'■;' v '■■: '»'?£rtJ "''^■fr1 S^J DUE /"* SEP l 3 1961 LAST DATE V V J THE STUDY OF MEDICINE, varossoboaiioAiii S7svs: NOSOLOGY. BY JOHN MASON GOOD, M. D. F. R. S. MEM. AM. PHIL. SOC. AND F. L. S. OF PHILADELPHIA, IN FIVE VOLUMES. VOL. III. FOURTH AMERICAN EDITION ,\BRA/? H. e. CAREY & I. IE A, E. PARKER, MAROT & WAITER, ANT> T. DESILVER : AND COLLINS & HANNAY, NEW-YORK. 1825. 1/.3 gjjtlawtpfjia, Piinted by WuHiM JJrowk. CLASS IV. CLASS IV. NEUROTICA. MSEASES OF THE NERVOUS FUNCTION ORDER I. PHRENICA. AFFECTING THE INTELLECT. II. JESTHETICA. AFFECTING THE SENSATION. III. CINETICA. AFFECTING THE MUSCLES* IV. SYSTATICA- AFFECTING SEVERAI. OR ALL OF THE SEW SORIAL POWERS SIMULTANEOUSLY CLASS IV. PHYSIOLOGICAL PROEM. J he numerous and complicated train of diseases we are now enter- ing upon appertains to the highest function of visible beings ; the possession of which emphatically distinguishes animals from plants^ and the perfection of which as emphatically distinguishes man from all other animals : these are the diseases of the nervous function; —which, in the sphere of its activity, embraces the powers of intel- lect, sensation, and muscular motion. Each of these powers evinces diseases of its own, and will consequently lay a foundation for a distinct order, under the class before us. While, as there are also other diseases that affect several of them simultaneously, we become furnished with a fourth order, which will complete the series. All these diversities of vital energy are now well known to be dependent on the organ of the brain, as the instrument of the intel- lectual powers, and the source of the sensific and motory. Though, from the close connexion and synchronous action of various other organs with the brain, and especially the thoracic and abdominal viscera, such diversities were often referred to several of the latter in earlier ages, and before anatomy had traced them 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 % doctrine of general belief at a time when mankind, few in num- ber, formed a common family, and were regulated by common no- tions. ri 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 popi'laily referred to as the seat of sensation, do and most, from the peculiarity of their nervous connexion with the brain, necessarily participate in the feeungs 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' it* 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 INT LLECTUAL PRINCIPLE. I. In man, and those animals whose encephalon approaches the ftearest 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 cerebei 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 a« a continuation of the brain extended through the whole chain of 'he- '>-,.*k-hor.e. They are similarly accompanied with a cineritious r.r h . ...oined substance which forms thr exterior of the three fi: i i^ions, but the interior of the spinal marrow, and appears to der.vt i:s nue from the great number of minute vessels that appertain to it. . According tolvi. Bauer's very delicate microscopic experiments^ when the substance of the b ain is m_.te a Tiatu< e that the slightest touch, even the mere suction in water, deranges and reduces them to that mass of globules of which the br^in appears to be composed when examined with less accuracy orunder le->s favourable ciicum- 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 colourii g matter.* • See Sir Everard Home's Croonian Lecture, Phil, Trans, for ltfltf. CL. IV.] PHYSIOLOGICAL PROEM. 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 minute bubbles of carbonic acid gass 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 oigan arises a certain number of long, whitish, pulpy chords, ton.posed of bundles of fibres, capable of being divided and subdivided into minuter bundles of fibrils, or still smaller fibres as far ;.s 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 memb. anes 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 motility 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 foiming the seat of intellect 01 tldaking; the sea* of the local senses of sight, sound, taste, and smt-li, and the seat of general feeiing 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 rise to the olfactory and optic nerves, (serving the purpose of pure sensations) gives rise also to the oculorum motorii, apparently serving the purpose of muscular motion. So the cerebellum gives rise to the trochleatoresand the tngemini, the first chiefly employed in producing motive power, the second sen->ile 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 heL-.rt, 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. 9 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.f 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. V.L. 1V.J PHYSIOLOGICAL PROEM, 9 We have thus far represented the spinal marrow as issuing from the brain, ui 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 mvertebral animals. Whence it is inferred that the nervous column is the radical part of the system, and that the brain is an increment from it in the more perfect classes.* The question is not of much importance, though there is some- thing ingenious in thus tracing animal life from its simpler forms. Yet the opinion seems to be in direct opposition to a well-ascertain- ed fact we shall have to advert to presently, namely, that the mag- nitude of the brain and the extent of its intellectual powers hold an inverse proportion to the size of the spinal marrow, and consequent- ly, upon this hypothesis, to their apparent means of supply. Nor is it the mode of induction usually adopted by physiologists oh like' occasions: since they generally describe the arteries as issuing from the heart, instead of giving rise to it, notwithstanding that the heart, like the brain, has been found totally wanting in some monsters, and the circulation carried on by an artery and a vein alone, of which Mr. Hewson gives a very singular instance ;f 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 the fifth, and branches from all the verte- bras, from whose union and decussation it is studded with numerous ganglions or medullary enlargements, of which there are not less than three in the neck alone tinted by an addition of cineritous sub- * Anatomie et Physiologie du systeme nerveux, &c. par F. J. Gall et Cfe Spurzheim, 4to. Paris, 1810. t Ob the Lynmh. Syst. Part H. p, 15. Vol. III.—B 10 PHYSIOLOGICAL PROEM. [cl. ir. stance, a larger number in its line through the chest, and others as it descends still deeper, independently of various confluences ot smaller branches that unite and form extensive net-works. Having reached the hollow of the os coccygis, it meets its twin from the op- posite side which has pursued a similar course, and been augmented by similar contributions. Thus equally enriched with the nervous stores of the brain and the spinal marrow, it sends off radiations as it takes the course of the aorta, to all the organs of the thoracic, abdominal, and hypogastric regions, to the lungs, the heart, the stomach, and intestines, the bladder, uterus, and testes ; and thus becomes an emporium of nerv- ous 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. There is no animal whose brain is an exact counterpart to that of man : and it has, hence, been conceived that by attending to the dis- tinctions between the human brain and that of other animals, we might be able to unfold a still more mysterious part of the animal economy than that of sensation or motion, and account for the supe- rior intellect with which man is endowed. But the varieties are so numerous, and the parts which are defi- cient in one animal are found connected with such new combina- tions, modifications, and deficiencies in others, that it is impossible for us to avail ourselves of any such diversities. Aristotle endeavoured to establish a distinction by laying it down as a maxim, that man has the largest brain of all animals in propor- tion to the size of his body; a maxim which has been almost uni- versally received from his own time to the present period. But it has of late years, and upon a more extensive cultivation of compa- rative anatomy, been found to fail in various instances: for, while the brain of several species of the ape kind bears as large a pro- portion to the body as that of man, the brain of several kinds of birds bears a proportion still larger. 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 simse ... * Dog .... ..i 171 L. lTil Elephant . . . i * Diss, de basi EnCephali. Gotting. 1778. 4to. CL. IV.] PHYSIOLOGICAL PROEM. 11 Sparrow Canary Bird Goose Turtle (smallest) M. Sommering has hence endeavoured to correct the rule of Aristo- 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 21b. 5£oz. But the remark applies farther than to man: for this acute phy- siologist has been able to trace a direct proportion between the de- gree of intelligence in every class of animals, and the bulk of the brain, where the latter bears an inverse proportion to the nerves that arise from it. And, we may hence observe, in passing, as in- deed, we have already hinted, that the nerves seem rather to be a product of the brain than the brain of the nerves: for it is much more easy to conceive how a fountain may become exhausted in pro- portion to the magnitude of its streams, than how a reservoir can be augmented in proportion to the minuteness of its channels. Upon a general survey, I may observe that the nervous structure of all vertebral animals, comprising the first four classes of the Linnean classification, mammals, birds, amphibials, and fishes, is characterized by the two following properties. Firstly, the organ of sense consists of a gland with a long chord or spinal marrow de- scending 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 Golumn, 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 2 5 1_ 74. 1 rrs~s j* PHYSIOLOGICAL PROEM, [CL. l« 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, to 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. Viicy 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 mate- rial, though peculiarly elaborated by peculiar organs, which are also capable of receiving more delicate impressions.* Touch, how- ever, has its peculiar local organ, as well as the other senses, for particular 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 extremities of the fingers. Its situation in other animals I shall advert to presently. • Anatom. Comparat. J. 25. CL. IV.] PHYSIOLOGICAL PROEM. 13 The difference 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 prehensil-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 ol 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 sus- picion 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 naturaUsts/wA/Aornf* 14 PHYSIOLOGICAL PROEM. [CL. IV. or feeling "horns. This belief has not been fulFy established, but it is highly plausible from the general possession of the one or the other of these organs by the insect tribes, the general purpose to which they apply them, and the necessity which there seems for some such organ from the crustaceous or horny texture of their external 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 animal 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 differ- ent parts of the mandible. The frontal sinuses, which are lined with this delicate membrane, are larger in the elephant than in any other quadruped, and in this animal the sense is also continued through the flexible organ of its proboscis. In the pig the smelling organ is also very extensive ; and in most of the mammals possessing proper horns, it ascends as high as the processes of the frontal bone from which the horns issue. It is not known that the cetaceous tribes possess any organ of smell; their blowing-holes are generally regarded as such ; but the point has been by no means fully established. We are in the same uncertainty in respect to amphibials and worms; the sense is sus- pected to exist in all the former, and in several of the latter, espe- cially in the cuttle-fish; but no distinct organ has hitherto been traced out satisfactorily. In fishes there is no doubt; the olfactory nerves are very obvi- ously distributed on an olfactory membrane, and in several instan- ces the snouts are double, and consequently the nostrils quadruple, a CL. IV] PHYSIOLOGICAL PROEM. 15 pair for each snout. This powerful inlet of pleasure to fishes often proves fatal to them from its very perfection; for several kinds are so strongly allured by the odour of majorum, assafoetida and other aromas*, that by smearing the hand over with these substances, and immersing it in the water, they will often flock towards the fingers, and in their intoxication of delight may easily be laid hold of: and hence the angler frequently overspreads his baits with the same substances, and thus arms himself with a doubLe decoy. There can be no doubt of the existence of the same sense in in- sects, for they possess a very obvious power of distinguishing the odorous properties of bodies even to a considerable distance be- yond the range of their vision: but the organ in which this sense resides has not been satisfactorily pointed out; Reimar supposes it to exist in their stigmata, and Knoch in their anterior pair of feelers. 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 lpbe nor ex- ternal passage. Thus in the frog, and most amphibious animals, the only entrance is the internal or that from the mouth; and in the cetaceous tribes the only effective entrance is probably the same kind; for though these may be said to possess an external aper- ture, 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 tu- bule 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 af- ter they have been cut off The sens* 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 PKOEM. [CL. IV eye-lid j both of which in man, but neither of which in most quad- rupeds are terminated by the additional defence and ornament of cilia or eye-lashes. In the elephant, opossum seal, cat kind, and various other 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 pupul 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 halt the eye-ball; in birds it will easily cover the whole ; and it is by means of this veil, according to Cuvier, that the < agle is capable of looking directly against the noon day sun. In fishes it is almost always upon the stretch, as in their uncertain element they are ex posed to more dangers than any other animal. Serpents have neither this nor any other eye-lid ; nor any kind of external de- fence 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 hai'", 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 otiier 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 dis- tinct organ of touch is the tips of the tongne and of the fingers, but the feeling is also diffused, though in a subordinate and less distinct degree, 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 doubt CL. IV] PHYSIOLOGICAL PROEM. 17 that, for want of such appropriate organs, they be less acute and precise than in animals that possess them. Whether there be any other than the five senses common to man and the higher classes of animals may be reasonably doubted, but we occasionally meet with peculiarities of sensation that can hardly be resolved into any of them Thus the bat appears to be sensible of the presence of external objects and obstructions that are neither seen, smelt, heard, touched, or tasted: for it will cautiously avoid them when all the senses are purposely closed up. And hence 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 occur- rence of the sensation itself, find no terms by which to express it. In Germany it has of late been attempted to be shown that every man is possessed of a sixth sense, though of a very different kind from those just referred to ; for it is a sense not only common to every one, but to the system at large; and consists in that peculiar kind of internal but corporeal feeling respecting the general state of one's health thjkt induces us to exult in being as light as a feather, as elastic 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- bestgefvhl, and gemeingefiifili " self-feeling or general feeling ;" and its organ is supposed to exist in the extremities of all the nerves of the body, except those that supply the five external senses.* I scarcely know why these last should have been excepted: for the sensation itself is nothing more than a result of that general sympa- thy which appears to take place between different organs and parts * Comment.de Canesthesi. Dissert. Aug. Med. Auct.Chr. Fred. Hubner, 1794. Nature and Origin of Mental Derangement, by A. Crichton, M. D. 2 voV 8vo. 1798. Vol. III.—C 18 rHBIOLOGICAL PROEM tJ, IV of the body, expressive of a pleasurable or disquieting feeling ac- cording as the frame at large is in a state of general or uninter- rupted 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 nerv- ous 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 clastic 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 nervf, 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. u 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 particular/y 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. n. 967. Ed, Basil, 1S42. r t Id. Sect. C p. 969. cl, rvv) 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 ves- sels 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 «f 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 gasses 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 nerv- ous 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 etheiial 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 satisfactory. 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 sensation 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 forming parts of the same organs. This distinction is supported by the concurrent observations and experiments of modern physiologists, with the exception that a separate and specific power has, for the most part been ascribed to each division of fibres; and, that many writers have supposed * Observations on Man, his frame, fee. his duty, and his expectations, 2 vols* so PHYSIOLOGICAL PROEM. [CL IV. the motive power to be inherent in the moving fibres themselves instead of being derived from the brain. Glisson appears entitled to whatever may be the credit of this last hypothesis; and Girtanner, who trod in ihe same footsteps, with a clear and comprehensive mind, considerably enlarged upon it, and gave to the moving energy the name of vis iNMTA,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 posseased 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 irritabil'ty, 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'Irritabilite, considered comme principe de vie dans la ture organisee. Journ. de Phys. 1790. j Vol. XXXVII. p. 324. CL. IV.j 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 capablr of maintaining respiration, and the opera- tion i.f several of the animal secretions, especially those that induce dii,-e-tion, for «;s long a period, But in drawing from such facts the corollary that the " identity of galvanic electricity and nervous influence is established by these experiments;" he seems to proceed fartbtr than he is warranted: for we have no right to say more, than that gal v.uric electricity is a stimulus exciting the nervous in- fluence into a state of continued secretion, or continued action; which mav possibly be done by various other stimuli, as well as by that of galvanism Upon the whole the nervous system seems to present itself, in the different rktsses of animals, under various scales of elaboration; but in every ac^.e to be a secernent organ through its entire range; operating by mens of two or more different sets of fibres, which may be .-.ecretories or conductors of as many different fluids or modifications 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 'race a variety of distinct and granular molecules, which seem to act the part of nervous ganglions, though we cannot discover their connexion. Tne brain has so much of the general structure and character of i 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 tiit brain to be a mere quality rather than a specific essence, and to be incapable of undergoing any change of recruit and ex- hansiion. he finds no adequate use for its glandular conformation. As we are justified, however, by all the force of analogy in regard- in;: it as .. gland, though unquestionably a gland of a peculiar kind, a".-- 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 sup- plied 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, o>> 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 nerves."! We see farther that for the purpose of elaborating the exqui- sitely fine and active fluid that, differently modified, excites the lo- cal organs of sense, and excites them in perfection, it is necessary that the nervous system should exist in its highest scale of fabrica- tion, and be crowned with the apparatus of a brain, though this is not the only use to which the brain is subservient: and hence it was long ago pointed out by Galen, that it is from the brain alone the nerves appropriated to the local senses take their rise J For * De Hippocr. et Plat. Decret. Lib. III. torn. I. p. 921. T On the Animal Economy, p. 261. X De Instruments Odoratius. Edit Basil, torn. 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 the sensific fluid in its simplest and least compounded state, or as Galen has it,* " is the dullest and rudest of all the sentient 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 afterwards. 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 fishmongers 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 experi- ments on the carp, lately instituted by Mr. Clift, he found its heart leaping, when out of water, four hours after a separation from the body.f If the apparently isolated molecules found in the make of the polype and various worms are ganglions of nervous irritation, * Loco Citat. t Phil. Trans. 1815, p. 90. 34 PHYSIOLOGICAL PROEM. [CL. IV. extending their vital influence through certain ranges or peri- pheries, we are also hence enabled to account for the peculiar tenacity with which the principle of life adheres to them, aiul 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 in the posterior part alone; and in the anterior part alone; and by destroying, in like manner, the spinal marrow at the neck, or where it unites with the brain ; in its middle or dorsal, and in its lumbar region The animals operated upon were chiefly rabbits. According to the experiments of M Le Gallois,* after vne de- struction of the brain, the action of the heart stiii continues for a considerable period of time unimpaired; while on the destruction of the spinal marrow at its upper or cervical extremity, this ac- tion becomes instantly so debilitated as to be no longer capable of supporting the circulation. Whence he infers that it is from the chord of the spinal marrow, and not from the giand 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 coniinue to act forcibly and steadily, provided the lungs be excited by the artificial breath of a pair of bellows. The brain and spinal marrow were destroyed by a hot wire, the animal being first stupefied by a blow on the occiput. Frogs and a few other animals were here employed as well as rabbits. It is not exactly stated how long, under this process, the heart continued to beat. Yet, contrary to what Dr. Philip seems to have expected, but in perfect concurrence with the hints I have just thrown out, he found that certain stimuli applied to the brain, whether in the anterior or posterior part of the head, increased very sensibly the action of the heart, the animal being still prepared as just stated. The same effect ensued when the same stimuli were applied to the cervical and even the dorsal part of the spinal marrow : but not when applied to the lumbar. Dr. Philip hence concludes that there are three kinds of vital power; muscular, possessed by the lowest kinds of animals that are destitute of both the others ; nervous, or that which is here de- nominated the medium of touch or simple feeling, chiefly derived irom, or dependent upon the spinal marrow, and possessed by ani- * Experiensu-s sur la principe de la Vie, &c t Phil. Trans. 1815, p. 15 and 414- C'L. IV.] PHYSIOLOGICAL PROEM. £5 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 gymnosophisits 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 ex- isting after death in a state separate from the body, to which, how- ever, it is hereafter to be re-united at a period when that which is now mortal shall put on immortality, and death itself be swallowed up of victory—we learn from the God of nature. And with such in- formation we may well rest satisfied: and with suitable modesty, direct our investigations to those lower branches of this mysterious1 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 t 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. Vot. III.—D Co PIl\SIOLOGICAL PROEM [CL IV Corruptibility and incorruptibility, intelligent and unintelligent, or- ganized and inorganic, are terms that convey distinct meanings to the mind, and impart modes of being that are within the scope ol our comprehension. But materiality and immateriality arc equally beyond our reach. Of the essence of matter we know nothing, and altogether as little of many of its more active qualities: insomuch that amidst all the discoveries of the day, it still remains a contro- vertible position, whether light, heat, magnetism and electricity are material substances, material properties, or things, superadded to matter and of a higher nature. If they be matter, gravity and ponderability are not essential pro- perties of matter, though commonly so regarded. And if they be things superadded to matter, they are necessarily immaterial, and we cannot open our eyes without beholding innumerable proofs of material and immaterial bodies co-existing and acting in har- monious union through the entire frame of nature. But if we know nothing of the essence, and but little of the qualities of matter, of that common substrate which is diffused around us in every direc- tion, and constitutes the whole of the visible world, what can we know of what is immaterial ? of the full meaning of a term that in its strictest sense comprehends all the rest of the immense fabric of actual and possible being; and includes, in its vast circumference, every essence and mode of essence of every other being, as well below as above the order of matter, and even that of the Deity himself? Shall we take the quality of extension as the line of separation between what is material and what is immaterial ? This, indeed, is the general and favourite distinction brought forward in the pre- sent day ; but it is a distinction founded on mere conjecture, and which will by no means stand the test of inquiry. Is space extend- ed ? every one admits it to be so. But is space material ? is it body of any kind ? Des Cartes, indeed, contended that it is body, and a material body; for he denied a vacuum, and asserted space to be a part of matter itself: but it is probable that there is not a single es- pouser of this opinion in the present day. If then extension belong equally to matter and to space, it cannot be contemplated as the pe- culiar and exclusive property of the former; and if we allow it to immaterial space, there is no reason why we should not allow it to immaterial spirit. If extension appertain not to the mind or think- ing principle, the latter can have no place of existence ; it can exist no where: for where or place is an idea that cannot be separated from the idea of extension. And hence, the metaphysical immate- rialists of modern time freely admit that the mind has no place of existence; that it does exist no where ; while, at the same time, they are compelled to allow that the immaterial Creator, or univer- sal Spirit, exists every where, substantially as well as virtually. Nor let it be supposed that the difficulty is removed by addiug to matter the quality of solidity in conjunction with that of extension, and hence distinguishing it as possessed of solid extent; for the quality of solidity is less characteristic of it than any we have thus far CL. IV.] PHYSIOLOGICAL PROEM. 