lead or other
noxious metals, it is almost always accompanied with symptoms of
colica Rhachialgia, or Painter's colic,  and is to be remedied by the
treatment already laid down under that disease.f
* Bresl. Samml. 1721.—p. 406. 503.
t Vol. I. p. 132.
END OF VOL. Ill 
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