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 possible 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, gift- ed 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 modification, of exhibiting the attributes of the soul, of being, under such a constitution, endowed with immortality for the first, and ca- pacified for existing separately from the external and grosser frame of the body; and that it is beyond the power of its own Creator to render it intelligent, or to give it even brutal perception, the argu- ment must be loose and inconclusive: it may plunge us, as it has plunged thousands before, into errors, but can never conduct us to demonstration. It may lead us, on the one hand, to the proud Brahminical 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 mate- rialism, 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 immaterialists, that by contemplating the mind as a distinct essence from that of the body, man is hereby rendered a compound being, possessing at one and the same time two distinct lives mysteriously united in an individual frame, and running In parallel lines till the hour of death. For whilst the known and obvious laws and faculties of the mind and body are so widely different) as they are acknowledged to be on all hands, some such composite union has been and must be allowed under every hypothesis whatever. And least of all have the scep- tical physiologists of the present day any right to triumph upon 28 PHYSIOLOGICAL PROEM. [CL. IV. auch 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 materialists, 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, in- deed, 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 manifes- tations, 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 century; was read and admired by most physiologists ; credited by many; and became the popular production of the day. Within ten A* 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 thafof 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, arfds the writer. it is comfortable to think that he exists, and on this account the physiologist cannot doubt of his being." L'intelligence de J'homme," says he, » se compose de phenomenes tellement differns de tout ce que presente d'ailleurs la nature, qu'on les mpporte £ un fitre par- • Principes de Physiologic 4 torn. 8vo. Par. 1800-3. fRecherches sur la Vie et la Mort, &c * Precis Elementaire de Pbj'aiologie. 2 torn. 8vo. Paris, 1816,1817. <£L. IV.j PHYSIOLOGICAL PROEM. 29 ticuliere qu'on regarde comme une emanation de la Divinite. II est trop consolent de croired cet Sire, pour que le physiologiste mette en doute son existence; mais la severite de language ou de logique que comport maintenant la physiologie, exige que Ton traite de rintelligence humaine comme si elleetait la resultat de Taction d'un organe. En s'ecartant, de cette marche, des hommes jestement 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, de choses qui sont envisagees generale- ment comme presque au-dessus de I'esprit humain."—" II existe wne science dont le but est d'apprendre a raisonner justement, c'est la logique, mais le jugement errone ou I'esprit faux (for judgment, genius, and imagination, and therefore false reasoning, all depend on organization) tiennent & lorganization. II est impossible de ce changer a cet egard; nous restons tels que la nature nous a fails."* 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 influence. 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."t The mind of this cele- brated craniologist seems to be wonderfully sceptical and bewilder- ed 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- plerj than any of the preceding, does not seem to be built en 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, Sec. 8vo. 1816. PHYSIOLOGICAL PROEM. [CL. IV certain properties which are called vital,as sensibility and irrita- bility. Masses of matter endowed with these new properties become organs and systems of organs, constitute an animal frame, and execute distinct sets of purposes or functions, for functions and purposes carried into execution are here synonymous. " Life is the assemblage of all the functions (or purposes) and the general result of their exercise."* Life, therefore, upon this hypothesis, instead of being a two-fold or threefold reality, running in a combined stream, or in parallel lines, has no reality whatever. It has no esse or independent ex- istence. It is a mere assemblage of purposes, and accidental or temporary properties : a series of phasnomena,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 phe- 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 pheno- mena which have occasioned its formation."}: The human frame is, hence, a barrel-organ, possessing a sys- tematic arrangement of parts, played upon by peculiar powers, and executing particular pieces or purposes; and life is the music pro- duced by the general assemblage or result of the harmonious ac- tion. So long as either the vital or the mechanical instrument is duly wound up by a regular supply of food or of the wince, so long the music will continue : but both are worn out by their own action : and when the machine will no longer work, the life has the same close as the music; and in the language of Cornelius Gallus, as quoted and appropriated by Leo X., —redit in nihilum, quod fuit ante nihil. There is, however, nothing new either in this hypothesis or the present explanation of it. It was first started in the days of Aris- totle by Aristoxenus, a pupil of his, who was admirable 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 har- monious 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, fcc. 8vo. p. 120. t H. p. 122. t Ibid. CL. IV.] PHYSIOLOGICAL PROEM. Jl 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 lzvib'us, 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 phsenomena 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 perpetual 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 per- fectly content to take its general nature, powers, and destiny, from the only volume which is capable of giving us any decided infor- mation 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, thaf 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 is the eye alone that beholds the tree, while the mind only perceives • Lucret. De Rer. Nat. III. 204. f Id. HI. 105—266. Lactant. in vit. Epicur. Polignac. Anti. Lucer. Lib - 923. 3£ PHYSIOLOGICAL PROEM. L.CL. iV 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 knowledge ot its hardness and other qualities. What then is the medium oy which such communication is maintained ? which enables the mind to have a perception of the form, size, colour, smell, and even dis- tance 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 them- selves are no longer present ? Is there, or is there not, any resem- blance between the external or sensible object, and the internal or mental idea or notion ? If there be a resemblance, in what does that resemblance consist? and how tsit 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 electric or magnetic aura, to pass without injury from the object to the sentient organ, and from the sentient organ to the sensory, or mental presence chamber? or has the mind itself a faculty of pro- ducing, like a mirror, accurate countersigns, intellectual pictures or images correspondent with the sensible images communicated from the external object to the sentient organ ? If, on the contrary, there be no resemblance, are the mental perceptions mere notions, or intellectual symbols excited in the mind by the action of the ex- ternal sense; which, while they bear no similitude to the qualities of the object discerned, answer the purpose of those qualities, a? letters answer the purpose of sounds ? or are we sure there is any external world whatever; any thing beyond the intellectual princi- ple that perceives and the sensations and notions that are perceiv- ed ; or even any thing beyond those sensations and notions, those impressions and ideas themselves ? Several of these questions may perhaps appear in no small degree 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 cele- brated luminaries of the age were at that time engaged; recalled mankind from the chasing of shadows to the study of realities, from a pursuit 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 en- 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 mat- ter, highly important in its subject, luminous and forcible in its ar- gument, 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 in- telligible world of the Greek schools, and the innate ideas of Des Cartes. Passing by all which, from actual experience and observa- tion it delineates the features, and describes the operations of the human mind with a degree of precision and minuteness which has never been exhibited either before or since; and stands, and proba- bly ever will stand, like a rock before the puny waves of opposition by which it has since been assailed from various qua> ters. The au- thor may speak of it with warmth, but he speaks from a digested .knowledge of its merits: for he has studied it thoroughly and re- peatedly, and there is, perhaps, 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. v«T ttt__v 54 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 popuiar 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 pur- pose ; those of the body being the external senses of sight, hearing, smell, taste, and touch ; and those of the mind the internal senses perception, 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* altogether inexplicable, immediately impress or operate upon the' mind, or excite in it perceptions or ideas of the presence and qualities of such objects; the word idea being here employed, not in any of the significations of the schools, but in its broad, popular meaning, as importing « whatever a man observes, and is conscious to himself he has in his mind;"* whatever was formerly intended bv the terms archetype, phantasm, species, thought, notion, or con- ception, or whatever else it may be which we can be emploved 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. t Lotfe b" "c™ §U8n.derstandinS>B. I. ch. i. « 3. CL. IV.] PHYSIOLOGICAL PROEM. $5 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 atten- tion 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 forever 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 whichsoever 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, juiciness, and sweetness; and so of the rest. Complex ideas are formed out of simple ideas by many opera- tions of the mind; the principal of which, however, are some com- bination 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 already observed, is a simple idea; and it ispne of the most common simple ideas that can be presented to the mind : for every object without and every notion within, tend equally to excite it: and being a simple idea, the mind, as I have also remarked, is passive on its presentation: it can neither form such an idea to itself, nor contemplate it otherwise than in its totality: but it can combine the ideas of as many units as it pleases, and hence produce the complex idea of a hundred, a thousand, or a hundred thousand. So, beauty is a complex idea; for the mind, in forming it, combines a variety of separate ideas into one common aggregate Thus Dryden, in delineating 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 re- spect, coincide in the same colour; and the mind, contemplating this agreement, may abstract, or separate the colour from the other properties of these three objects, and form the idea which is indi- cated by the term whiteness ; and having thus acquired a new idea by the process of abstraction, it may afterwards apply it as a cha- racter to a variety of other objects; and hence particular ideas be- come general or universal. 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 mu6t be always far more numerous than letters. I have instanced 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 referable, 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 correspondenc e, congruity and connexion with each other; and as many, perhaps, on the contrary, a natural repugnancy, incongruity and disconnexion. Thus, if I were to speak of a cold fire, I should put together ideas that are naturally disconnected and incongruous; and should consequently make an absurd proposition, or to adopt common language, talk nonsense. I should be guilty of the same blunder if I were to talk of a square billiard-ball, or a soft, reposing rock; but a warm fire, on CL. IV ] PHYSIOLOGICAL PROEM. 37 the contrary, a white or even a black billiard ball, and a hard rug- ged rock, are congruous ideas, and consequently consistent with good sense. Now it is the direct office of that discursive faculty of the mind which we call reason, to trace out these natural coinci- dences or disjunctions, and to connect or separate them by proper relations : for it is a just perception of the natural connexion and congruity, or of the natural repugnancy and incongruity of our ideas that shows a sound mind and constitutes real knowledge. The wise man is he who has industriously laid in and carefully assorted an extensive stock of ideas ; as the stupid or ignorant man is he who, from natural hebetude, or having had but few opportunities, has collected and arranged but a small number. The man who discovers the natural relations of his ideas quickly, is a man of sagacity ; and in popular language, is said and correctly so, to possess a quick, sharp intellect; the man, on the contrary, who discovers these relations slowly, we call dull or heavy. If he rapidly discover and put together relations that lie remote, and, perhaps touch only in a few points, but those points striking and pleasant, he is a man of wit, genius, or brilliant fancy, of agreeable allusion and metaphor ; if he intermix ideas of fancy with ideas of reality, those of reflection 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 princi- ples, and, as we say in popular language, and with perfect correct- ness, 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. Itoften 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 know- ledge, which the busy and boundless fancy of man paints upon it with an almost endless variety. The whole is derived from expe- perience, the experience of sensation or of reflexion ; from the observations of the mind employed either about external sen- sible objects, or the internal operations of itself, perceived and re- flected 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 58 PHYSIOLOGICAL PROEM. [CL. IV. mind itself: for we accustom ourselves to describe the will as being overpowered by the judgment; or the judgment as being over- powered by the imagination; or the mind itself as being carried headlong by the violence of its own passions. By all which, how- ever, we only mean, or should only mean, that the mind does not, on such occasions, exert its own faculties in a fitting or sober man- ner, or that from some diseased affection, it is incapable of doing so. For the faculties of the mind are so many powers ; and, as powers, are mere attributes of a being or substance, and not the being or substance itself. These, therefore, being all different powers in the mind or in the man, to do several actions, he exerts them as he thinks fit: but the power to do one action is not operated upon by the power to do another action : for the power of thinking operates not on the power of choosing, nor the power of choosing on the power of thinking: any more than the power of dancing operates on the power of singing, or the power of singing on the power of dancing,* as any one who reflects on these things will easily perceive. The body has its feelings, and the mind has its feelings also ; and it is the feelings of the latter which we call passions, a mere Latin term for the feelings or sufferings of colloquial language. The feelings of the body are numerous and diversified, as those of simple ache or ease, hunger, thirst, heat, cold, and a multitude of others. Those of the mind are still more numerous and more diversified, for they 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 ok 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 and mind, may be constitutional and permanent, periodical or recurrent, or merely incidental and tem- porary. The body may be of a sanguineous temperament, of a platonic temperament, of a nervous or irritable temperament- and the mind 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. 129. €L. 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 pecu- liar faculties of the mind that chance to be thus affected. The mind and the body bear also, in many cases a reciprocal influence on each other; which is sometimes general, and some- times limited to particular faculties or functions. It is hence that fever or cephalitis produces delirium; and vapours or low spirits dyspepsy. The mind, therefore, like the body, becomes an interesting field of study to the pathologist, and opens to his view an additional and melancholy train of diseases. It is these which will constitute the subject of the first order of the class we have now entered upon, and which are entitled to a deep and collected attention. CLASS IV. NEUROTICA. ORDER I. PHRENICA. MBtawa affectfiut the Kntellcct. ERROR, PERVERSION, OR DEBILITY OF ONE OR MORE OF THE MEN- TAL FACULTIES. 1 he word phrenica is Greek, from the Greek noun em- plated 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 ; accord- ing as these propensities are limited to a single purpose, or are un- confined and extend to every thing, pccasionally, however, t-nong ancient writers, we find melancholy insanity limited to insanity ac- companied with gloom or despondency, without any attention ro the universality or partiality of the disease: for an undue secretion of melancholia, 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 pathological. Yet the pathologists themselves have not been uniformly true to their own import: for even Dr. Cullen, who has followed the tech- nical signification in his synopsis, by defining melancholy as " in- sania fiartialis 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 limitation of the delirium to single objects or train of ideas, but by its concomitant dejection and desponde'ney. There seems to be an equal incorrectness, though of a different kind, in M. Pinel, whose book is, nevertheless, of great merit. Delirium or wandering is made a pathognomic symptom in his defi- nition 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 heuce while some definitions are so narrow 44 NEUROTICA. [CL. IV.—OK. 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 clay. 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 characterizes it by false fierce/ition ; 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 daily 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 wagon 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 latter editions of his synopsis is " injured functions of the mind in judging (mentis judicantis) 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- izes 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** 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 III. Ch. IU. Vol. II. f Id. Book I. Ch. V. p. 181, 182. Vol. I. * Id. Vol. I. p. 401. 4ti 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 subordina- tion of the judgment, which is designed by nature to be the govern- ing 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 constitution, or some corporeal affection but so long as the irregu- larity 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 de- ranged 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 dis- criminating them ; or the memory may not retain them, or the im- agination or the passions may be in a state of unruly excitement: all which will lay a foundation for different kinds or genera of dis- eases, ;.;.nd 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 in- jured during the existence of insanity; and next that, though from a violent or complicated state of the disease, the morbid con- dition often extends to some other, or even to all the other mental faculties, yet it does not necessarily or essentially extend to them ; for a madman may be furious or passionate, yet every madman is not so; his memory may fail or his attention be incapable of fixing itself, or his imagination be wild and extravagant, but these do not always occur. The faculties, however, of the judgment and the perception are affected in every case, though they are not alwavs 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 al- ternately the perception free or nearly free from all estrangement whatever, the disease, being, however, always accompanied with irregular remissions ; 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. 1.] 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 suddenly start, and looking at the visitor's walking stick, tell him that that drawn sword will never save him from destruction, nor all the men that slept with him in the same bed the night before—that his rival is now pushing forward with all speed on a black horse with a large army behind him, and that to- morrow he will fight and lose his crown. In such a case, and it is by no means an extreme one, the percep- tion and the judgment travel soundly and in harmony at the outset of the interview; but they soon separate and abandon each other as far as east and west. It is not always easy to say whether the fresh paroxysm of insanity that thus suddenly displays itself is limited to the one faculty or to the other, or is common to both. For if the perception suddenly wander, the judgment has anew 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 fur- nished by the faculty of perception : or both may equally wander, and accompany each other in the visionary scene, as they at first associated in the real. It is obvious, however, if I mistake not, that both faculties are affected in the derangement of insanity jointly or in irregular succession. How far a morbid state of the mental faculties may in any case depend upon the mind itself, as distinct from the sensorium or instrument by which it is connected with the body, it is impossible for us to know till we become acquainted with the nature of this connexion, and perhaps also with the essence of the mind, which, in our present state of information, seems to be a hopeless subject of inquiry. But we may possibly obtain some insight into the manner in which correct ideas of perception are changed in their nature and rendered incorrect or incongruous by a diseased judgment, by attending to a process of variation that is frequently occurring in perfect sauity 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. I. 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 fiercefltion 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 perception presented to it, we can have no great difficulty, I think, in conceiving by what means such a variation may be produced and may ramify into incongruities of great extravagance in a judgment deranged by disease. Nor is there much difficulty in conceiving how the paroxysm should be subject to remissions or even intermissions more or less regular; or the derangement be limited, as we frequently find it, and especially in melancholy, to particular subjects or trains of ideas. For first, all diseases have a tendency 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 in no man in a state of the most perfect sanity whose judgment is equally strong and exact upon all subjects: and few whose judgments are not manifestly influen- ced and led astray by partialities, or peculiar incidents of a thousand kinds; insomuch that we dare not, on various occasions, entrust to a man of the strictest honesty and the clearest head a particular subject for his decision, whom we should fly to as our counsellor upon every other occurrence. And it is not therefore very extra- ordinary that in a morbid state of the mind, and particularly of that faculty which constitutes the judgment, there should be an aberra- tion in some directions or upon some subjects which does not exist upon others. Concerning the remote or even the proximite cause of the dis- ease, we have yet much to learn. From the view we have taken in the proem of the close connection 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 II. Ch. ix. § 8. GE. 1.] NERVOUS FUNCTION. 4? of England, France, Germany, and Italy, but with no satisfactory result The shape or thickness of the scull has been started, in- deed, as a cause, by many anatomists of high and established repu- tation; but the conjecture has been completely disproved by others, who have found the very structures supposed to be most certain of producing madness, exist in numerous instances with perfect sound- ness of intellect. A particular shape of the scull seems, indeed, to be often connected with idiotism from birth or soon after birth, but with no other species of mental derangement whatever. Morgagni engaged in an extensive course of dissections upon this subject, and pursued it with peculiar ardour: and his results are given in his eighth epistle, from the second to the eighteenth arti- cle. In some cases the brain was harder, in some softer, than in a healthy state; occasionally the dura mater was thicker, and was studded with soft, whitish bodies on the sides of the longitudinal sinus. This sinus itself sometimes evinced polypous concretions; and the pineal gland, or several of the glands in the plexus choroides were in a diseased state. Dr. Greding,* with a like spirit of inves- tigation, has arrived at a like diversity of facts. Meckel tells us that he found the brain denser and harder than usual ;t Dr. Smithy descried a bony concretion, and Plenciz and various others repre- sent the brain as bony or calculous in various parts ; while Jones, in the Medical Commentaries, found it shorter than usual with a thick- ening 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 misforma- tion 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 appearance . that have hitherto been detected. The dissections of Greding extended to not fewer than two hundred and sixteen maniacal patients, the whole of whomhow- • Vermischte medicinische und chirurgische Schriften. Altenb. 1781. ■j Hist, de l'Acad. Royale des Sciences, &c. Ann. 17W. Berol.4fo. 1761, * Med. Observ. and Inquir, Vol. VI Vol. III.—G 50 NEUROTICA. [CL. IV.—OR. 1 ever, died of disorders unconnected with their mental ailments: three of the heads were uncommonly large, two exceedingly small; some of the scull-bones extremely thick, others peculiarly thin ; in some, the frontal bones were small and contracted, in others, the temporal bones compressed and narrow.* In a table containing an aggregate of the patients received into the lunatic asylum at Bicetre during a considerable part of the French revolution, from 1784 to 1792, by far the greatest 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 fanaticism, 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 imaginiation 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 pre- dominant exercise of the judging faculty: not one naturalist, phy- sician, 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 diseace 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: * Vernuschte Schriften, ut supra. GE. I NERVOUS FUNCTION. 51 and in proof of this he adverts to various dissections which have shown a considerable derangement, not only in the function but even in the structure of one or more of the abdominal organs, and particularly 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 epi- gastric or some other abdominal organ : for, in whatever this mor- bid 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 net 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 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, for1 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 ofthe 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. L p. 138. 5S 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 aeries of ingenious arguments to prove that mania consists in some inequality in the excitement of the brain,* or ot the nervous power,f 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 nve do not clearly understand in every part of the medullary substance ofthe 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 endeavors 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, con- sequently, typhus fever may become a source of delirium as well as inflammatory. And as the various secretions can only be elabo- * Pract. Phys. Vol. IV. Aph. MDLXII. fid. 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 ac- cumulation 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 dimi- nished secretion of this fluid producing a general debility ofthe liv- ing 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 ofthe iris.* Sometimes, however, the increased secretion of sensorial power is so considerable as not only to affect the head, but to augment the corporeal sensibility generally. And hence Hoffman makes accu- mulated sensation an ordinary symptom of this disease,! mistaking the exception for the general rule : and Riedlin gives us an instance of a maniac, who, instead of calling for and being able to endure large quantities of snuff, sneezed and was convulsed on smelling the mildest aromatics.! 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 lat- ter we have already observed that something of a constitutional make or physiognomy is often discernible; and the same is con- tended 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 melan- cholic temperament: either of which constitutions exercise such a control over the disease as to give it a peculiar modification what- ever be the nature of the exciting cause ; which is in truth of little • Blumenb. Bibl. I. p. 736. t Opp. Suppl. II. 2. t Lin. Med. 1696. p, 29. ol 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 inde- pendent of the nature of the exciting cause; or at least to be far more influenced by the constitution of the individual, and the pecu- liar degree of his physical and moral sensibility. Men of a robust Constitution, 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 ofthe paroxysms of individuals of more moderate 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 hap- pens that they become furious or unmanageable. Their pleasing dreams, however, are at length overtaken by, and lost amidst the gloom of an incurable fatuity Those of the greatest mental ex- citement, of the warmest passions, the most active imagination, the most acute sensibility, are chiefly predisposed to insanity. A me- lancholy reflection 1—but such as is calculated to call forth our best and tenderest sympathies." It has long been a current opinion that insanity is a disease more common to our own country than to any other: and this opinion has of late been rendered more seriously alarming by the following as- sertion of Dr. Powell, secretary to the commissioners for licensing lunatic establishments, and which is given as the result of his official tables of returns from 1775 to 1809 inclusive, divided into lustra or periods of five years each. " Insanity appears to have been considerably upon the increase: for if we compare the sums of two distant lustra, the one beginning with 1775, and the other ending with 1809, the proportion of patients returned as having been received into lunatic houses during the latter period, is to that of the former nearly as 129 to 100." " The facts also," says he, « which present themselves to the observation of the traveller, whatever direction he may take through this country, and all the local information which we receive 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 commissioner's book, bear the * Med. Trans. Vol. IV. p. 131 Art. Observations on the Comparative Preva- lence of Insanity at different periods. GE. I.j NERVOUS FUNCTION. 55 * i proportion of three to two, which is probably far above the mark, still the aggregate number of insane persons for the year 1800, contrasted 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 ofthe extent to which insanity is prevalent in the same towns, which is, nevertheless a loose mode of reckoning, though it is not etrsy to obtain a better, we have reason to conclude that insanity is, com- paratively 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 disea.se in our own country appear to rest on a stabler foundation. Taking Dr. Powell's result as drawn from full and incontrovertible data, and comparing the supposed march ofthe 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 ofthe 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 retrogres- sion, instead of an advance, has actually taken place. Dr. Burrows has industriously collected many of these, and, as far as they go, they lead to such an inference almost without exception.! Yet it is . probable that even this inference does not give us the precise fact, • Inquiry into certain causes relative to insanity, &c. p. 93. 8vo. 1820. t Inquiry, fcc. ut supr. p. 66. et alibi. 56 NEUROTICA. [CL. IV.—OR. I. and that it is as chargeable with an error on the favourable side, as the opposite account is on the unfavourable; since the increase of licensed houses, whose returns seem to have swelled the list of the commissioners beyond its proper aggregate, has been considerably supported by a transfer from the establishments which have thus fallen off. And hence, allowing the error on the one side to com- pensate 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. THE DISCREPANCY BETWEEN THE PERCEPTION AND THE JUDGMENT LIMITED TO A SINGLE OBJECT, OR Z. FEW CONNECTED OBJECTS, OR TRAINS OF IDEAS: THE WILL WAYWARD AND DOMINEERING. We have already stated that whatever be the exciting cause of mental alienation, the symptoms are, in every instance, greatly mo- dified by the prevailing idiosyncrasy, and hence, though a love of solitude, gloom, fear, suspicion and taciturnity are the ordinary signs of the present species, these signs often yield to symptoms widely different, and sometimes even of an opposite character ; and we hence become possessed ofthe four following varieties: « Attonita. Mute, gloomy, retiring melan- Gloomy melancholy. choly. p Errabunda. Roving, restless melancholy, e- Restless melancholy. vincing a constant desire to change the abode y Malevolens. Morose or mischievousmelancho- Mischievous melancholy. ly; occasionally terminating in suicide or the injury of others. o Complacens. Self-complacent and affable me- Self-complacent lancholy: occasionally rejoicing melancholy. in a visionary superiority of rank, station or endowment. The same variety of symptoms, as chiefly modified by the pre- vailing temperament, are noticed by Francastorio. u The phlegma- tic," says he, « are heavy ; the sanguine, lively, cheerful, merry, but not witty; the choleric are in rapid and perpetual motion, GE. I.—SP. I.] 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 serious consideration I find some patients that have nothing of these qualities : and others that exhibit every diversity of feeling: for some are sad without being fearful; and others fearful without be- ing 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 ofthe 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."! 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 ofthe 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 lluman Understanding-, Book U, Ch. XL § 2 Vot. III.—H 58 NEUROTICA. [CL. IV.-OR. i. 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 ofthe mind. And hence, whenever hypochondrism merges into actual insanity, 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 dis- ease ; the morbid state of the brain influencing the abdominal organs in the latter case, as the morbid state of the abdominal organs in- fluences 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 appears 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. ViC- 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 tonight; or if he walk at all, seeks for orchards, back-lanes, and the gloomiest places he can find. " One ofthe 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 by-stander : but he does not shun the presence of man, if asked a question he does not an- swer, and yet appears to understand what is said. He does not yield to admonition nor pay any attention to objects of sight or touch: he seems immersed in profound thought, and totally occupi- ed by foreign matters. Yet at times he is more awake : if food be put to his mouth he eats, and if liquor be presented he drinks." 1VI. de Sauvages then adds, that this rare modification of the disease occurred once to Dr. James, physician to the elector of Saxony, in a man about thirty years old, who was terrified with the thought that the Deity had condemned him. It continued for four months during the autumn and winter ; but the patient was at length restor- ed to his right understanding.* Grief, and particularly for the loss of friends, discontent, severe disappointment, the dread of some real or imaginary evil, a violent and long continued exertion of any of the passions, and deep unin- terrupted study, have frequently proved accidental causes or acces- sories of this variety of melancholy, where the peculiarity of the constitution has formed a predisposition, and have sometimes pro- duced it even where no such predisposition can be traced. In like manner it has proceeded from immoderate exercise ; insolation, or long exposure to the direct rays of the sun; sudden transitions from heat to cold; powerful stimuli applied to the stomach. In the case related by Sauvages the disease appears to have pro- ceeded from a heated imagination exercised upon false views of religion: and perhaps there is no cause more common or more operative, especially in timid minds; and more particularly still * Nosol, Med. Class VIII. Ord, III. 60 NEUROTICA. [CL. IV.—OR. I. where the conscience is alarmed by a review of a long catalogue of real delinquencies, and a dread of eternal reprobation. The same causes operate in the production of roving or restless melancholy, forming the second variety, and exhibiting a modifi- cation 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 tho 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,'' xays 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 of all reason ; one supposeth himself to be a dog, cock, bear, horse, glass, butter. He is a giant, a dwarf, as strong as an hundred men, a lord, duke, prince. Many of them are 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, vana; Finguntuy species: more like dreamers than men awake, they feign a company of entire fantastical conceits; they have most frivolous thoughts impossible to be effected, and sometimes think verily that they hear and see pre- sent before their eyes such phantasms or goblins they fear, suspect or conceive : they still talk with and follow them. "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 * Frambps. Consult. Lib. 1,17. GE. I.—SP. I.] NERVOUS FUNCTION. 61 fiction, that pleasant waking dream. If it be offensive, especially, they cannot forget it; they may not rest or sleep for it; but still tormenting themselves Sisyphi saxum volvunt sibi suis." How melancholy a reflection 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 ©f .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 overcome with this horrid disorder, he, in the interval of his vapours, was es- teemed one of the most facetious companions in the university." The third variety, in which the alienation assumes a morose or mischievous character, is perhaps the most common form under which the disease makes its appearance. Sometimes the patient is extremely passionate, and will quarrel furiously with every one alike in whatever tone or manner he is addressed, and expresses himself with great violence of language, occasionally with gross unqualified abuse, but occasionally also in a style of repartee that was never evinced in a sane state. More generally, however, he selects his objects of resentment: which are, for the most part, unaccountably taken from his nearest relations and kindest friends. Against these he harbours the blackest suspicion and jealousy, believing that they are haunting him to take away his money or his life, or to put him to torture. He loads them with every term ofthe 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 beiween these two faculties of the desire and the will, and has exemplified it by the chastisement with which an indulgent father frequently finds him- self called upon to visit an offending child, and which he wills to perform though his desire is in the utmost degree reluctant. The disease before us is pregnant with examples of the same kind, and 62 NEUROTICA. [CL. IV.—OR. I strikingly shows the correctness with which this great master of his subject analyzed the human mind. We have already observed that the peculiar turn or modification of the malady depends in general far less upon the immediate and exciting cause, than upon the constitutional temperament, or some operative principle which we cannot always develop. And in proof of this it may be observed, that I have drawn the principal linea- ments ofthe 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 degree 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 fond- ness of her nearest relations has since removed this faithful watch- woman, 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 indif- ference or even violent aversion, and to utter exclamations and em- ploy language ofthe 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 ipsanity 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 GE. I.—SP. I.] NERVOUS FUNCTION. 63 cold or hunger, he has also little feeling of decency or religion. In 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 con- sciousness of his degraded condition. And it is singular to observe, what may also contribute to alleviate the distress ofthe sympathis- ing heart, how completely his unconsciousness prevails even after a patient'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 inmates without dread. The fourth variety or self-complacent melancholy is per- haps less frequent than any of the rest; but it occurs occasionally, and is often accompanied with a high-coloured and ruddy com- plexion, 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 music, dancing, and to be in women's company. Aristo- tle 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 over- joyed with the performance.* Such persons have not unfrequently thought themselves called upon to undertake some desperate adven- ture, 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 sleeplesss 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 from * Lib.de Reb. mir, 64 NECROTIC A. [CL. IV—OR. f this time the idea of miracles so strongly possessed his imagina- tion that he began to believe he could perform some hinfself. 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 that he had already removed one error in his mind in this way; for there was an old woman whom he had at one time con- sidered as a witch, but whom he afterwards discovered upon trial to be no such 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 present species is equally advisable for the ensuing, it will be most expe- dient to reserve the discussion of it till the latter has been described in its order. SPECIES II. ECPHRONIA MANIA r.HE DISCREPANCY between the perception and the /udgmem general; great excitement of the mental, sometimes o> 1 he corporeal powers. This species appears under almost infinite variety of character, of which, however, it may be sufficient to mark the following, mo- dified for the most part by the predisposing causes that we have Already noticed, as modifying the preceding species: « Ferox. Furious and violent madness. /3 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- HE. L—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 ofthe 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 the eleventh part of the whole) had become deranged after delivery, during or immediately subsequent to the period of suckling. In the higher ranks of society the proportion of puerpe- ral maniacs he calculates to be not less than a seventh of the whole. Of the above 92 cases, 16 occurred from the first to the fourth day after delivery : 21 from the fifth to the fifteenth : 17 from the six- teenth to the sixtieth day ; 19 from the sixtieth to the twelfth month of suckling ; and in 19 cases it appeared after voluntary or forced weaning. Of the above 92 cases 8 were idiotic, 35 melancholic, and 49 ma- niacal. The respective ages were as follows : 22 from 20 to 25 years; 41 from 25 to 30 years; and 12 above 30. Fifty-six out of the ninety-two were entirely cured, and thirty-eight of these within the first six months. Fright was the most frequent cause.* I have said that a virtuously restrained orgasm in a full habit, and where no steps have been taken to reduce the entonic vigour, has occasionally induced mania. There is a curious instance of the powerful effect of such a state related by Kemnesius, in his History of the Council of Trent, which though it did not terminate in mad- ness, proved quite as fatal. In the year 1419, Rossa, nephew to the King of Portugal, and Archbishop elect, of Lisbon, was taken seri- • Quarterly Journal of Foreign Medicine. No. I. p. 98. Vol. Ill—I 60 NEUROTICA. [CL. IV.—OR. I. ously ill at Florence. His physicians told him that his disease pro- ceeded from an excessive irritation of the genital organs, and that he would certainly die unless he committed fornication or married. With a courage worthy of a happier issue, he resolved on death, and met it without breaking his vow of celibacy.* The following instance, however, will prove that mania itself is sometimes a consequence of the same firmness of mind. A clergy- man of exemplary character, and one of the most distinguished preachers 1 have the pleasure of being acquainted with, was many years ago very unexpectedly attacked with a paroxysm of mania, the cause of which it seemed impossible to unfold. He recovered in about six months, and returned to a regular and punctilious dis- charge of clerical duty. He is a man of exquisite taste, warm ima- gination, exalted and highly cultivated mind. With these qualifica- tions, in less than a year after his recovery, he married his maid servant, and the world imagined he was gone or going out of his senses a second time. A confidential statement of his situation soon proved to myself that nothing could be more prudent or praise- worthy than the step he had thus taken, and which had excited so much astonishment among his friends. He was fully convinced, he said, though he had never communicated it to any one, that the cause of his unfortunate malady was a genital irritation, exciting to a constant desire of matrimony, which he was not in a situation to comply with, and which compelled him to exercise from day to day a severe restraint upon his feelings. On being fully restored to health, he found the same morbid propensity beginning to return. I felt, said he, it would again drive me mad if I did not relieve it, and my principles forbade me to think for a moment of relieving it immorally. To what respectable family could I now offer myself, having so lately been discharged from private confinement ? The servant who lived with me was a very excellent young woman: her disposition was amiable, her mind well capable of cultivation, and her form and manners by no means unpleasing : and hence, after mature deliberation, I determined upon marrying her if she herself would venture upon so perilous a risk. He married her accordingly ; —has ever since, for upwards of twenty years, enjoyed an almost 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. Fart III. De Ccelibatu sacerdotum. t Cent. III. Obs. 14. * 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,t 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 sensible 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 his 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. HI f Sanctacrux, De Melancholia, p. 29. Lentilius, Miscell. I. p. 36. £ Hoffman, Beschreibung der VVeichsel;.opl?s, &c Eph. Nat. Cur. Cent. I. II. Obs. 35. § Forestus, Lib. X. Obs. 24. 6g NEUROTICA [LC. 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 ot rest which follows is generally short and sleepless ; the patient is obsti- nate ; he will not speak a word ; and clenches his teeth it any thing be offered him to swallow; or else cunningly pretends to drink a little, but immediately squirts it out on the person who offers it. Instantly he again breaks out into all the wild and extravagant lan- guage and actions he committed before. If kept in strict coercion he has often so much command over himself as to behave mildly and modestly ; and were it not for the general expression of his countenance, and the peculiar glistening appearance and rapid movement of his eyes, he might impose on many of the bystand- 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 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 covetuousman 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 Senerio, a madman of considerable wealth, who thought himself and everything about him great; that he had a great wife and great hcrses, 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 Ant. of Melancholy. Part 1. Sect. 3. GE. L—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 despond- ent madness; for though this modification ofthe disease may occa- sionally 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 exhaus- tion 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 ofthe kindred faculties assuming a paramount power, there is a general anarchy and confusion in the ideas that flit over the sensory without connexion or association of any kind. And hence Pinel has admirably characterized it, as consisting in a "rapid succession or uninterrupted alternation of insulated ideas and evanescent and unconnected emotions; continually repeated acts of extravagance ; complete forgetfulness of every previous state; diminished sensibility to external impressions; abolition of the faculty of judgment; perpetual activity without object or de- sign, 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 intractable, 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 or 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 de- vour their feces. Of the nature of the ideas that take place in the sensory, and are expressed by an unintelligible muttering, we know nothing further than that, from the screams and howlings with which their jargon is accompanied, there can be no doubt that they are often excited by painful sensations of body or mind. It is happy for those who suffer under this as well as under the preceding form, that they rarely sustain a long conflict; the exhaus- tion of sensorial power by repeated paroxysms soon leading to a • De l'Alienation Mentale, Chap. III. iii, § 176. ro NEUROTICA. [CL. IV.—OR. I total torpitudc, and consequently a death of the sensorial organ; though there arc 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 con- dition of the brain, we find least to justify hope ; the patients gene- rally become weakened by fresh paroxysms, and often sink into a state of idiotism. The firs: 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 ofien 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 ofthe 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 tlie 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 perma- nent recovery who possess an hereditary taint: the disease may indeed leave them for a time, but the predisposition remaining, they commonly 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 pait as many recover; and if more than two * Vcrmischte Scluiften ut supra. &c. GE. l.—SP. II.] NERVOUS FUNCTION. 7 1 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 employed in almost all the larger lunatic establishments in our own country and on the continent, especially at Bcthlem, 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 ofthe 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 temperaments, 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 where the demand for blood-let- ting is unequivocal, it has been carried to a mischievous extent, and ruined its own benefit. Thus Plater made a point of repeat- ing 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 already 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. 8€. 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 effectually cleared of viscid or acrimonious matter that may irritate or clog them up. But, beyond this, by keeping up such an increas- ed action in the abdominal region as the organs may bear without debility, we may diminish or change the morbid action in the head by remote sympathy, or entirely withdraw it by a revulsion. A spontaneous 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 extremely costive. If the black hellebore ofthe ancients, which appears to have been a different plant from that of the modern dis- pensatories, 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.t Upon no other description of medicines can we place any rational dependence. Emetics, narcotics, and other sedatives, and anti- spasmodics have been tried for ages in every form and in every proportion; sometimes alone, and sometimes in conjunction with blisters and the warm or cold bath. There are instances in which they have all appeared to produce some benefit, but the far greater number in which they have failed prevents us from placing any reliance upon them. Of the narcotics the chief that have been had recourse to are opium, aconite, belladonna, 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. f Annotat in Zapat. Mirabil. p. 136. GE. I—SP. II.] NERVOUS FUNCTION. T$ 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 hys- terics, hypochondrism and madness of every kind, and especially that which was formerly described under the name of dsemonoma- nia,t whence, indeed, its technical name of hyfiericum or fuga dae- monum under which it was also celebrated. It occupied a place in a late edition of the pharmacopoeia of the London College, and was at one time noticed as an antispasmodic even by Dr. Cullen, who rejected it however, most deservedly, in his maturer courses of lectures. Its only sensible qualities are those of a slight resinous bitter, not worth the trouble of extracting. Camphor is a sedative far better entitled to attention, and appears to have been tried with more extensive -success than any other me- dicine 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 phy- sicians 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 unhappily no impression was made on the constitutional disease.^ • Friborg. Coll. Soc. Med. Haffn. II. p. 176. f Abrah. Mayer, Archiv. der Practischen Arsneykunde. t Mat. Med. Vol. II. p. 294. Vol. Ill— K 74 NEUROTICA: [CL. IV.—OR. I. 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 ofthe 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 ofthe same kind to the same organ, while the body, with a view of encouraging a revulsion more effectually, was plunged into a warm bath. The process will be found described in his Beytrage zur medicinischen Gelehrsamkeit, published in quarto at Halle in 1749. And I men- tion the fact as an act of justice to the author, since the same pro- cess has of late years been revived in our own country as a new discovery. Daniel thought it highly beneficial; and by its recent re- vivers it was at one time held up as a specific: but whatever suc- cess may in a few rare instances have attended it, the practice has not been able to work itself into public favour: and a sober atten- tion 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 oc- casional 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 rous- ing 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 de- sire. 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 1 Vo' VII. p. 61 J- Nachrict, Von dem Klinischen institut. zu Enlangen. 1783. 8vo. GE. I.—SP.II] NERVOUS FUNCTION. 7S soberly and dispassionately. This will at first, perhaps, be only of use as promoting a habit of moral order and quietisin • bot every good man will indulge the hope that it may afterwards introduce into the mind the higher blessing of spiritual peace and ronsola- tion. Yet the attempt must not be begun too soon, and in no case till the patient has acquired not only a spirit of subordination but of tranquillity. Before this period nothing can be so absurd as to attempt devotional instruction of any kind: for the subject of religion can only be addressed to the reason or to the passions: the former of which does not exist in a state to be influenced, and the latter of which, if they could be influenced at all, would only add to the ex- citement, and increase the disease. The clear duty of the priest and the physician is in this case one and the same: it is to bring the mind home to the world around it: to draw it down and fix it upon things of time and sense, instead of rousing it to things invisible and eternal: to enable it to behold God in the materialities of his works instead of urging it to a contemplation of him in the spiritual- ities of his word. To instigate a madman to an abstract and elevated commanion with his Creator, who is incapable of holding an inter- course upon ordinary topics with his fellow-creature, is to cure a frozen limb by pouring boiling water upon it, or to teach the optics of Newton in a nursery. In many cases the cure mainly depends upon withdrawing the patient's mind as much as possible from every former scene and every former companion, in setting before him a new world, and giving an entire change to the current of his recollections and ideas. There are particular cases, however, and perhaps particular peri- ods of the disease, if we could accurately hit upon ihem, 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 illustra- tion of this remark, in the case of a lady, twenty-eight years of age, of a good constitution but susceptible mind, who fell into a state of melancholy, in the ordinary sense of the term, a few months after a second child-birth, and at length became furious. " She was now," says he, " put under the care of an experienced attendant, sepa- rated entirely from her husband, children and friends; placed in a neat cottage surrounded by agreeable country (it was the finest season of the year) and visited regularly by her physician. For several weeks she manifested no improvement; sometimes she was occupied with one notion, sometimes with another; but they were always of the most gloomy description: at length it became her firm belief that she was to be executed for her crimes in the most pub- lic and disgraceful way; every noise she heard was that of the workmen erecting the scaffold; every carriage, the officers of jus- tice 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 a^ 76 NEUROTICA. [CL. IV.—OR. 1 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 cars 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 inter- view with her, thinking that the best way to convince her he was not dead was to show himself. This was objected to; he was told the general fact that patients are more likely to recover when completely separated from their friends; that if she saw him she would say it was not himself but his ghost. But the husband was obstinate and an interview was consented to.w 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 clown 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, look 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 intcrtsted, and 1 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 1 had complete possession of her mind, I ventured to ask her in a joking manner, whether I was not very communicative for a ghost; she laughed; I immediately drew her from the subject, and again engaged her attention with her children and friends. The plan succeeded beyond my hope; I dined, spent the evening with her, and left her at night perfectly herself again." He went the next morning in a state of intense anxiety to know whether his success had been permanent; but her appearance at the window with a cheerful countenance soon relieved his apprehensions. While he was there Dr.----came in; he went up stairs without knowing the effect of the interview, and came down, saying, " it looks like magic!" With a view of confirming her recovery, she was ordered to the sea side to bathe. As soon as the day of her departure was fixed, she began to droop again, the evening before it she was very low, and on the morning of her setting off was as bad as ever. This state continued for several weeks, in spite of sea air and bathing, and ceased as suddenly as it had done before, apparently in GE. I.—SP. II.] NERVOUS FUNCTION. 77 consequence of interviews with friends, calculated to remove the apprehensions by which her mind was haunted She has since then continued perfectly well, and has had another child without the slightest threatening of her former malady."* This was a bold venture, and the physician must be of a temper more than ordinarily sanguine who would predict a like success upon every similar attempt. Yet we have already had occasion to observe, that puerperal insanity is more easily recovered from than most other forms of the disease. GENUS If. EMPATHEMA. THE JUDGMENT PERVERTED OR OVEHPOWERED BY THE FORCE Of SOME PREDOMINANT PASSION; THE FEATURES OF THE COUNTE- NANCE CHANGED FROM THEIR COMMON CHARACTER. The term empathema is derived from the Greek 7r*0j>f**, « passio," " aff'ectio," whence efMxBn, " cui insunt affectus seu perturba- tiones ; 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 ofthe 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. I manie sans delire, although he admits that the judgment and per- ception, and, indeed, all the reasoning faculties of the mind are in most cases undisturbed. In like manner Sauvages has incorrectly merged the whole family into a single species under the genus mania, to the utter confusion of both. It is not a little singular that Dr. Crichton, who has written so ex- cellently on the diseases of the passions, and has illustrated 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 those diseases, or have transferred them, like Sauvages, to insanity,—under his no- menclature, delirium; although, as I have just remarked, the per- ception and the judgment (a diseased condition of which are 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 fierverted 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 fciior 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 for delirium. The genus empathema has three species; the first characterized 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. II.—SP. I.] NERVOUS FUNCTION. 79 SPECIES I. EMPATHEMA ENTONICUM. TEmpuMmxrt Excitement THE PREDOMINANT PASSION ACCOMPANIED WITH INCREASED EX- CITEMENT, ARDOUR, AND ACTIVITY; EYE QUICK AND DARING; COUNTENANCE FLUSHED AND TUMID. The varieties are innumerable : the chief are as follows : « Letitiae. Ungovernable Joy. Q Philautise. Self-love. Self-conceit. y Superbiae. Pride. ^ Gloria? famis. Ambition. e lracundiae. Anger. £ Zelotypiae. Jealousy. All these, and indeed, all other passions whatever are as much direct and indirect stimulants to the mind as provocative foods or drinks are to the body. Employed occasionally and in moderation both may be of use to us, and are given to us by nature for this pur- pose : but when urged to excess they throw the system off its healthy balance, rouse it by excitement or depress it by exhaustion, and weaken the sensorial vessels by the wear and tare they produce. As those we are now contemplating are attended with increased action they have some few symptoms in common, how widely soever they may differ in others ; of which the chief are an augmented temperature and an accelerated pulse. If carried to such a degree that the judgment loses its power, or in other words the man has no longer any command over himself, they betray themselves by their effect on particular features and particular organs, according as the emotion is of a painful or a pleasurable character, or as the pain or the pleasure predominates in those which partake of both. There are some 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 praecordia 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 may be thought, perhaps, that the vulgar character of the heart SO NEUROTICA. [CL. IV.—OR. I. as indicative of hatred or revenge, is merely figurative and has no foundation in nature. But this is not the case : for anger when long indulged is well known to affect the functions of the liver, and has often laid a foundation for jaundice, and consequently for a deeper colour ofthe 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 pr 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 diarrhoea and inconti- nence of urine ; grief disorders the stomach, and affects the lachry- mal glands; sudden fright divests the muscles of locomotion, and produces palsy ; while mirth throws them into involuntary action, and compels a man to leap, laugh and sing. This, however, is to digress ; for our present business is to con- template the mental rather than the corporeal effects of the passions when urged to excess, or intemperately protracted. The instances of derangement produced by a sudden fit or 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 a 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 ofthe 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.L] 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- haavet 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 instan- taneously to become discharged of its contents, like a Leyden phial loaded 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 pardon to a culprit just on the point of his being turned off at the gallows. 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 testator 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 ren- dered 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. f De Morb Nerv. lib. ix. cap. 12, i Comment, torn. III. p, 141. § Lib. IX. cap. 12. XT__Ht T S;2 NEUROTICA. |CL. IV.—01.*. I moved ; Lory that of a stricture ofthe polyrtis with incessant vomit- ing;* and Trellian, what we should less have expected, a radical cure of melancholy f In the second variety wc have noticed the predominance ot 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 man," says Mr. Mason in his treatise on Self- knowledge, " has his foible as well as a fool; but the difference be- tween them is, that the foibles of the one are known to himself and concealed from the world : the foibles of the other are known to the world and concealed from himself. The wise man sees those frail- ties in himself which others cannot; but the fool is blind to those blemishes in his character which are conspicuous to every one else."^ It was under the influence of this disease that Menecrates, as we learn from ./Elian, 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. monarch; 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 worsh pthat was paid to him with the greatest complacency, but growing hun- gry 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-endowment s, 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, torn. I. p. 37, $ Lib. XL1 p. 17. * Part 1. Ch. VII. § Lib. XII, cap. 51. tiE. n.—SIM.] 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 minis- ters and commanders, that we are to look for the most striking in- stances of this malady. Many a crown won by good fortune, and which might have been preserved by moderation, has been lost by the delirium of pride and vain-glory; of which the history of De- metrius of Macedonia furnishes us with one of the most memora- ble examples: who, in his disgraceful fall, was obliged to abandon, among the other idols of his heart, the unfinished robe which was to have hung over his shoulders a magnificent embroidery of the sun, the moon, and all the stars of heaven, to have represented him as the sovereign lord of the whole. There is. however, another kind of madmen, to adopt the words of Butler,* opposite to these; "that are insensibly mad and know nothing of it; such as affect to contemn all praises and glory, and think themselves most free when they are most mad: a company of cynics, such as monks, hermits, and anchorites, that contemn the world, contemn themselves, contemn all titles, honours, offices, and yet in that contempt are more proud than any man living They are proud in humility, proud in that they are not proud. They go in sheep's russet, many great men that might maintain themselves in cloth of gold, and seem to be dejected : humble by the outward 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."t When the passion of pride is united with that of ardent desire after something beyond us and above us, it constitutes the next feel- ing of ambition : and hence this also is an inflating emotion, a tym- pany of the mind, and may be called firosfiective vanity, as pride is relative vanity, and self-conceit fiersonal. It is the more dangerous to the understanding in consequence ofthe 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. 64 NEUROTICA. [CL. IV.—OR. I. one of this train of passions pass over the mind, the blood, as i3 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 ofthe 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 already 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, there is a combination of irritating passions, and the combination is still more complicated; for it is a compound of suspicion, hatred, eager desire of revenge, occasionally intermixed with love. To hot climates it appears to be endemic, and there is not perhaps an eastern dynasty that does not offer 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 recommended in ungovernable passion: though the violence of the excitement should unquestionably be reduced by venesection and purgatives. After this, time and perfect quiet must be chiefly depended upon: yet judicious conversation, and more especially a judicious • Of Mental Derangement, Rook III. 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 under it will soonest learn his own emptiness, and the means of remedying this defect. And hence the advantage of a public edu- cation 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. ISmjiassfoueUi ©egression. I HE PREDOMINANT PASSION ACCOMPANIED WITH DIMINISHED EXCITE- • MEM, ANXIETY AND LOVE OF SOLITUDE: EYE FIXED AND PENSIVE; COUNTENANCE PALE AND FURROWED. The mental emotions productive of these effects are at least as numerous as those which harass the frame by increased excite ment. The following may serve as examples: a. Desiderii. Ungovernable Love. /3 Auri famis.-------------Avarice. y Anxietudinis.-------------Anxiety. ? Moeroris.-------------Heart-ache. e 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 S6 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 retardation and small- ness of the pulse, wantof 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 praecordia: and hence the striking and beautiful apoph- thegm of the wise man, " Hope deferred maketh the heart sick." It is felt by children at a distance from home and who are eager to return to the embraces of their parents ; by foreigners who have a strong and inextinguishable love for their country, and are anxious to return to the scenes and the companions of former times: and by the 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 domestic virtues and feelings much stronger than they seem to have been of late years, produced not only a permanent melancholy but hectic fever. Yet it is to the third that our attention is chiefly called on the present occasion, from the greater frequency of its occurrence and the severer and more tragic effects to which it has led, where obstacles have arisen in its progress. We have, on the present occasion, nothing whatever to do with the gross passion of concupiscence, which is as different from that of pure and genuine love as light from darkness. The man of lust has indeed his love, but it is a love that centres in himself and seeks alone his own gratification : while the passion we are now speaking of puts self completely out of the field, and would voluntarily sub- mit to every pain and sacrifice, even the loss of life itself in pro- moting 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 double source "Nuptial love," says lord Bacon, "maketh man- kind ; friendly love perfecteth it; but wanton love corrupteth and embaseth it."'1 What it is that first lights up this flame is of no importance to the present subject. A peculiarcastof 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 ofthe enamoured beholder gives • Essays, No. X. C.E. II.—SP. II] NERVOUS FUNCTION 87 token of a mind adorned with all he can wish for; or an actual knowledge, from long acquaintance, of the existence of such inter- nal cultivation and excellence, may be equally causes of the same common effect. And hence this is of little or no account; for the passion being once excited, the judgment runs a risk of being over- powered by its warmth and violence; and the moment it is over- powered, the new train of ideas that are let loose upon the mind are of a romantic character; and as soon as any obstacle starts 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 sentient organ. Yet love-sickness itself, whatever mischief it may work in the corporeal frame, by sleepless nights, a feverish pulse, and loss of appetite,* and however, from the exalted state of the imagination and the increased sensibility of the body, it may transpose the reali- ty of life into a kind of visionary existence, and so far produce men- tal derangement, rarely leads to direct insanity so long as there is the remotest hope of the attainment of its object. But if hope be suddenly cut off by an inexorable refusal, the intervention of a more fortunate rival, the concealment of the object of adoration, or any other cause whatever, the mind is sometimes incapable of resisting the shock thus produced by the concurrent yet opposite powers of desire and despair; and in a moment in which the judgment is com- pletely overwhelmed, the love-sick maniac calls to his aid the de- moniacal passion of revenge, and, almost at hazard, determines upon a plan of murder directed against his rival, his mistress, or himself. The story of Mr. Hackman and Miss Rae will at once, perhaps, occur to the recollection of most of the author's readers in proof of this assertion. He himself had some acquain- tance with the former; and is convinced from what he knew of him that nothing but a paroxysm of insanity could have urged him to so horrible an act. The operation of the passion of avarice, when it has once ob- tained an ascendancy over the mind, is altogether of a different na- ture from that of the preceding variety, though it often produces a wider and more chronic alienation. It has not a stirring property of any kind belonging to it; but benumbs and chills every energy of the body as well as of the soul, like the stream of Lethe ; even the imagination is rendered cold and stagnant; and the only pas- sions with which it forms a confederacy are the miserable train of gloomy fear, suspicion and anxiety. The body grows thin in the midst of wealth, the limbs totter though surrounded by cordials, and • Schurig. Gyneaolog p. 94. Horstius, An Pulsus aliquis amatorius concedendus ? DUizer, de Natura Amoris. Gioss. 1611. 4to. 88 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 indi- vidual 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 Maxi- mus 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 harassed 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 describe 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 burden 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; Cactera de genera hoc, adeo sunt multa, loquacem, Delassare valent Fabium. In the mean time, continues the younger Democritus," thus mucl: I may say of them, that generally they crucify the soul of man, at- tenuate our bodies, dry them, wither them, rivel them up like old apples, and make them as so many anatomies."! • Lib. VII. Cap. t Anat. of Melancholy. part I. Sect. II. Subs. X. BE.II.-SP.il.] NERVOUS FUNCTION. 89 Nothing can be more different than this constitutional pining, and the pains produced by heart-ache or the reality of severe grief. The former is talkative and querulous; the latter is dumb and flies from company. The sensorial exhaustion is so considerable that the mind, with its attention upon the full stretch, has scarcely strength enough to collect the train of ideas on which alone it re- solves to dwell ; and hence all conversation is irksome, the pre- sence 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 'erminate in quiet sleep, is the in- let of apoplexy. Even in viie former case the irritability 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 proper sway in the mind, and the temporary derangement alto- gether ceases. At times, indeed, this never returns, and the pitiable sufferer 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 a 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, Warsavie curatis^ Vni TTT__M 90 NEUROTICA. [CL. IV.—OR. I. tress into which his last hazard had plunged his wife and family: but if his selfish love of gaming had not triumphed over his rela- tive love for those he had thus ruined he would not have been in- volved in any such reverse. While Beverley was in despair; it was his wife who was broken hearted. The sources of this most agonizing emotion are innumerable, 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 two, to sur- render himself to the laws of his country, and court the disgrace of a public execution. Yet the same miserable feeling has some- times followed from an ideal cause, especially in a mind of natural timidity, or constitutionally predisposed to a gloomy view of nature. For such, by a mere exercise of their own meditations, but far of- tener by the coarse, but empassioned 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 receite them. And under the influence of such an impression they too frequently work themselves up into a state of permanent in- sanity, or hurry themselves by their own hands into the horrors of a fate from which they feel assured that no repentance or power of religion 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 conjested, 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. QE. 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 for ever 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 oppressed him, has re- turned to his sober senses, and learned a juster estimate of worldly possessions. The same attempt has often been recommended in dissappoint- 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 donotthink this is much to be trusted to. Where the choice between two young persons of fair character is really imprudent, yet the affections are so rivetted as to bid defiance to all forcible attempts to unfetter them, a promise of consent on the part of the reluctant parent at the distance of a given period of time, as a year and a half or two years, with an undertaking on the part of the lovers neither to see or correspond with each other in the mean time, an engagement easily fallen into, has answered in many instances to which I have been privy. The ardour has gradually cooled on the one side or the other, the judgment has been more impressed with the nature of the imprudence, or a more attractive form has inter- posed and settled the question irretrievably. While on the con- trary, if the fidelity should hold on both sides to the end, and the passion be heightened instead of depressed, as in this case there is most reason to suppose it would be, hard, indeed, must be the heart that would extend the restriction farther, and that would not wish joy to so Reserving a couple,. NECROTIC A. [CL. IV.-OR. L SPECIES III. EMPATHEMA INANE. ?|8ir>BrafurtJ JJasstou. WAYWARD AND UNMEANING PASSION, URGING TO INDISCRIMINATE ACTS OF VIOLENCE : AIR HURRIED AND TUMULTUOUS J COUXTKN VNCK FLUSHED ; EYES GLARING AND PROMINENT. This is the manie sans delire of M Pinel: a case of frequent occur- rence but incorrectly named in this manner, since, in the opinion of all other nosologists, and perhaps all other pathological writers, the character of delirium (that is of diseased judgment, diseased 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 a weak and indulgent mother, was encouraged in the gratification of every caprice and passion of which an untutored and violent temper was susceptible. The impetuosity of his disposition increased with his years. At school he was always embroiled in disputes and quarrels; and if a dog or a horse offended him he in- stantly put it to death. 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 estate as well as to the discharge of his relative duties, and even distinguished himself by acts of beneficence and compassion. But his deep-rooted propensity to quarrel still haunted him, and wounds, law-suits, and pecuniary compensations were the general consequence. At last an act of notoriety put an end to 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. HI.] NERVOUS FUNCTION. 93 ♦ the visionary hero to a fresh paroxysm of fury. He siezed, with a vigorous grasp, the sabre of his next neighbor, 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. illusion, fggallucftuitfon. THE JUDGMENT PERVERTED OR OVERPOWERED BY THE FORCE OF TH1-V IMAGINATION ; THE SPIRITS PERMANENTLY ELEVATED OR DEPRESSED; THE FEELINGS OF THE MIND DEPICTED IN THE COUNTENANCE. Vlusia is here derived from the Greek uteris, " oberratio," from <*.Xvu, "errabunda. mente afficior,"—" inquietus oberro:" whence the Latin term allucinatio or hallucinatio. According to the rule which renders the Greek t>, 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 in 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 before us. Whenever the genus exists, hypochondrias or hypo- chondriasis 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 EI.ATIO. SENTIMENTALISM. MENTAL EXTRAVAGANCE. -.------HYPOCHONDRIAS? HYPOCHONDRISM. LOW SPIRITS* i>4 NEUROTICA. [CL. IV.—OR. I, SPECIES I. ALUSIA ELATIO. Sbentunrntalfem. JHrntal Sptrabasanrr. ROMANTIC IDEAS OF REAL LIFE; ARDENT AND EXALTED FANCY? PLEA- SURABLE FEELINGS ; FREQUENT PULSE ; GREAT ACTIVITY ; EKE KEEN AND LIGHTED UP J COUNTENANCE CONFIDENT AND ANIMATED. The merit or demerit of this species, named from the rhetoricians elatio, and with them importing " elevated, exalted, magnificent style or imagery," must, I fear, mainly rest with the author himself. It is, however, strictly derived from nature, and is intended to fill up what has hitherto been left as a vacant niche by the nosologists. Alusia, or hallucination, like ecphronia or insanity, comprises a list of affections that arc characterized by two opposite states of nerv- ous 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 lat- ter 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 destructive under the second. This species embraces the following varieties:—• a, Heroica. Chivalry. Romantic gallantry. p Facetosa. Crack-brained wit. v Ecstatica. False inspiration. $~ 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 imaginaton 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 "tne attention could once be seriously engaged, capable of being GE. III.—SP. I ] NERVOUS FUNCTION. 9j 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|fcntimental 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, Amadisof 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 Quixotte 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 coun- try, 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 Shakspeare felt himself under in making all his maniacal charac- ters, whether really or but pretendedly so, deeply versed in the prose or poetical romances ofthe day, and throwing forth fragments of exquisite force or beauty in the midst of their wildest and most discordant 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 t» picturesque customs: D6 NEUROTICA. [CL. IV.—OR. I. "You must si 113" Down a-down an you call him adoion-a. O, how the wheel becomes it! It is the false steward that stole his master's daughter." We have not space for the explanation, but it may he found in the commentators, or in the interesting and elaborate history of " Shakspeare's Times," by my early and valued friend Dr. Drake. The second variety of the present species, that of crack-brained wit, is derived rather from the peculiar 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 fa'ce.ious 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 i-resistible a propensity »o 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 appre- hension necessary to constitute the one is widely different from that necessary 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 minstreh was commonly denominated the king's fool, as uttering from the unbridled 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. GE. III.—SP. I.] NERVOUS FUNCTION. or The morbid afflatus has often been aped by cunning impostors 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 ecstacies, and especially of inveigling them into a hearty belief of their own miraculous powers. When the passions of men are once set afloat, and the subject presented to them is full of the marvellous and the terrible, they are too apt to confound the false with the real, and are prepared to proceed to whatever extremities the magician may choose to lead them. We are told by Lucian that when Archelaus,a celebrated Greek actor, perform- ed the part of Andromeda in the tragedy of Euripides, several of the spectators were seized with delirium; some at the time of performance, others a day or two afterwards; during which they did nothing but declaim in a theatrical manner, and piteously lament the fate ofthe persecuted princess. Burton, therefore, has some reason for remarking that what the impostors before us, or the brain-sick enthusiasts whom they imitate, once broach and set on foot, " be it never so absurd, false, and prodigious, the common people will follow and believe. It will run like murrain in cattle, scab in sheep. Nulla scabies superstitione scabior; as he that is bitten by a mad dog bites others, and all in the end become mad. Either out of 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 relations 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 fom the flame of purgatory ofthe 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 ofthe Saints, in loco. IT^* TTI XT 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, he 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 Lamisin, 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 GE. 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. fl&jiorfionfrrfeni. 2,oto Sbpivits. GLOOMY IDEAS OF REAL LIFE ; DEJECTED SPIRITS ; ANXIETY *, DYS- PEPSY ; LANGUID PULSE; INDISPOSITION TO ACTIVITY; EYE OBLiqUE 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 occasins, 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 inven- tion, 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 Diodes, a contemporary physician of reputa- tion, had done in his Book on Gastric affections, as a simple disease of this organ. The controversy has been in different times con- tinued to our own day ; and it does not seetn to be even yet univer- sally settled whether hypochondrias should be regarded as a mental or a dyspeptic malady. In Pinel the disease seems to be included under alienation mentale and its different varieties, to be distributed, though without particular remark, amidst the five species into which he has divided that genus. 100 NEUROTICA. [CL. IV—OR. I. The present species bears so near a resemblance to several of the varieties of genuine melancholy as to be often distinguishable from them with great difficulty ; and the more so as it is no uncommon thing for hypochondrias to terminate in melancholy, or for melan- choly to be combined with hypochondrias. Both may be the result of a predisposing constitution, or may be primarily induced by acci- dental causes where no such constitution exists ; and the predispo- sition 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 prccurser of both. And in like manner a sedentary life of any kind, and especially severe study protracted to a late hour in the night, and rarely relieved by social intercourse, exercise, or nugatory amusements; a debauched and dissolute habit, or excesses in eating and drinking, may become causes of either of these mala- dies from accessory circumstances that cannot be traced out even where the predisponent temperament does not seem to exist. But it is very justly observed by Sir A. Crichton, that even in those "whose health is much deranged, true melancholy seldom arises, except mental causes of grief and distress join themselves to the corporeal ones : and this constitutes one of the characters which distinguishes melancholia vera from hypochondriasis. The former may be said to be always excited by mental causes, and consists in various 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 peri- odical or other habitual discharge, as that of an issue, or of a hemor- rhoidal flux, a chronic ulcer, or some external eruption. The melancholy man seldom lives long, and his disorder often commences in the meridian of life. He frequently terminates his days by violence, or at the utmost never attains old age. The hypochondriac seldom becomes affected till after the meridian of life, and very generally continues to the stage of longevity. The common corporeal symptoms are a troublesome flatulency in the stomach or bowels, acrid eructations, costiveness, a copious dis- charge of pale urine, spasmodic pains in the head and other parts of the body, giddiness, dimness of sight, palpitations, general sleep- lessness, and an utter inability of fixing the attention upon any sub- * Of 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 varieties: * Autalgica. Vapours. .fi Pertaesa. Weariness of life. y Misanthropica. Misanthropy. Spleen. In the first variety, which is commonly distinguished by the name of vapours, or low spirits, the patient is tormented with a visionary or exaggerated sense of pains or some concealed disease ; a whimsical dislike of particular persons, places, or things; or groundless apprehensions of personal danger or poverty. Greding gives an account of a medical practitioner who applied to him for assistance, under an impression that his stomach 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 tad- poles. He had spent his life in trying to expel this imaginary evil, and had travelled to numerous places to consult the first physicians of the day upon his obstinate malady It was in vain to attempt convincing him that the gurglings or borborygmi he heard were from extricated and erratic wind. He argued himself, says M. Greding, into a great passion in my presence, and asked me if I did not hear the frogs croak. I have at this moment under my care, a hypochondriac of about fifty years of age, who affords sufficient proof that Moliere drew his Malade Imaginaire from nature, and hardly added an exaggerating touch. His profession is that of the law ; his life has been uniformly regular, but far too sedentary and studious; without having any one clearly marked corporeal affection, he is constantly dreading every disease in the bills of mortality, and complaining one after another of every organ in his body; to each of which he points in succes- sion as its seat; especially the head, the heart, and the testes. He now suspects he is going to have a cataract, and now frightens him- self with an apprehension of an involuntary seminal emission. It is rarely that I have left him half an hour, but I have a note to inform me of some symptom he had forgotten to mention, and I have often five or six of these in the course of the day. The last was to state that shortly after my visit he had had a discharge of three drops of blood from the nose—a change which he thought of great 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 without opiates ; his pulse is variable, sometimes hurrying on abruptly, and without any obvious cause, to a hundred strokes in a minute, but often very little quicker than in a state of health. His tongue varies equally, and is irregularly clean, milky and brownish, and then suddenly clean again. He is irritable in his temper, though he labours to be calm; and is so rooted to his chamber that it is difficult 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 incle- ment 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 call- ed by Pechlin suffocatio hyfwchondriaca ,-* 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 Donutus 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 arc 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 Vith ghosts or hobgoblins. They dare not go over a bridge or near a pool, rock, or steep hill, lest they should be tempted to hang, drown, or precipitate themselves: and if they come to a place where a robbery or a murder has been committed, they instantly fear they are suspected. Trincanvellius had a patient that for three years together, could not be persuaded but that he had killed a man, and at length sunk into a confirmed melancholy, and made away with himself for fear ofthe gallows, f It is a melancholy reflection that the wisest and best of mankind are as open to this affliction as the weakest, and perhaps more so. Pascal himself was at one time so hallucinated with hypochondrism, as to believe that he was always on the verge of an abyss into which he was in danger of falling. And under the influence of this terror he would never sit down till a chair was placed on that side of him on which he thought he saw it, and {bus proved the floor to be substantial. Under the second variety we meet with atotally distinct setof morbid feelings and ideas ; for the patient is here oppressed with a • Lib. I. Obs. 31. | Consil. XIII. Lib. I. GE. III.—SP. II.] NERVOUS FUNCTION. 105 general listlessness and disgust; an irksomeness and weariness of life, often without any specific reason whatever. This is the me- lancholia Anglica of Sauvages, who describes it as common to our own countrymen, under the attack of which, says he, «languid, sor- rowful, tired of remedies of every kind, they settle their affairs, make their wills, take leave of their friends by letters, and then put an end to their lives by hanging, poison, or some other means: exhibiting a wish to die, not from insanity, or severe grief, but tranquilly, from a mere tsdium vitas, or irksomeness of existence." This may occasionally be the case; but by far the greater number of suicides in our own country proceed not from hypochondrism, but a despondency produced by real losses, and belong, therefore, as I have already observed, to the genus empathema. Yet this miserable upshot occurs in a few instances from the feeling, or rather the want of feeling here assigned: the perpetrators of the horrid deed being generally those who having been actively en- gaged in the heigh-day and meridian of life, have retired upon their fortunes with a view of enjoying them in quiet; but who un- happily find themselves fitted for any thing rather than for quiet; who have no taste for reading, reflexion, or domestic tranquillity, and are too proud to return to the bustle of the world and the ex- citement of 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 fifty years of age. He got tired of these in a few months, and hav- ing no other resource, shot himself.* Burton has well described the state of mind of many that are tor- mented with this most wretched malady :f but still more so those affected with the third variety, which is strikingly accompanied with peevishness, general malevolence, and an abhorrence of man- kind. " They are soon tired with all things ; they will now tarry, now be gone ; now in bed they will rise, now up, then go to bed; now pleased, and then again displeased; now they like, by and by dislike all, weary of all; sequitur nunc vivendi nunc moriendi cupi- do, saith Aurelianus:}: discontented, disquieted: upon every light • Zoonom. Vol. IV. p. 90. Edit. 8 vo. t Analysis of Melanch. Part I. Sect. III. i. 2. i Lib. I. Cap. VI. 104 NEUROTICA. [CL. IV.—OR. I. occasion or no occasion or object; often tempted to make away with themselves; they cannot die, they will not live: they complain, weep, lament, and think they lead a most miserable life: never was any man so bad. Every poor man they see is most fortunate in respect to 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 division of mental alienation, more may often be accomplished by medicine; though we must by no means be inattentive to moral discipline. 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 Dysfiefi- s/o,are manifestly called for and will often be found serviceable. Post-obit examinations have also frequently pointed out another local cause which otherwise we should little expect; and that is a displacement of the transverse colon. M. Pinel, as we have already observed, regards this as a very common cause of insanity in all its forms; but there can be no question that it is a powerful and ready cause of the present species of mental alienation. M. Esquiral, who has found it as frequently as M. Pinel, tells us that this displacement sometimes consists in an oblique, and sometimes in a perpendicular direction of the intestine, so that its sinister extremity lies behind the pubes; whilst it has sometimes descended into the form of an inverted aorta even below the pubes and into the pelvis. No disease of the organization has been found in any instance, and hence the change of place must proceed from relaxation and debility alone, where the misposition is not connate ; on which account it may, in some instances, be an effect, as it is certainly a cause in others. It is under these circumstances that we chiefly meet with that pain in the epigastrium to which we have already adverted, and which GE. III.—SP. II.] NERVOUS FUNCTION. 105 gives the feelings 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 opera- tion 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 ofthe lower belly; and it is possible that the intestine may gradually right itself under a course of the warmer tonics, as columbc, canella alba and cassummuniar, or lose its morbid irritability by habit. But these are rare terminations ; for more generally the displacement increases and the disease itself gains ground and becomes more incurable. Congestions from weakness of vascular action in one or more of the abdominal viscera, are a frequent result of the present com- plaint, and not unfrequently a primary cause : and hence we may see why the bleeding piles should be serviceable in so many in- stances as to obtain from Alberti the name of medicina hypochondria* corum,* and why leeches repeatedly applied to the anus, as recom- mended by Schoenheyder, should often have a like beneficial ef- fect.f 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 recom- mended by Deidier and other respectable writers; and readily had recourse to by hypochondriacs themselves to relieve their distress- ful 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 patient 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 conversation produce a deeper effect than they seem to do. Loqua- city 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. t Act Soc. Med. Hafn. II. p. 313. t Mat. Med. Vol. If. p. 245. Edit. 4to. Vol. Ill— O T06 NEUROTICA. [CL. IV.—OR. I. tive. In the antalgic variety in which he is perpetually haunted with a feeling of some dreadful disease which exists no where but in his own fancy, the hallucination, when we possess his confidence, should be removed by a candid statement of the fact, and if necessa- ry, friendly expostulation : but the moment we find the preposses- sion is too strong to be removed by argument, it is better to humour the conceit and to pretend to prescribe for it. It is sometimes ne- cessary, indeed, for the hypochondriac is often possessed of great cunning, to drop all pretensions whatever, and to put him in good earnest upon a course of medicines for a disease we know he is as free from as ourselves. Thus, a firm belief that he has an invete- rate itch is a common delusion with a patient of this kind, and it will be often found impossible to persuade him that he is cured till his whole body has been repeatedly rubbed over with sulphur or hellebore ointment. 1 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 injections for a gleet which he said accompanied it, though he had no dis- charge whatever. It was in vain to deceive him by suppositious medicines, for he was a man of considerable learning, and well acquainted 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 tsedium vita?, where the time seems to hang intolerably heavy on the patient's hands, from his having, in a mistaken search after happiness, relinquished a life of constant ex- citement and activity for the fancied delights of rural retirement and quiet, the best and most radical cure would be a return to the situa- tion that has been so unfortunately abandoned : but if this cannot be accomplished the patient must be put into a train of pursuits of some other kind. If he be fond of the sports of the country, he should weary himself in the day time with hunting or shooting, or even horse-racing rather than be hypochondriacal from idleness ; and spend his evenings in the bustle of dinner parties or cards. And if he be capacified for higher and more useful occupations, let him plunge headlong into the public concerns ofthe parish and its neigh- borhood, become a member of its select vestries, a trustee of the highways, or a magistrate of the district. The habit of excitement must for some time be maintained though it be afterwards let down by degrees: and the intermediate steps are of no great importance so tar as they answer their purpose. We are not at present argu- ing the case upon a principle of ethics or of religion; but merely upon a principle of moral medicine. Yet I have often known per- sons of the above description broken in by degrees to a love of do- GE. in.—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. APHELX1A. inactivity of the attention to the impressions of surrounding objects during wakefulness. Aphelxia is derived from m.tpt'hca "abstraho, retraho, avoco, ab- duco;" 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, whereby they are made capable of being roused or excited by the different objects addressed to them ; and an exercise of the faculty of attention 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 ofthe mind, into a state of exertion or of allowing it to be in- dolent; and it is chiefly upon this want of power, or the same power intensely exerted, that the phenomenon of revery depends; thus giving rise to the three following species of mental aberration: 1. APHELXIA SOCORS. ABSENCE OF MIND. 2.--------INTENTA. ABSTK ACTION OF MIND. 3. —■——— OTIOSA. BROWN STUDY. 108 NEUROTICA. [CL. IV.—OR. I 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 con- sent of the will to relax itself, and give play to whatever trains of ideas are uppermost or most vivacious in the sensory. SPECIES I. APIIELXIA SOCORS. ^hscnrc of $&mtf. 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 langh 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 ofthe 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 is no attention whatever the case must necessarily verge upon fatuity. In early life the attention, like every other faculty of the mind, is weak and wandering, is often caught with difficulty and rarely fixed upon any thing. Like every other faculty, however, it is capable of being strengthened and concentrated; and may be made to dwell upon almost any object proposed. But this is a work of time, and forms one ofthe most importai t 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 ar- rested 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 disco- ver a considerable capacity and genius if the department were chang- ed 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 re- lated by Sir A. Crichton, in a young patient under the care of Dr. Pitcairn and himself, which, though some other circumstances ap- pear 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 gen- tle and calm, but somewhat unsociable His absence of mind was extreme, and he would sometimes willingly sit for a whole day without moving. Yet he had nothing of melancholy belonging to him; and it was easy to discover by his countenance that a multi- plicity of thoughts were constantly succeeding each other in his imagination, many of which were gay and cheerful; for he would heartily laugh, at times not with an unmeaning countenance, but evidently from mental merriment. He was occasionally so strangely inattentive that, when pushed by some want which he wished to no NEUROTICA. [CL. IV.—OR. I. express, if he had begun a sentence, he would suddenly stop short after getting halfway through it, as though he had forgotten what else he had to say. Yet when his attention was roused and he was induced to speak, he always expressed himself in good languaage 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 limes 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 exer- cise 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 unu- sual 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 ge- nerally 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. bE. IV.—SP. H.] NERVOUS FUNCTION. Ill SPECIES II. APHELXIA INTENTA. gltetractfon of $&inn. THE ATTENTION WOUND UP AND RIVETED TO A PARTICULAR SUBJECT; WITH SYMPATHETIC EMOTION OF THE MUSCLES AND FEATURES CON- NECTED WITH ITS GENERAL DRIFT. In this species the faculty of attention, instead of being feeble, or contumacious to the will, is peculiarly strong, and vehemently ex- cited, and acts in perfect co-operation with the will itself And in many instances the sensorial energy maintained is so great, and de- mands so large a supply of sensorial power, as apparently to exhaust the entire stock, except indeed the reserve which is in almost all cases instinctively kept back for the use of the vital or involuntary 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 spokeu to or conversation may take place around him, or he may even be struck upon the shoulders without any knowledge of what is occurring. Abstraction of mind maybe produced by various causes, but the following are the chief, and form two distinct varieties : a Aphelxia a pathemate. From some overwhelming passion. 0 Aphelxia a studio. From intense study. Of the first variety we have already offered abundant exam- ples in the two preceding genera ; and especially in the cases of ungovernable joy or rapture, grief and despondency; under the in- fluence 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 themselves 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- • Blumenb. Bibl. I. p. 736. | Darwin, Zoonom. III. I. ii. ?, 112 NEUROTICA. [CL IV.—OR. I. ment, as well as the attention, are jointly called into action and kept equally upon the stretch. Of the power of this variety of revery in rendering an individual torpid and almost dead to all around him we have a decided instance in Archimedes at the time of his arrest. When the Roman army had at length taken Syracuse by stratagem. which the tactics of this consummate engineer prevented them from taking by force, he was shut up in his closet, and so intent on a geometrical demonstration, that he was equally insensible to the shouts of the victors, and the outcries of the vanquished. He was calmly drawing the lines of a diagram when a soldier abruptly en- tered his room and clapt a sword to his throat. " Hold, friend," said Archimedes, " one moment, and my demonstration will be finish- ed." The soldier, surprised at his unconcern at a time of such ex- treme peril, resolved to carry him before Marcellus; but as the philosopher put under his arm a small box full of spheres, dials, and other instruments, the soldier conceiving the box to be filled with gold, could not resist the temptation and killed him on the spot. SPECIES III. APHELXIA OTIOSA. Urofon Stutrg. LEISURELY LISTLESSNESS J VOLUNTARY SURRENDER OFTHE 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. III. I. ii. 2. and again IV. II.iv.2. CE. IV.—SP.III.] NERVOUS FUNCTION. US 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 st"!l deceiv'd, some stranger's near approach. 'Tis thus the understanding 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 studiously 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 ; whileothers 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 inte- resting 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. III.—P 114 NEUROTICA. [CL. IV.—OU. 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. PARONIRIA. SleejMBistttrfoince. THE VOLUNTARY ORGANS CONNECTED WITH THE PASSING TRAIN OF IDEAS, OVERPOWERED BY THE FORCE OF THE IMAGINATION DUhING DREAMING, AND INVOLUNTARILY EXCITED TO THEIR NATURAL OR ACCUSTOMED ACTIONS : WHILE THEOTHCR ORGANS REMAIN ASLEEP. Paroniria, from 5r«/>* and o»£a», signifies, "depraved, disturbed or morbid dreaming." So in Dioscorides* Pvo-ovetpoi, signifies " tu- mtiltuosis et malis somniis molestans." In treating ofthe genus ephialtes, or night-mare,f 1 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 oneiro- dynia, 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 ':ure. * Vol. H. p. 127 f Vol. I. Ord. II. Gen. V. p. 338. GE V.] NERVOUS FUNCTION. 115 The three following species are so clearly and decidedly of one and the same family, as to prevent all dispute in their present posi- tion. They are here, however, associated for the first time in a genus distinct from ephialtes. 1. PAHONIRIA AMBULANS. SLEEP-WALKING. 2----------LOQUENS. SLEEP-TALKING. 3----------SALAX. NIGH 1-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 autho; 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 thoseof the body as to the effect produced upon them. Some of them, as the will, the perception, the judgment, are in a state of general torpitude like the voluntary organs of the body; while the memory and the imagination, like the vital or involuntary organs of the hody, 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 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 Traumern und Nachtwaudlern. Weimer 1784. Horst, De Natura, Differentiis et Causis eorum qui dormientes ambulant, 116 NEUROTICA. [CL. IV.—OR. I the third species of the genus, or that which consists in dormant and involuntary salacity. SPECIES I. PARON1RFA AMBULANS. Somnambulism. Slrrj)~&*faIfctHg. 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 state 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 exhaustion sustained by the organs or faculties that have been less employed, in consequence of the share of sensorial power which, as from a common slock, 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 C»E. V.—SP. I.] NERVOUS FUNCTION. H7 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 ofthe 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 ofthe 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 stomach; 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 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. 144. 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. Ycates, 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 coolly 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 LOQUENS. Slecaj=^aUtfufl. 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 ofthe 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. jig 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 assumption of a character which he finds introduced into the dream, to draw from the dreamer the profoundest secrets of his bosom, the dreaming ideas generally consisting of those on which the dreamer is most employed when awafce, 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. 3&fflnt=$oilutiou, THE SEXUAL ORGANS EXCITED INTO VENEREAL ACTION BY THE FORCE OF THE IMAGINATION DURING DREAMING. By Sauvages this affection is absurdly placed among the species of gonorrhoea, which, with great looseness of generic character is de- fined "passio cujus praecipuum symptoma est ftuidi fiuriformis vel seminiformis effluxus stillatitius ex urethra." This definition is, in- deed, wide enough to embrace the affection before us; but the ab- surdity consists in intermixing a natural discharge produced by the ordinary orgasm with morbid discharges, in which, in most cases, there is no orgasm whatever. Dr. Cullen, however, has continued to assign the same place and the same name to the present species, and this with still greater inconsistency; since he has struck out of his definition of gonorrhoea the epithet seminiformis, and confined it to a " fluxus humoris ex urethra firater naturam." So that he has been obliged to break his own bounds to introduce this natural flux no 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 dormientiu7n, 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 celebrated friend of the author's, the Reverend William Jones of Nayland, 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 occasion during his sleep, he composed a very beautiful little ode of about six stanzas, and set the same to very agreeable music : the impression of which was so firmly fixed in his memory, that on rising in the morning he sat down and copied from his recollec- tion, 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. CLE. v.—SP. in.] 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 ofthe 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, creduntse extollere vestem; Totius humorem saccatunn corporis fundunt; Quom Babylonica, magnifico spleivlore, rigantur. Turn, quibus aetatis freta primitus insinuantur, Semen ubi ipsa dies membris matura creavit, Conveniunt simulacra foris e corpore quoque, Nuntiae prseclari voltus pulchrique coloris, Qui ciet irritans loca turgida semine multo, Ut quasi transactis saepe omnibus rebus, profundant, Fluminus ingentcis 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 stiil greater number of the vegetable bitters, and particularly the ex- tracts of hop and lettuce. Dr. Cuilen, indeed, as we have already observed, supposes a sedative power to exist in all ihe bitters, though not equally in all. How far the Prussic acid might be em- ployed for this purpose I cannot say from personal practice: but if it really consist, as it is supposed to do, of the sedative principle of the laurocerasus or bitter almonds, it may possibly prove a very serviceable remedy. Our next object of attention should be to prevent all undue ac- • De Rer. Nat. IV. 1020. Vol. III.—Q 12£ 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 oft" 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 sensorial, 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 conse- quently 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. Pa- gani 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. * Journ. de Medicine, torn. LXXIV. GE. VI. NERVOUS FUNCTION. 123 GENUS VI. MORIA. iFatuftg. 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 de- note 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 Sauveiges to mental imbecility (moria imbecillis,) though, as already observed, he had just before used moria in the sense of me- lancholy. It is precisely in the signification now offered that the term is employed by Erasmus, in his celebrated treatise entitled u Moria Encomiuni" 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 morositatesare in fact " cor/iorea 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 ofthe powers of the mind operating upon the mind itself or upon the body. The present is founded upon a natural or permanent dulness, or hebetude of one or more of the same powers, producing a deficiency in the understanding, which, however, may be regarded as the ge- neral 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 imbecillis., imbecility. %,-'• — demens, irrationality, 124 NEUROTICA. [CL. IV.—OR. 1 SPECIES I. MORIA IMBECILLIS. JHeutal Xmftrcflftg. THE DEFECT OR HEBETUDE PARTIAL, OR CONFINED TO PARTICULAR FACULTIES OF THE UNDERSTANDING. We have already observed that all the faculties of the mind are as subject to a diseased disturbance as the organs of the body: and hence all of them are liable to be affected by the present species. The whole ofthe varieties, therefore, under which mental imbeci- lity is capable of being contemplated might form an extensive list: but it will be sufficient to confine ourselves to the four following: a. Stupiditas. Dulness and indocility of the appre- Stupidity. hension; torpitude and poverty of the imagination. /S Amnesia. Feebleness or failure ofthe memory. Forgetfulness. 7 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 dulness of several ofthe facul- ties besides the apprehension and the imagination ; and sometimes, perhaps, in all of (hem : 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 alusiajaceiosa, 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 fur- nished 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 vvant 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 dulness 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 dulness 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 temporally 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 chorogiaphy 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 civilzed 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 afar severer evil than dulness of • Essay concorning 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 do often 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, a 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 ofthe 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 impassions of all kinds from the senses, and therefore looked out ofthe window, although rather dark, to see if he could be made sensible of the situation ofthe house. The loss of memory gradually went off, and in less than half an hour his memory was perfectly re- covered."! This might possibly be connected with a gouty habit to which Mr. Hunter was subject, though not at this time labouring under a paroxysm. The late bishop of Landaff, Dr. Watson, gives a singular case of partial amnesia in his father, the result of an apoplectic attack. " I have heard him ask twenty times a-day," • Cent. II. Obs. 41. f Sir Everard Home's Life prefixed to his Treatise on the Blood, Inflamma- tion, &c. 4to. 1791. GE. VI.—SP. I.] NERVOUS FUNCTION. 1£7 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 ofthe head in many fevers a great inroad is frequently made upon the memory, and it is long before the conva- lescent can rightly put together all the ideas of his past life. Such was one of the effects of the plague at Athens, as we learn from Thucydides, rover JV text &>,(.>, e%Xf*£xve 7tx^xvtikx xtxcrrxirxq rut trx-Tm iftoieos' >cctt jjyv«jj the intensity of the light. When she had been there about tei days, she observed one evening at the time of sun-set that, first tte fringes of the clouds appeared red, and soon after the same cobur was diffused over all the objects around her, and especially ifihe 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 sjund 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 strcngly excited to throw off the impression easily—and that of the rec 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 retun of the same cause. Tie second variety of false sight or that in which the real objects appear changed in their natural qualities, is by Plenck de- norcinated, 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, trhle, 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 mista- ken for another, as red for green, green for yellow, or every hue appears alike. Examples of this imperfection are not unfrequent. Mr. Scott has given a singular instance of it in one of the volumes of the Philosophical Transactions,* and Dr. Priestly in another.t The last is especially worthy of notice as in some degree a family cefect; and was communicated to Dr. Priestly 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. LXV1II. 1778. p. 611. t Id. LXVU. 1777. p. 260. GE. I.—SP. VI.] NERVOUS FUNCTION. 145 qualities of objects; and hence he thought stockings were sufficiently distinguished by the name of stockings, and could not conceive the necessity of calling some red and others blue. He could perceive cherries on cherry trees, but only distinguished them, even when red-ripe, from the surrounding leaves, by their size and shape. One of the brothers appears to have had a faint sense of a few colours, but still a very imperfect notion : and upon the whole they seem to have possessed no other distinguishing power than that of light and shade, into which they resolved all the colours presented to them; so that dove and straw-coloured were regarded as white, and green, crimson, and purple, as black, or dark. On looking at a rain-bow one of them could distinguish it as consisting of stripes, but nothing more. Dr. Nicholl of Ludlow has published a case in the Medico-chirur- gical Transactions,* of the same kind, though the imperfection seems to have been confined to one or two colours alone. The pa- tient could easily distinguish the green of the grass or the leaves ofthe trees, but, like those in Mr. Huddart's statement, he confound- ed with the green the red fruit of flowers which happened to be inter- mixed with it. The false-sight in this case was also connected with paropis longinqua; for the patient saw objects at a greater distance than other people, and more distinctly in the dark. The irids were here, also, gray, with a yellow tinge round the pupil. The causes of these varieties are not always assignable ; many of them, however, are the same as have been pointed out under the variety of ocular spectres. Diplopia, or errors of number, have often been occasioned by long exposure to severe cold, sometimes by local spasm, sometimes by hydrocephalus.! Baumer gives a case produced by a wrong position of the pupil.$ Raghellini another caused by a double pupil.§ In Lentin is a singularly com- plicated example of objects seen triply.|| Where the disease is not structural, but dependent upon an en- tonic 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 employ- ed both generally and topically: and in the last instance by stimu- lant collyviums, 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, syspa- sia, syncope, plethora, cephalitis, and various fevers. * Transac. ofthe Medico-chir. Soc. Vol. IX. f Justi, Haldinger, N. Mag-. Band. XI. t>. 446. * Art. Hafn. I. Art. XXV11. § Lettera al S. Coechi sopra 1' offesa della vis*.a in una Donna. Venet, 1748. 1749. II Libr. II. Obs. 20 Vol. ITT.—T 14b NEUROTICA. [CL. IV.—OR. II SPECIES VII. PAROPSIS CALIGO. gtyafte <£ovntn> DIMNESS OR ABOLITION OF SIGHT FROM OPACITY OF THE CORNEA, OR SPOTS UPON ITS SURFACE. The Latin term caligo sufficiently explains the nature ofthe dis- ease,by importing "dimness, darkness, cloudiness, obscurity." In old English this filmy opacity was denominated " a web of the eye :" whence Shakspeare in King Lear, " This is the foul fiend Flibber- tigibbet; he gives the web and the pin, squints the eye, and makes the hare-lip." The pin is a variety of the synezesis, " closed or contracted pupil," or of one species 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 often, however, a common consequence of old age. Judging from the last species, we may place the usual proximate cause in a torpitude of the absorbents of the cornea, whence the finer and more attenuate parts of the secerned fluid are alone carried off, and the denser and grosser left behind. Hence stimulants and tonics, as blisters, weak solutions of brandy, camphor, alum, and nitrate of silver, are often found useful in the present day; as the saffron- coloured, or golden acrid juiceof the chelidonium majus, or greater celandine, diluted with water or milk, was formerly. The disease is often accompanied with or preceded by congestion ofthe vessels of the head, and consequently a stupid pain and hea- viness: and in some cases there is reason to apprehend that this affection ofthe 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 ofthe 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.—si>. v».] NERVOUS FUNCTION. 147 would probably answer as well. These plants in their recent state have very little smell; but their taste is extremely acrid, and when chewed they erode the tongue and fauces. Other German practi- tioners, however, as 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 fre- quently 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 suc- cess alone,f and Hufeland as satisfactorily in combination with warm bathing, and the internal use of millepedes :J the last of which, how- ever, may be spared without any serious risk. The disease 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 ©jjacttg. DIMNESS OR ABOLITION OF SIGHT FROM OPACITY OF THE HUMOURS. Glaucosis is a Greek term from yXxvxoq, "bluish or greenish-tint- ed," from the common colour of the obscurity. It was also called by the Greeks glaucoma, and by the Romans glaucedo. Glaucosis is here preferred to glaucoma, because the final oma imports usually, and, for the sake of simplicity and consistency, ought always to im- port external protuberance, as in staphyloma, sarcoma, and various 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 hu- mours, similar to that described under the last species; and is sometimes benefited by a like stimulant and tonic plan of treatment. Sennert calls it indeed a caligo, and distinguishes it by its proceed- ing from a defect of the aqueous humour—calgo, a defectu humo- risaquci; by which he seems to mean that the torpitude belongs • On the Principal Diseases of the Eyes. | Nouvelles Observations, &c. t Von Blathern. p. 159. *, Farr. Med. Conomun. II. 148 NEUROTICA. [CL. IV.—OR. II. rather to the excretory than the absorbent vessels; but, in this case, the cornea would appear depressed or flattened, which is rarely if ever a symptom. Both this and the preceding species have sometimes ceased spon- taneously,* without any apparent cause; and Helwigt gives an in- stance in which the cessation was not only spontaneous but sudden. They have also been carried off by fever. SPECIES IX. PAROPSIS CATARRACTA. Cataract. DIMNESS OR ABOLITION OF SIGHT FROM OPACITY OF THE ORYSTAL- » 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.a.rxp'pxa-o'a " to disturb, destroy, or abolish." K.x,rxppxx.Tw or xxt«pxk.tv<;, 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 being opened. And it is probably from this last sense that the term cata- ract 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 clo- ses his opposition to their view : Dicere porro oculos nullam rem cernere posse, Sed per eos animum utforibus spectare reclusis Difficile est.* To deem the eyes, then, of themselves survey Nought in existence, while uY 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 1 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. * De Rer. Nat. Ill 360. GE. 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 obacura, as that for amaurosis was gutta serena; the pupil in the 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 em- phatically 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. I oy gutta the Arabian wri- ters sometimes employed aqua ; and hence cataract and amurosis 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: « Lenticularis. 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 memhrane 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 Strars. Gott. 1773. 8vo. t WenzeJ, Traits de la Cataracte avec des Observations, Paris, 1786. 150 NEUROTICA; [CL. IV.—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 con- sistence ; 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 oirifie, as the soft by that of unrifie. il 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 com- mon 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 sometimes through only a part of it; while, however, the part that remains undissolved is rarely, if ever, so firm as the centre of the sound crystalline." Mr. Pott proposes it as a question, whether cataracts, 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 the 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 storm.$ Like paropsis Glaucosis or humoral opacity, it has sometimes ceased spontaneously, or without any manifest cause ;§ and Helwig gives an instance in which the cessation was not only spontaneous but sudden.|| It has also, at times, been carried off by a fever.lf There is hence, specious ground for conceiving that some medi- cine might be discovered capable, by some general or specific ac- tion, of producing a like change, and proving a remedy for the dis- ease ; and the more so as we find ganglions and other accidental deformities frequently removed from the extreme parts of the sys- * Chirurgical Observations relative to the cataract, &c. 8vo. 1775. London. ■j- De la Fontaine, Chirurg. Med. * Ritcher, Chir. Bibl. Band. VI. 158. § Hagedorn, Observ. Med. Cent. I. Obs. 50. Franc. 1698, 8vo. Ludolf, Miscell. Berol. torn. IV. 258. Walker, On the Theory and Cure of a Cataract. | Observ. Physico-med. 23, Aug. Vind. 1680, 4to. % Velschius, Episagm. 20. Gfi. 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,or protracted vomiting, electricity, and puncturing the tunics of the eyes, but without any certain advantage. This is the more to be lamented, because what- ever surgical operation may be determined upon as most 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 can readily imagine, but from the tendency which is sometimes met with from idiosyn- crasy, habit, some peculiar acrimony, or other irritable principle, to run rapidly into a state of ulcerative inflammation, and in a sin- gle night, or even a few hours, in spite of the wisest precautions that can be adopted, to endanger a total and permanent loss of vi- sion. I speak from personal knowledge, and have in one or two instances seen such an effect follow, after the operation had been performed with the utmost dexterity, and with every promise of success ; and where a total blindness has taken place in both eyes, the operation having been performed on both ; neither of them be- ing quite opake antecedently, and one of them in nothing more than an incipient state of the disease, and the patient capable of writing and reading with it. And hence it is far better in the author's opinion, to have a trial made on one eye only at a time, and that the worst where both are affected and one is still useful, than to subject both to the same risk; for the sympathy between them is so considerable, that if an inflammatory process from any constitu- tional or accidental cause should show itself in either, the other would be sure to associate in the morbid action. The usual modes of operating for the cure of a cataract, are three ; that of couching or depression : that of extraction : and that of ab- sorption. The first was well known to the practitioners of Greece and Rome; and is ably described by Celsus, who advises, in cases where the lens cannot be kept clown, to cut it into pieces with the sharp-edged acus or needle, by which mean it will be the more rea- dily absorbed. And from this last remark we have some reason for believing that even the third of the above methods, that of absorp- tion, was also known at the same time; as it is probable, indeed, that the second, or the operation by extraction, was likewise ; since we find Pliny recommending the process of simple removal or de- pression in preference to that of extraction or drawing it forth; " squammam in oculis emovendam potius quem 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 of 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 outerside 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 the vitreous is weak and inconaiderable : 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. l SPECIES X. PAROPSIS SYNIZESIS. Closctr JJuju'l. DIMNESS OR ABOLITION OF SIGHT FROM CONTRACTION OR OBLITERA- TION OF THE PUPIL. The term synizesis is derived from c-wiga,« consido, coeo, coales- co ;" and was used amongst the Greek grammarians before it obtain- ed an introduction into the medical vocabulary, to signify the coales- cence of two or more syllables into one. This species exhibits two varieties : x Simplex. Simple closure of the pupil. Simple closed pupil. GE. I.—SP. X] NER.VOUS FUNCTION. 155 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 ofthe 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 ofthe fine fringe ofthe iris by which it is surrounded. But in a very few instances the fringe or rays ofthe 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 hereditary.^ 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 in- stance of two pupils hereby produced,§ and Janin of not less than five.|| Dr. Plenck, who unnecessarily multiplies diseases, confines the term synizesis to a total contraction ofthe pupil; and makes its partial 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. Dec. HI. Ann. VII. VIII. Obs. 21. f Anat. Acad. Lib. VI. cap. 3. i Medinische Bermerkungen, p. 1. § Vide Marcel. Donat. Lib. VI. cap. ii. p. 619. || Memoires, &c. Vol. Ill—U 154 NEUROTICA. [CL. rV—OR. IT SPECIES XI. PAROPSIS AMAUROSIS. Btop Sbtvtnt. DIMNESS OR ABOLITION OF SIGHT WITH AN UNALTERABLE PUPIL, USUALLY BLACK AND DILATED ; BUT WITHOUT ANY OTHER APPARENT DEFECT. This is the gutta serena ofthe 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 doubtful as to which of the two diseases he ought to ascribe his own blindness: Thee I revisit safe And feel thy sovereign, vital lamp; but thou Revisit'st not these eyes, that roll in vain To find thy piercing ray, and find no dawn. So thick a drop serene has quench'd their orbs, Or dim suffusion veil'd,* The term amaurosis is derived from the Greek u/axv£os, "obscu- rus, caliginosus, opacus." The most common cause is a paralysis of the retina, usually in conjunction with a paralysis and dilatation ofthe iris. Occasionally, however, the iris is rigidly contracted* its debility being accompanied with great irritability ; and hence, offering two varieties; to which a third may be added, from the dis- eases assuming, at times, an intermittent type. * Atonica. With permanent, atony and dilatation Atonic amaurosis. of the pupil. £ Spasmodica. With a permanent contraction of the Spasmodic amaurosis. pupil. y Intermittens. With periodical cessations and re- Intermittent amaurosis. turns. 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. torn. IV. p. 77. Hev, Medic. Observ. and Inquir. Vol. 5. p. 1, GE. I.—SP. XI] NERVOUS FUNCTION. 155 stead of being black has evinced a pale or nebulous appearance.* In the first of these exceptions the disease has not acquired com- pletion : 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 ofthe 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 fiin or fiin-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 example already under P. Caligo, which he calls web-eye: another is contained in the following couplet: ■ -----Wish all eyes Blind with the pin and web. The existence of an amaurosis is known by the specific symp- toms of the pupil being peculiarly black and dilated, and the want of 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 accident. The black cataract has sometimes been confounded with it, or mistaken for it, of which we have just noticed an instance in Mil- ton, as has also that modification of the capsular cataract, in which the posterior lamina ofthe capsule is alone opake. The occasional cause is, therefore, for the most part incapable of being followed up. Richter contends that it is often dependent upon a dyspeptic state of the digestive organs ; and it has often occurred suddenly upon a plethoric state of the vessels, apoplexy, cephalaea, a blow on the head, or some other injury of the sensorium. It is also well known to be temporarily produced by the juice of the so- lanum or atropa Belladonna ; and in one or two instances perma- nently from an accidental inmission 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. torn. IV. p. 77. Gooet, Cases, Ed. II. p. 52. ) Bosnian, Beschreibung von Guinea, p. 369. Boyle, Tract, de Concord. Medic, Specific. 15b NEUROTICA. [CL. IV.—OR. H. suppressed catarrh, suppressed hemorrhages, or venesection when rendered habitual,* suppressed exanthems and eruptions of various kinds, especially porrigo, herpes, and scabies, by some sudden strain or other violence; or by some overwhelming passion of the mind as wrath or terror.f It has also appeared as a sequel or metastasis upon fevers; and succeeded to the vise 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 affection. Where we can decidedly trace its existence to plethora, whether entonic or atonic, or to some violent injury to the head, bleeding and purgatives are clearly indicated, but have frequently failed: for in the exquisitely tender organ of the eye, palsy is often induced before these evacuations can relieve the oppression. In the spasmodic variety active eme- tics frequently repeated, and resolutely persevered in at each time till the system becomes weakened, as in the treatment for the epidemic 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 water, has sometimes also afforded benefit Where it has followed on repelled eruptions, it has been occa- sionally found to yield to setons and blisters, or a restoration of the suppressed efflorescence : and, as in other diseases, what has some- times proved the sources of its production, has been found its best remedy, so that the cause has become the cure. Thus it has at times yielded to the violence of a fever, to that of a sudden blow on the head, to a strong light, to a paroxysm of convulsions. Elec- tricity, and especially 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- ^■c-ther unsuccessful; nor is the magnet without its recommendations, having been applied to the upper part of the spine, while minute br.gs 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 hi^ra. Of the arnica or German leopard's bane, Pellier, as well as Collier, speaks warmly. The latter recommends it in all nervous atonies, whether general or local. He employed the flowers of the , * Heister, Wahmehm. B. ft. p. 441. Bresl. Samml. 1726.1. 503. f Herculanus, Comm. in Rhazis Lib. IX. Richter L. C.p. 81. Schaarschmid, Med. und Chir Nachrickten 111. n. 18. * Redlin, Curat. Med. Milienar. n. 822. Oehme de amaurosis, p. 20. § Wurkung des Kiinstbichen Magnets, &c. p. 24, 25. Hell. v. Nootaagel, 1. c. § 22. Eph. Nat. Cur. Dec. II. Ann. v. Obs. 247. GE. L—SF. XI.) NERVOUS FUNCTION. 15r 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. Ritcher, Schmiicker and other German writers declare it to be of no avail. The Pulsatilla is certainly better entitled to attention. "I would recommend it," says Dr. Cullen with his usual liberality, « to the attention of my countrymen, and particu- larly to a repetition of trials in that disease so frequently otherwise incurable, the amaurosis. The negative experiments of Bergius and others are not sufficient to discourage all trials, considering thaat the disease may depend upon different causes, some of which may yield to remedies though others do not."t When distilled with water it gives forth a terebinthinate substance resembling camphor, which necessarily possesses a stimulant, and hence a medicinal power. Whence the eruphrasia officinalis, or eye-bright, obtained the character it once possessed as a specific in this disease, it is difficult 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 atone 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.} Cheyillard conbined the use of antimonials with blisters : but cold applied externally, and cold bathing as recommended by Warner, will often be as much entitled to our attention, as any other process. Dr. Powell relates a case of sudden loss of vision, preceded by an acute cephalaea, in which an emetic was found, during the act of vomiting, abruptly to restore sight to the right eye (for both were affected) with a sensation as if a flash of lightning had taken place, but the vision was soon again lost. More than a twelve- month afterwards the patient tried emetics again : when, after the use of the second, the pupils of the eyes recovered the power of dilating and contracting on exposure to light, and preserved it till death, but the power of vision was not restored. During the whole of this case of blindness, the sense of hearing was peculiarly acute.§ * Prodigious enlargement and dropsy of the eye. Dr. Layard Phil. Trans. 1757-8. Vol. 50. p. 747. f Mat. Med. Vol' 11. Part II. Ch. V. p. 216. * Beobachtungen und Untersuchungen, &c. Band IT. Nurmb. 1767. § Trans. Med. Vol. V. p. 226. 15? NEUROTICA. [CL. rV.—OR. IT. SPECIES XII. PAROPSIS STAPHYLOMA. Urotuiirrant 25|>e. ENLARGEMENT OF THE BALL OF THE EYE ; PROTUBERANCE OF THECOR- NEA ; SIGHT DIM OR ABOLISHED. The term staphyloma is derived from crxtyvXy., " uva," a grafie, from the resemblance of the tumour to the pulpy and semi-trans- parent appearance of this fruit. Ritcher seems first to have pointed out the real nature of this disease ; which from the difference of its cause and prominent symptoms, may be considered as affording three varieties: x Simplex. From increased secretion of the Simple protuberant eye. aqueous or other humour: pupil transparent. /S 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 GE. 1.—Sl\ XII.] NERVOUS FUNCTION. 159 causes ; where there is no pain, which is usually the case, the second. In the second and third varieties the pain is frequently severe and shoots backward into the head, attended with constant restless- ness, heat, and other febrile symptoms, and at times with a sense of tension and fiery sparks, which frequently continue, not only till the 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 ofthe 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,f or vehement muscular action.! In the first variety, and where the cause consists in an atony of the absorbents ofthe 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 Ritcher. 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 §ure 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 takes place, and the pain still continues se- vere, nothing will more certainly afford relief than taking away the painful distention of the eye by making an incision into the 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 Transactions.|| The patient was a lad of thirteen years of age, engaged at the time in beating dung about a pasture He felt all at once a violent pain in his eye, which increased and was ac- * Act. Nat. Cur. Vol.11. Obs. 194. Saint Yves. Norveau Traite des Maladies des yeaux. Paris 1722, f I.ayared, Phil. Trans. Vol. 1.1758. + Prochaska, Mohrenheim Weiherischen Bcytrager, B. II. § Surgery, Vol. Ul. p. 319. ii Tract, de ductibus oculorum aquosisp. 120. Vol. 1. 1758. 160 NEUROTICA; [CL. IV.—OR. II. companied with an 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-ccp full of the accumulated liquid. The cyst, consisting apparently of a part of the sclerotic tunic which had been left, collapsed, and the next day was easily removed : when the wound healed without fur- ther inconvenience or disfigurement than that of appearing to have the eye closed. SPECIES XIII. PAROPSIS STRABISMUS. Sqttftttfttfl. 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 err^xQas, " 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 ofthe one eye is in unison with that of the other; aad, 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 fix them upon any object we please. And such is tire 1 ^E. I.—SP. XIII.] NERVOUS FUNCTION. 161 force of habit that they at length involuntarily associate in the same action, and it is difficult for us to give to the one eye a different direction from that ofthe 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 ofthe eye employed: and if they do, in the two former cases, the object still appears double; and hence, the neglected, or weaker eye, wan- ders and stares at one or at various objects, while the eye relied upon is fixed upon some other. And it is this divergence of the optic axes, this inaccordance of direction, or looking at different objects at the same time, that constitutes the present disease. It is obvious, therefore, that strabismus may have three varieties : x Habitualis. From a vitiated habit; or the custom Habitual squinting. of using one eye, and neglecting the other. 3 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 dependence 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 man- ner under the same want of discipline. In the third variety the difference of form or position, respects the situation or figure of the one eye compared with the other, or of the particular parts of the one eye compared with those of the other: in consequence of which the one is favoured and the other thrown into disuse. In this last varietv a complete cure is hardly to be expected. Vot TTT.—X 162 NEUROTICA. [CL. IV.-OR. If. Jn 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 to children ; for although the sight must hereby be restrained in each eye to a common line, the child will still use the sound eye alone, and leave the irregular eye unemployed. It is a better plan to affix some object near the orbit of the affected eye at such a distance that it may constantly catch and draw 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. SENSE OF HEARING VITIATED OR LOST. Paracusis is a term of Hippocrates derived from irxfXKovu " perpe- ram, depravate, vitiose audio." The mechanism of the ear is as complicated as that of the eye, and as admirably adapted, in all its parts, to the "perfection of the sense which constitutes its function. Its lobes, its entrances, its openings, its various drums, its minute and multiplied foramina, its delicate bones, all contribute to one common effect. Even the surrounding bones, and still more than this, the teeth, are in no small degree auxiliary to the same object; as the experiments of M. Perolle, given in the fifth volume of the Turin Transactions, have abundantly established ; as they have, also, that bone in general is a far better conductor of sound than air, alko- hol, or water. We may hence learn one very important use ofthe four minute bones deposited in the posterior chamber ofthe tympanum, the loss of any one of which impairs the hearing, and, in some instances, has produced total deafness : of which we have a striking proof in the case of a lad, described in the Philosophical Transactions, who had parted with the incus on one side, and both the incus and mal- leus on the other, by means of an ulcerated sore throat that opened CE. II.] NERVOUS FUNCTION'. ]«]o a passage from the fauces into each ear. and through which the bones were discharged. The tympanum, on the boy's recovery, seems not to have lost its vibratory power, for he was sensible of violent or sudden sounds, but altogether insensible to conversation, and apparently as deaf in the ear that had only 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 ofthe diseases ofthe 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 vision and blindness. As the eye is at times affected with illusory objects so is the ear with illusory sounds; and as, when the optic axes do not harmonize, as in strabismus, the same object may be seen double, so may the same sound be heard double when the 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 exquisite, have no cochlea. It has since been conceived by Sir Everard Home that it is the membrana tym- pani in which this fine feeling is peculiarly lodged,^ and that it de- pends upon the muscularity of this membrane : yet the same feeling has remained, and in a high degree, in persons whose membrana tympani has been ruptured. Paracusis asa genus includes the following species: I. PARACUSIS ACRI3. ACUTE HEARING. 2. --------— OBTUSA. HARDNESS OF HEARING. 3.-------—— PERVERSA. PERVERSE HEARING. 4. .-----.----- DUPL1CATA. DOUBLE HEARING. 5.------■ ILLUSORIA. IMAGINARY SOUNDS. 6. — ■ SURDITAS. DEAFNESS. * Vol. LI. No. 50. 1761. f Epi3t. Cent. IV. No. 40. * Phil. Trans. Year 1800. lb<4 NEUROTICA. [CL. IV.—OR. U SPECIES I. PARACUSIS ACRIS &cute H?rarfnfl. HEARING PAINFULLY ACUTE AND INTOLERANT OF THE LOWEST SOUNDS. This occurs occasionally as an idiopathic affection in nervous and highly irritable idiosyncrasies, and bears a striking analogy to that acritude of sight which we have noticed under paropsis lucifuga acris. It depends upon a morbid excitement, sometimes of the whole of the auditory organs, but more generally of some particular part, as the tympanum, or the labyrinth, and particularly the cochlea, or some of the internal canals. In many instances it seems confined to the branches of the nerve; and Bonet gives an instance of it from the very singular cause of a triple auditory nerve formed on either side.* It is found frequently as a symptom of ear-ache, head- ache, epilepsy, otitis, cephalitis, and fevers of various kinds. The sensation is sometimes so keen as to render intolerable the whisperings of a mere current of air in a room, or the respiration of persons present, while noises before unperceived become 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- phalitus 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 sympathise 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. CE. II.—SP. I.] NERVOUS FUNCTION. 165 the necessity of hearing any thing like a noise : a loud sound affects my eyes, and a strong light my ears. They seem to act reciprocally. My head is certainly not so bad, nor any thing like it, as it was at Clifton, but still the sudden attacks I have from over-exertion of the mental powers, or upon any other excitement, make me al- ways fearful I shall lose my senses." Injections of warm water, or a few drops of almond oil dropped into the ear will occasionally succeed in affording relief, by relax- ing the spastic tone of the vessels. But cold water and cold appli- cations about the ear, and even pounded ice where there is no ten- dency to a periodic rheumatism, by directly inducing torpitude, will, at times, have a better effect: laudanum may also be intro- duced into the ear and a blister be applied to its immediate vicinity. SPECIES II. PARACUSIS OBTUSA. ?Ijartmcss of Rearing. 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. t N. Anmerk. I. 5 Obser. Medico-Chirurg. XX, 8yo, 1718. 16u 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 whatever resinous part it possess, and a like inunction will be found the best means of destroying insects. Atonic or nervous deafness will often bid defiance to our utmost exertions: but it will sometimes yield to local stimulants and tonics; of the former are alkohol, ether, camphorated spirits, and the tinctures of the gum resins, as myrrh, amber, kino, balsam of Tolu, and blisters about the ear. Of the latter, cold water, and solutions of alum, white vitriol or other metallic salts. Where hardness of hearing is habitual and cannot be radically cured, we can only endeavor 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 conveni- ence, obliged to deviate from this direction, and to bend the tube into the segment of a circle by which some degree of power is al- ways lost. The metal of which the tube is made should be that which is found most sonorous, or, in other words, which most com- pletely reflects, instead of absorbing, the sound; and while the fun- nel or larger aperture is as wide as possible, the extreme end of the pipe cannot be too small. SPECIES III. PARACUSIS PERVERSA. ftrcbersc Rearing. 1 HE EAR ONLY SENSIBLE TO ARTlCULAE SOUNDS WHEN EXCITED li V 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, '.K. II.—SP.IU.j NERVOUS FUNCTION. IG; of almost any kind.* It consists, according to Sauvages, who seems to judge rightly concerning it, in a torpitude or paresis of some parts of the external organs, which in consequence of this additional sti- mulus, convey the proper sounds addressed to them beyond the membrane of the tympanum, in the same manner as the drowsy or those who are sluggish in waking, do not open their eyes, or ad- mit the light to the retina unless a strong glare first stimulate the exterior tunics. It seems, however, sometimes to depend upon an obstruction of the Eustachian tubes. Under the influence of this species it sometimes happens that particular sounds or noises prove a better stimulus than others though equally loud or even louder: as the music of a pipe, of a drum, or of several bells ringing at the same time. Holder relates the case of a man who never heard but when he was beating a drum;t and Sauvages a similar case of a woman who, on this ac- count, always kept a drum in the house, which was constantly play- ed upon while she was conversing with her husband. The latter gives another case of a person who was always deaf except when travelling in a carriage, during which time, from the rattling ofthe wheels, he was perfectly capable of hearing and engaging in con- versation. And Stahl gives an instance of like benefit derived from the shrill tone of a pipe.i. 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 masticatories, and injections, bark, valerian, alone or with ammonia, and a free use of the siliquose and coniferous plants as a part of the common diet. • Feiliz in Richter Chir. Bibl. Band. IX. p. 555. f Phil. Trans. 1668 No. 26. * Colleg. Casual. N. 76. and«5rT«^<,"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. It. already had occasion to observe, is also employed to express morbid external sensation of any kind, whether of touch, taste, smell, sight, or hearing : while by Dr. Young it is equally applied to one at least of the faculties of the mind, as in dysaesthesia interna, which he characterizes as " a want of memory, or confusion of intellect." This genus embraces three species as follow : 1. PARAPSIS ACRIS. ACUTE SENSE OF TOUCH OR GENERAL FEELING. 2.--------EXPERS. INSENSIBILITY OF TOUCH OR GENERAL FEELING. 3.--------ILLUSORIA. ILLUSORY SENSE OF TOUCH OR GENERAL FEELING. SPECIES I. PARAPSIS ACRIS. &cttte Sense of South. 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: x Teneritudo. Soreness. /3 Pruritus. Itching. V Ardor. Heat. ^ Algor. Coldness. In the first variety or that of soreness there is a feeling of pain- ful uneasiness or tenderness, local or general, on being touched with a degree of pressure that is usually unaccompanied with any trou- blesome 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 concomitant of de- bility, and may, in many instances, be regarded as the simple pain of debility, the uneasiness of an organ thrown oft" 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 CE. 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 ofthe 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 ofthe animal frame does not altogether depend upon an harmonious co-operation of the whole of tlie 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 and gradual, is accompanied with no uneasy sensation whatever; but if either be violent or sudden, a feeling of soreness is a certain result, of which we have daily examples in strains and spasms. There may perhaps be no great difficulty in accounting for this: but the more common cause of tenderness is of a different kind, and a cause which often operates when neither of these are present though it is often combined with them. In order that every part of an organ may play upon every other part with a feeling of ease and comfort, it is well known that through- out the entire system, not only every surface, but every, even the minutest, interstice in the tunics of the minutest vessels, is 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 a part of a mobile and lubricous effusion, are transformed into so many harsh and stationary goads. • Vol, in. p. SO. Vot.TTT___A » 186 NEUROTICA. [CL. 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 a vis a tergo, or a 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 alike 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 coagulate 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 can easily trace the principle that renders warmth, gentle friction, and such stimulants as spirits, balsams, and essential oils, of general advantage wherever the kind of ten- derness we are now describing occurs, and is unconnected with inflammation. The sense of itching, which may be defined a painful titillation, local or general, relieved by rubbing, is commonly a result of some mechanical or morbid irritant applied externally or internally to the part affected; though sometimes, unquestionably, dependent upon a morbid sensibility of the nerves of feeling themselves. If the sum- mit ofthe 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 Avith 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 fctill deeper, it is combined with a sense of piercing, which we call pricking, as when the keen hairs of several species of dolichos or cowhage are handled or blown upon the skin by a light breeze. UE. V.—SP. I.] NERVOUS FUNCTION. 187 In many cases all these modifications of itching are the effect of some acrimonious secretion on the surface of the body, or of an acrimonious change in the common matter of perspiration in con- sequence of its lodging in the cutaneous follicles longer than it should do. The papulous efflorescences we shall have to treat of under the third order of the sixth class will afford abundant 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 sensibility ofthe summits or extreme ends of the cutaneous nerves. This affection is also found as a very troublesome symptom in pernio and other cutaneous inflammations, as likewise in urticaria and other rashes. The sensations of heat and cold may be explained at the same time. An easy and 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 it does in every instance, excite a change in the bulk of living organs and the juxta-position of their particles; for it enlarges the former in every direction, and only does this by separating the particles from each other; in which forcible and sudden divellication we have a second source of the trouble- some and acute sensation which so constantly accompanies a tem- perature 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. Colo 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 Httle beyond this, and still 188 NEUROTICA. [CC. 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 produces uneasiness to the nerves of feel- ing by a process precisely the reverse of that we have just shown to be pursued by heat, and consequently in a two-fold manner. First by lowering the warmth of the organ, or of the system, below its scale of ease and comfort, and next by 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,f and the observation is quoted and called curious by Dr. Darwin, "that those people who have been confined some lime in a very warm atmosphere, as of 120 or 130 degrees of heat, do not feel cold, nor are subject to paleness of their skins, on coming into a temperature of 30 or 40 degrees; which would produce great paleness and painful sensation of coldness in those who had been for some time confined in an atmosphere of only 86 or 90 degrees." The cause is not difficult of explanation. The sensorial power is exhausted and the nerves of feeling ren- dered 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 syn- cope, hysteric syspasia, nausea, and atonic empathema; in all which the affection is general. • Tom. II. p. 348. f On Simple Fever, p. 168 r.E. v.—sp. ii] NERVOUS FUNCTION. 189 SPECIES II. PARAPSIS EXPERS. XnsenatJbfltts of Eouch, Gfeueral iFeeifng. THE ORGAN OF TOUCH TOTALLY IMPERCIPIENT OF OBJECTS AP- 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 accompanied with uneasiness. S Complicata. Complicated with insensibility in Complicated insensibility. several of, or all, the other senses. _ Occasional and local numbness is common to most persons. A tight bandage or accidental pressure of one limb upon another, by obstructing the flow of 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 ofthe 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 clearly show a tendency to paresis if not paralysis. But there are some persons who possess by nature a numbness or privation ofthe 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 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 ofthe Medico-Chirurgical Transactions. The patient aged 58, had been first affected in Jamaica about three years be- 190 NEUROTICA. [CL. IV.—OR. B. 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 the body, in his head, neck, back, shoulders, breast, arms, abdomen, he felt nothing whatever, and even laughed at the singularity of the phaenomenon ; as, with the exception of numbness, and cutaneous insensibility, he laboured under no kind of disease. The complaint continued two days, and seems to have yielded to venesection." Insensibility of touch, either simple or complicated, is also felt as a symptom of apoplexy, palsy, catalespy, 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 XUuaorg Sense of ./bcia/is, and n. filantaris, 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.---------MAMMJE. 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, ou le Tic doulou reux de la face. >rE VI.— SP. I.] NERVOUS FUNCTION. 193 are external, and serve to convey impressions peculiar to them- selves. It is, however, sufficiently known to every one that there is not an organ in the body but is possessed of nerves productive of a very different kind of sensibility from any of these, less distinct, perhaps, and elaborate, but the index of its weal or wear, its com- fort or disquiet: and which may be sufficiently expressed by the name of general feeling. It is possible, indeed, that this general feel- ing, may, in some degree, be differently modified in every organ ; but as the distinctions, whatever they may be, are not nice enough to trace out and arrange, as they are in the local senses, it is suffi- cient for all the purposes of pathology to regard this feeling as com- mon to all the sentient organs, and consequently as one and the same. We have already taken some notice of it in the proem to the pre- sent class,* and have observed that it has been described by some physiologists under the name of caenesthesis, and by the Germans is denominated gemeingefuhl, 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. fierfoe=acuc 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 AD- JOINING MUSCLES. This is the trismus maxillaris, or t. dolorijicus of M. de Sauvages, for it is not necessary to make a distinction between them as Sau- vages 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 • Ante, p. 18. f Commentatio de Cstnesthesi Dissert, lnaug. Mcdica.—Auctore, C.F. Hub- ser, 1794. Vol. III.—B b 194 NEUROTICA. [CL. IV.—OR. II in the present day. I shall have occasion to observe, more at large tinder the genus trismus, 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 pain makes its assault, resembling the bite of an insect; but, according to Sauvages and Soleyscl, 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 ofthe 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. When, however, the disease is seated in the seventh pair of nerves, we can be at no loss to decide concerning it, in consequence of the course and divarications of the pain, which commences with great acuteness in the fore part of the cheek towards the mouth and alae of the nose, sometimes spreading as high as the forehead, and rami- fying in the direction of the ears. At other times the forehead, temple and inner angle of the eye on the side affected, and even the ball of the eye itself, form the chief lines of pungent agony, while from irritation of the lachrymal gland the eye weeps involuntarily. In this case we may reasonably suspect the disease to be seated in some part of the superior maxillary nerve, constituting the second branch ofthe 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 s.eems sometimes to have been produced by cold, and sometimes by mental agitation in persons of an irritable temperament. But it has been found in the robust as well as in the delicate, in the middle-aged, as well as in the old. Andre appears to have been the earliest writer who remarked this painful affection with accuracy, and be succeeded in removing »,E. VI.—SP. 1.] NERVOUS FUNCTION. iOg 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 the next fif- teen 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. Thourel, and Pujol have each published a valuable paper on the same subject in the Memoirs ofthe 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 ofthe 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 ta speak at large when treating of the genus entasia in the ensuing order. « The nerves," remarks Dr. Parr, " that supply the eye externally and the slight connexion of the intercostal with the brain are nearly from the same spot in the cerebrum, and it did not seem improbable in the case alluded to, that the disease may have really been at the origin of the nerve, although felt as usual at its extremity." Dr. Parr was, in consequence, induced to try arsenic, and in one instance, he tells us with a decidedly good effect. It is also said to have been since found serviceable in a few other cases. In Mr. Thomas's hands, however, we shall presently perceive that it completely failed. Mercury is also reported t« have occasionally proved successful, and especially when carried to the extent of sali- vation ; though in numerous instances it has been tried even to this last effect without any benefit whatever. When about thirty years ago animal magnetism was a fashionable study in France, it was had recourse to for this disease among others, and had its day of favour as a popular remedy. Of late, however, 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 temporary benefit. " My father," says Dr. Percival of Dublin," in his manuscript comment on the present author's Nosology, was subject to neuralgia./ariez for several years, and used a variety of medicines 0 ig5 NEUROTICA. [CL. IV .—OR. 15 without relief. He was worse in close damp weather, and much worse when his mind was occupied. At length he had an issue in- serted in the nucha, kept his bowels free with James's analeptic pills, and exchanged a town residence for the country. In this si- tuation he soon threw off the disease, from which he was free for a considerable time before his death." Change of scene, a transfer of morbid action, and a recruited cheerfulness of spirits are valua- ble auxiliaries in the present as in every other nervous affection: but I much question whether these alone have ever operated a cure. A spontaneous cure is the work of time alone; and time, though often a long and tedious period is requisite, will generally accom- plish it, and probably did so in the case before us. The fact is that the nervous system in every part, and every ramification, becomes gradually torpefied by excess of action ; and as the eyes grow blind and the nostrils inolfacient by strong stimulants applied to them, so the nervous twigs of every kind, after a long series of irritation from the present disease, become exhausted of power and obtuse in feeling. In the mean while the only artificial cure is to be found in a di- vision of the affected branches, provided they can be followed home. Dr. Haighton completely succeeded some years ago in a case in which he divided the suborbital branch of the fifth pair; and Mr. 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 artery near the centre of the ear next the cheek, which gave also a chance of dividing a branch of the affect- ed nerve; but without success. Internally opiates were administer- ed in large quantity when the pain was exceedingly violent : bark being used freely in the intervals, but without effect. The pain spread in various directions from a point in the left cheek a little before the ear, sometimes to the nose, and forepart of the lower jaw, and sometimes to the orbit of the eye on the same Bide; 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 irrt- GE. VI.—SP. I.] NERVOUS FUNCTIO.N. 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 ofthe 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 ofthe nose, and also made some smaller incisions about the ala nasi. To divide the great branch lying below the zygomatic process, I found it neces- sary to pass the scalpel through the masseter muscle, till it came in contact 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. 19b NEUROTICA. [CL. IV.—OU. 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 Mr. Bos- worth's case he has expressly noticed the morbid stretching of the arms, and the tendency to epileptic actions. SPECIES II. NEURALGIA PEDIS. f£eroe=ache of the iPoot. 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 alter- nated with other nervous affections, and was at length complicated with convulsive asthma. In calling, as I believe for the first time, the attention ofthe 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 ther GE. VI— SP. IIJ NERVOUS FUNCTION. 199 lately occurred to me in a clergyman of this metropolis, about for- ty-five years of age, but otherwise in firm health and cheerful spi- rits. He had for many years been a victim to it. The paroxysms • were short and of uncertain recurrence, but so acute as nearly to make him faint, and at length compelled him to relinquish the du- ties of the pulpit, for which from his zeal and eloquence he was ad- mirably qualified, but where he had frequently been obliged to break off with great abruptness from the unexpected incursion of a fresh paroxysm. The pain usually extended up the calf of the leg towards the knee, and ramified towards the toes in an Opposite direction, and was usually compared by himself to that of scalding verjuice poured over a naked wound. The tibial branches ofthe 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 ofthe offsets from the peroneal branch associate in some instance in the morbid action. Every therapeutic process that the art of medicine in the hands of the most experienced physicians of this metropolis could devise, was in this case tried in a long and tedious succession in vain. Sometimes external and sometimes internal preparations, or a tight ligature, appeared to afford a temporary alleviation, and to protract the intervals: but never any thing more. It was in consequence proposed by a surgeon of great eminence to amputate the leg, which was at one time on the point of being submitted to, though 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 disease 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. NEUROTICA. tCL. IV.—OR. II. SPECIES III. NEURALGIA MAMMAE. 3iertoe=aehe of the JJreast. SHARP, LANCINATING PAINS DIVARICATING FROM A FIXED POINT INTHi 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 then eighteen years of age, who, for more than two years, had been subject to a painful disorder of the breast that seemed equally to defy all parallel and all mode of treatment. On examin- ing into the nature of the symptoms, 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 without inconvenience, but during the pain the whole breast was acutely sensible. The paroxysms returned at first five or six times in the course of the day, and were short and transient: but as the 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 compara- tively 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 frequent and vehement as to embitter her whole life, and incapacitate her from pursuing any employment, for it frequently happened that, if she attempted needle-work, her fingers abruptly dropped the needle a few minutes after taking hold of it, from a mixture of pungent pain and tremulous twitching. The twitching or snatches in rne 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 lancinating pain did not descend below the elbow, a considera- ble degree of trepidation reached occasionally to her fingers' ends. Her general health was in the mean time unaffected, and she was regular in menstruation. I had no hesitation in regarding this a non-descript species of neuralgia; and as little in communicating my fears that no plan of medicine we could lay down would be more than palliative, even if it should prove thus far beneficial, and that we must trust to time alone for a cure, and that obtuseness of sensibility which I have 200 r >- VI —SP. III.] NERVOUS FUNCTION. 201 : as a common consequence of high nervous irrita- t'l) 'he organ becomes exhausted and torpefied. ■>-.' .!•.;)■ >rocess was nevertheless, tried in succession,for f obtaining relief, if not full success. Bleeding, local frequency v d profusely repeated; purgatives of all :ics and antispasmodics of all kinds ; the hot and cold etricity and galvanism in every form; rubefacients, blis- ns, issues, and whatever else could be suggested, were .,. to scivice in succession. But every thing was equally v,i „j.:, vail: nor do 1 know that even a temporary relief was ob- uuiiC''. r>y any of these. Narcotics of all kinds proved impotent: ii j. ;,-ni..^b, indeed, and a comatose stupor were hereby in various •is.ai^es obtained, but the interval of wakefulness was as much as ever toi -r.ented with the same racking paroxysms. From the pow- vi-fui inhueuce of nux vomica in many cases of nervous affection, io some of which we shall have occasion to advert hereafter, I had jonie 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. III.—C c CLASS IV. NEUROTICA. ORDER III. CINETICA. Miacanai affecting the fflltimUB. IRREGULAR 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 ofthe 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 blood, or whether they form a CL. IV.—OR. III.] NERVOUS FUNCTION. 205 distinct system of fibres, merely attached to those of the muscles, is at present undecided. It is certain that tendons possess nothing of the peculiar structure of muscles, and seem to be more nearly allied to the simple solid. It appears singular, at first sight, that the tendinous fibres which thus seem to be compacted into a firmer and more substantial cord than those of the muscles, should be sometimes broken by muscular exertion, while the muscular fibres remain uninjured; yet this un- questionably depends upon their greater rigidity, and consequently, inability of yielding to the force by which they are opposed. And hence it is that the bones themselves are sometimes broken in the same manner as by a violent jerk, or a sudden and spasmodic con- traction, of which we shall presently meet with examples, espe- cially in the patella, the ribs, and the arm. The muscles them- selves, however, are occasionally ruptured by a like irregular vio- lence and excess of power, as the recti abdominis in tetanus, and the gastrocnemii in cramps. Muscular action then consists in a mutual attraction and concen- tration of the constituent fibres of muscles in a manner peculiar to living matter, for we cannot imitate it by any combination or action of mechanical fibres. It is not however a contraction in every di- mension, since in this case the muscular volume would be dimi- nished; but in length only, attended with a proportional increase of bulk so as to preserve the absolute vol»me unchanged, or nearly BO. It is easy to conceive, from these few remarks, that the force ex- erted by muscular ronti action may be enormous; but by the me- chanical physicians it was calculated in the most extravagant man- ner from premises in many instances wholly chimerical. Thus Borelli estimated the force with which the heart contracts in or- der to carry forward the circulation of the blood, to be equal to not less than 180,000 lbs. at each contraction; while Pitcairn, applying the same speculation to the function of digestion, conceived that this process is accomplished by a muscular exertion divided equally be- tween the stomach and the auxiliary muscles that surround it, amounting in the stomach alone to the force of 117,088 lbs. for which « had he assigned five ounces," says Professor Munro, "he would have been nearer the truth."* Yet we do not want these visionary calculations to prove the wonderful power possessed by muscular fibres; the facts we have already adverted to, and others we shall have to notice in the course of the present order, are suf- ficient to establish their astonishing energy, without having re- course to unfounded hypotheses, or exaggerated statements. In general, says Dr. Parr, in a very excellent article upon this subject,! it appears that the force with which a muscle contracts is in proportion to the number of its fleshy fibres, and the extent of • Monro, Comp. Anat. Pref. p. viii. t Med. Diet, in verb. Musculas. 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; though where the sleep is profound and le- thargic the diminution amounts to almost a cessation, except in the voluntary organs. When muscles are not exercised, the sensorial or irritable fluid moves forward with an easy flow: or in the words of Haller " the vis insita is very slightly exerted;" but we can still trace its influence by the position which the limbs assume and dis- cover the relative strength of the antagonising muscles. Thus we find the flexors stronger than the extensors; for during sleep, the head falls forward, and the body, legs, arms and fingers are slightly bent. The cause of this additional strength is easily explained; for the flexors have stronger and more numerous fibres; their insertion is farther from the centre of thoir 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, afterbirth, 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 characterized 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. CL. IV.—OR. raj 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 in a direct line from the sensorium, whence indeed the close connection they hold with it, the control the will exercises over them, and their catenation with the prevailing emotion of the 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 tenor of their action is more equable, more permanent, more uninterrupted, and less subject to fatigue or weariness. 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 ofthe 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- Japse, or by obviating the too sudden alteration of these states."* This proposition seems rather to follow from Dr. Cullen's singu- • Yol. I. Ord. II. Gen. V. p. 388, 206 NEUROTICA. [CL. IV—OR. 111. lar doctrine concerning the mutable condition of the energy of the brain, and the immutable nature of the nervous power which is pro- pagated from it by vibrations, than from the clear face of facts be- fore us. Spasms, in many instances, are altogether local; they are confined to particular muscles, or particular sets of associate mus- cles, and have no effect on the brain whatever so as to disturb its energy; of which we have examples in hiccough, priapism, cho- rea, and often in palpitation. They depend upon some irritation existing not at the origin, but at the extremity of the nerves: and, where such is their source, even though the chain of morbid action should at length reach the brain and affect its energy, as in convul- sions from teething, epilepsy from worms, or some palpitations from ossific or polypous concretions, all the antispasmodics in the world will afford no relief so long as the local cause of irritation continues to operate; while the moment this is removed, where it is capable of removal, as by the use of a gum-lancet or active anthelmintics, all the powers of the brain become instantly tranquillized; its 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. CONSTRICTIVE SPASM. II. CLONUS. CLONIC SPASM. III. SYNCLONUS. COMPLEX SPASM. RE. I] NERVOUS FUNCTION. -207 GENUS I. ENTASIA. (Eonstrfetfbe Spasm. IRREGULAR MUSCULAR ACTION PRODUCING CONTRACTION, RIOTDITY, OR BOTH. Entasia is derived from the Greek turxa-tf, "intentio," "vehe- mentia," " rigor," from «»««»», « 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. RABIkS. CANINE MADNESS. 8. ACROTISMUS. SUPPRESSES PULSE. SPECIES I. ENTASIA PRIAPISMUS. IJrtapism. 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. lcl. iv.—or. nr. 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 cantharidesas 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 trectores penis, unconnected with any stimulus arising from a fulness of the vesiculae seminales. Dr. Darwin says, he had met with two cases where the erection, producing a horny hardness, continued two or three weeks without any venereal desire, but not without pain. The easiest attitude was lying upon the back with the knees bent upwards. The corpus cavernosum urethrae at length became soft, and in a day or two the whole rigidity subsided. One of these patients had been a free drinker, had a gutta rosacea on his face, and died suddenly a few months after his recovery from the present complaint. It is 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. TOrg=3£eeft. rERMANENT 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, a»f uj, " 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 HE. I.—SP. HJ 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. C Irritata. From excess of muscular action on the Spastic wry-neck. contracted side. y Atonica. From direct atony of the muscles on Atonic wry-neck. the yielding side. The first variety is mostly congenital,though sometimes pro- duced by severe burns or other injuries. And a like effect occa- sionally issues from a cause that may be noticed in the present place, though not connected with a morbid state of the muscles; a displacement of the muscles from an incurvation in the 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 be found most serviceable, as tending to diminish pain, and restore action to the weakened organ. In direct spasms the same process will also frequently be found useful, but the application of cold water as a tonic and antispasmodic will often answer better. Where the 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 si*th class, under the head parosti \flexilis. Vol. Ill—D d 210 NEUROTICA. [CL. IV.—OR. 1M SPECIES III. ENTASIA ARTICULARIS. Jttuseular Stfff=fotnt. 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. S Atonica. From direct atony in the yielding Atonic stiff-joint. muscles. y Inusitata. From long confinement or neglect of Chronic stiff-joint. use. Besides the ordinary causes of cold, inflammation, and strains, by which the first and second varieties are produced, the former has sometimes 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 thigh bone. In a case of the latter kind, it was successfully attacked by Richter,|| with a cautery of a cylinder of cotton. In this and the third variety, much benefit is often derived from repeated and long continued friction with a warm hand, and particularly if illined with some stimulant balsam or liniment. In an obstinate contraction of the fingers succeeding to a fractured arm, Dr. Eason relates an instance in which the rigidity suddenly gave way to a pretty smart stroke of electricity after every other mean had failed, and the patient had the use of his fingers from this time.*f Such exercise, moreover, or exertion of the limb should be recommended as it may bear without fatigue. The cold bath, as an antispasmodic, has sometimes been serviceable in the first variety, and more fre- quently, as a tonic, in the second. • Starke, Klin. Instit. p. 32. f Paullini, Cent. I. 39. * Vit. Gabriel. § N. Magazin. Band XI. 78. D Chir. Bibl. Band X. 219. \ Edin. Med. Comment. V. p. 84. HE. 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 surprise 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 immovable, and cannot be forced into an imitation without the utmost awkwardness and fatigue. SPECIES IV. ENTASIA SYSTREMMA. (tvamp. SUDDEN AND KIGID 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 o-vo-TgtQ*, " contorqueo," " convolvo in fascem." Stremma, the primary noun, 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 of cramfius, which has hither- to been commonly employed, though at the same time commonly reprobated 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 with it. The parts chiefly attacked with cramp are the calves of the legs, the neck and the stomach. The common causes are sudden ex- posure to cold, drinking cold liquids during great heat and perspi- ration, eating cold cucurbitaceous fruits when the stomach is infirm 212 NEUROTICA. [CL. IV.—OR. HI. 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 ofthe 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 another quarter, will also frequently effect a cure : and it is to this princi- ple 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. t>" CE. I.—SP. IVJ 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 case it must be treated according to the methods already pointed out under those respective heads. SPECIES V. ENTASIA TRISMUS. &0TKeTr=$ato. permanent and rigid fixation OF the muscles of the lower jaw. This disease is by the French writers called tic The technical term is derived from the Greek «$i£«, " to gnash or grind the teeth;" which, like the French synonym, is supposed by the lexi- cographers to be an onomatopy, or a word formed from the sound that takes place in the act of gnashing. In truth it was to a disease in which morbid gnashing formed a 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.1V.—OR. IH tic to import a state of muscle directly opposed to that which it first indicated, is another striking proof of the incongruous change which is perpetually occurring in the nomenclature of medicine, for the want of established rules and principles to give fixation and a definite sense to its respective terms. Dr. Akerman is the only writer of reputation I am acquainted with in recent times, who has used trismus in its original intention ; or rather, who has united its original with its modern meaning. For he employs the term generically; and arranges under it the two species of trismus tonicus, being that now under consideration, and trismus clonicus, or the disease it originally denoted. But this arrangement is uncalled for, and inconvenient, and has not been re- ceived into general use : the term trismus being, with every writer ofthe 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 sfiecies 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 employed 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, u 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 continue limited to its specific symptoms. And as Dr. Cullen has * Pract. of Ehys. Book. III. Sect. I. Chap. I. § MCCLXVII. CE. I.—SI'. 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 ofthe causes* that affect the human race. These causes, for the most part, are chilness and damp operat- ing upon the body when heated, and hence sudden vicissitudes 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 t 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 : x Nasccntium. Attacking infants during the first Locked-jaw of infancy. fortnight after birth. £ Algidus. Occurring at all ages, after ex- Catarrhal locked-jaw. posure to cold and damp, es- pecially the dew of the eve- ning, the symptoms usually ap- pearing within two or three days. y Traumaticus. Occurring as the consequence of Traumatic locked-jaw. 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."J. 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 feature. The principle I • Bajon. Abhandlungen Yon Krankheit auf der Insol Cayenne, &c. f Delarochc, Journ de Med. torn. XV. p. 213. Foresius. Lib. X. Obs. 111. Schenck, Obs. L. 1. N. 250. * Pract of Pbys. Book. 1IT. Sect. I. Chap. I. § MCCXIX. 21G NEUROTICA. [CL IV.—OR. Ill 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 ofthe 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 further 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 a 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 continued chain of nervous fibres, however, this principle of sympathy which induces remote parts, and particularly remote ex- tremities, to associate in the same morbid action, is peculiarly con- spicuous. Hence, if a long muscle be lacerated in any part of its belly the tendinous terminations are often the chief seat of suffering. As the ulnar nerve sends off twiggs from the elbow to supply the fore-arm and fingers, a blow on the internal condyle of the humerus gives a tremulous sensation through the fore-arm and hand; and as the ulnar nerve itself is only an offset from a plexus or commissure of the cervical nerves which also give a large branch to the scapula, 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 ofthe 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 GE. I.—SP. V.] NERVOUS FUNCTION 217 inflammation of the liver, the top of the shoulder suffers, as form- ing the extreme point of the phrenic chain by which these organs are connected; and as the upper surface of the diaphragm is in di- rect contact with the left and very sensible orifice of the stomach, an uneasiness at the apex of the heart becomes the cause of irrita- tion to this orifice in consequence of its 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, is tetanus, neuralgia, lyssa, and hemicrania. And, although from the intricacy of the intersections and decussations with which various nerves pursue their radiating courses, it is impossible for us, in many instances, to determine why one line of connexion suf- fers while another remains unaffected, yet in most instances we may be able, by an accurate survey, to trace the catenation, and hence to obtain some insight into the physiology of these exquisite- ly curious and complicated disorders. In mapping the nervous ramifications which give rise to trismus or locked-jaw, we must regard the ganglionic system, consisting of the various branches of the intercostal trunk, and the numerous branches which unite with it from the whole line ofthe spinal mar- row, as constituting the centre; and as, from this centre, we per- ceive ramifications radiating in every direction to the face, the entire 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 ofthe animal economy we have just pointed out, the muscles ofthe 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. III.—E e otg NEUROTICA. [CL. IV.—OR. Ill 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 irritations 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 ri^id, and set the teeth so closely toge- ther, that they do not admit ofthe 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 others 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 navel 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 " 1 am informed," says Dr. Cullen, " of its frequently occurring in the Highlands of Scotland ; but I never met with any instance of it in the low country."* Whether according to the con- jecture of this celebrated writer, it is more common to some dis- tricts than to others, has not been sufficiently determined. " It seems," says he, "to be more frequent in Switzerland than in France." Hot climates, however, constitute its principal domain; and hence it is not very surprising that Bajon should place one of its chief residences at Cayenne;! 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 ot the tongue, with some difficulty of swallowing liquids after their intro- duction into the mouth, the disease thus making an approach towards lyssa or canine madness in its symptoms, as we have just endeavour- ed to show that it does in its physiology. According to the observa- tions of Baron Larrey, indeed, this approach is in many instances very considerable ; for he informs ust laton post-obituary examina- tions he has often found the pharnyx 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 varieiy, 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. , _ ira. f Bajon, Abhandlung. von Kranheit.auf der Insel Cayenne, 5cc. Lrp. uai. * Principles of Military Surgery, 246. % Briot, Hist, de la Chimrgic Militaire en France. &c. 8ro. Beganson, wu. 220 NEUROTICA. [CL IV.—OR. HI. is little quickness of the pulse, sometimes none whatever, and little or no disorder of any kind, though the bowels are usually very cos- tive. If the patient pass the fourth or fifth clay 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 symp- toms are much later in showing themselves; and sometimes do not make their appearance till eight or nine clays afterwards, occasionally, indeed, not at all, till the wound is healed. The disease is more dan- gerous in proportion to the delay : the adjoining muscles of the face become more affected, and, as is already observed, the spasms often shoot downward into the back or chest, and trismus is complicated with tetanus. The breathing is nasal and abrupt, the accents are in- terrupted and slow, and uttered by the same avenue ; the muscles of the nose, lips, mouth, and the whole ofthe 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 Spain, the mortality was nearly the same. But as the treatment ofthe 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. tetanus. permanent and rigid fixation of many or all the voluntary muscles; with incurvation of the body and dyspncea. Tetanus is derived from titxivu, which itself is a derivative from retvu,"tendo, extendo." Like trismus, it is a term common to the early Greek writers, among whom it was used synonymously with opisthotonus and emprosthotonus, though the two latter were after- wards employed to express two distinct modifications of the disease. From peculiarities in the seat or mode of its attack this species offers us the three following varieties: GE. I.—SP. VI.] NERVOUS FUNCTION. 221 « Anticus. Tetanus of the flexor-muscles. Tetanic procuration. The body rigidly bent for- wards. ? Dorsalis. Tetanus ofthe extensor-muscles. Tetanic recurvation. The body rigidly bent back- wards. y Lateralis. Tetanus of the lateral muscles. Tetanic transcurvation. The body rigidly bent later- ally. ? Ercctus. Tetanus of both the posterior and Tetanic inflexibility of anterior muscles. The body the 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 deference 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 ecstasis under that genus: and as this appears to be its proper place, it will now be found arranged there accordinly. 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. Hcnnen, " after wounds and operations, has been known to produce the disease in some : and sympathy, though a rare cause, in others." It is said also to have been produced by insolation or exposure to the direct rays ofthe 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 pa- roxysms 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. HI. cold, and by the time it reached the scapula, was immediately suc- 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 ofthe 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 times 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 sterum, 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. GE. I.—SP. VI] NERVOUS FUNCTION. o.->.', the head is forcibly retracted, and the jaws snap with a fixation that rarely allows them to be afterwards opened wide enough to admit the little finger. This vehemence of paroxysms may not, perhaps, last longer than for a few minutes or even seconds: but the spastic action prevails so considerably, even through the inter- vals, that it is difficult for an attendant to bend the contorted limbs into any thing like an easy or reclined position. The breathing is quick and laborious, and the pulse, though calmer and less hurried, small and irregular. The face is sometimes pale butoftener 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 pa- roxysms. The last stage ofthe 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 jerked 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 any languid ; but more commonly rigid and immovable in their sock- eta : 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 ■...... ■■ ii ■ ■ ■ * Hist, des Maladies de St. Domingue, II. p. 171. .>24 NEUROTICA. [t I. IV .—OR. III. 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 the 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 are longer, and the muscles being generally more relaxed, he is able to take a little nourishment. Through the whole period there is an obstinate costiveness, partly from want of food in the stomach, but chiefly from an association of the mouths of the 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, andof 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 is not worth while to put the smallest dependence upon them: nor has the warm or cold baths 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 spastic 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. 1.—SP-. VI.] NERVOUS FUNCTION. 225 uctive 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 cither the proper treatment or the probable event ■ it h s, 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 irritabilit; operate in many cases after the disease has once displayed its hideous features, and render the local treatment of subordinate importance. In numerous instances, however, a change in the condition of the wound has produced a beneficial result: and hence various means have been resorted to for the purpose of effecting such a change, as local bleeding, anodyne applications to allay the morbid sensibility ; resinous, terebinthinate, or mercurial stimulants to excite a new action; and amputation of the diseased limb. The first of these three plans is the ordinary mode of practice, and in full plethoric habits it has sometimes proved favourable; the second plan seems to have been very generally employed by Baron Larrey, who occa- sionally used stimulants of a far higher power, as penciling 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 lnquir. I. Art. I. White, Med. Obs and Inq. II. Art. XXXIV f Thompson's Annals of Plrilosophv. Vol. III.—F f 2£U> NLUKOTICA. [GL. IV.—OR. III. the difficulty of supporting the system by common means, and the great sensorial exhaustion which is perpetually taking place, it is Jar 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.t 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 flow of saliva from the mouth spontaneously, has, by many persons, been regarded as a favourable sign. The disease, however, does not seem to be accompanied with any symptom that can be called critical; and it is hence probable that this spontaneous flow of saliva is nothing more than a result of the violent action and alternating relaxation of all the parts about the fauces. Never- theless, salivation, where it has been accomplished, is said by many writers to have been serviceable, though I know of no practitioner who has relied on it alone. And, in reality, such is the rapidity with which both trismus and tetanus usually march forward where thejr have once taken a hold on the system, that we have seldom time to avail ourselves of this mode of cure, were its pretensions still more decisive than they seem to be. Opium, then, in every stage and every variety of both tetanus and locked-jaw, is the remedy on which we are to place our chief, if not our only dependence. But to give it a full chance of success it should be administered in very free doses, and it is not easy for us to be to© 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 Hot Climates, p. 257. f Tallman. Amer. Phil. Trans. I. XXI. Cochran, Edin. Med. Com. Vol. III. p. 18& t Vol. I. p. 88. r.E. i.—sp. vi.] NERVOUS FUNCTION. 227 days, in the course of which the patient took five hundred grains of this narcotic. For the first six clays 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 power of opium, in this disease it is sudorifics, and particularly ipecacuan. And upon this subject Dr. Latham has given a valuable paper in the Medical Transactions, in which he offers examples of failure in the use of James's powder, when used either alone or in alternation with. opium ; but of full success by uniting the two powers of the nar- cotic and the sudorific, though he afterwards preferred ipecacuan to James's powder, and prescribed in the form of the compound powder of this name. He gives cases in which he employed this compound in very severe attacks, and sometimes in what seemed to be its last stage of the disease, with an immediate arrest of its symptoms, and progressively a perfect restoration to health. His doses consisted of ten grains repeated every three or four hours. In no instance was there any unusual inclination to sleep, how long soever this treatment was continued, which in one case was for a fortnight: nor was there any degree of sickness nor any other inconvenience, except that of 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.—OIL III 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. iiauirs. SPASMODIC CONSTRICTION OF THE MUSCLES OF THE CHEST; SUPER- VENING TO THE BITE OF A RABID ANIMAL ; TRECEDED 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 disease 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 kwx ZwtrvTypx, which is the term used by Teucer; while Ulysses, speak- ing of him to Achilles, says, -----xgetTfgx ft i AT22A Mum.* 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 ofthe 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 Sau- vages, " apud Gallo-provinciales experientia, canes luposque rabidos bibisse, manducasse, flumen transasse, ut olim Marologii, et bis Forplivii 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 :t though even here a spasmodic constriction of the muscles of the chest, and sometimes of • Iliad IX. 237. f On Canine Madness, p. 10. * F«br. Nachricht von einer todslichen Krankheit nach dem tollen Hunds- bisse Gott. 1790. 8vo. ».E. 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 ofthe 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.t 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 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 and of the chest generally, sufficiently show that the present species of disease bears a very close analogy to the two preceding, in the mis- chief which it excites ; and as by far the most frequent cause of the two preceding species is the irritation of a wound or puncture on the surface ofthe 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 Dr. J. Innes. Ed. Med. Ess. 1. p. 227. t Discours sur la Rage, et ses Remedes. Chateaus Gontier, 1714,12mo. 230 NEUROTICA. [CL. IV.—OR. III. system, that if a morbid action commence in any part whatever of a continuous chain of functions, or of fibres, it often produces a peculiar impression upon its extremities ; so that the extremities themselves form, in many instances, the chief seat of distress and even of danger : and this more especially where the one extremity of the chain becomes affected in consequence of the primary affec- tion of the other. And we have also endeavoured to show, from the general course and intermediate connexions ofthe nerves which supply the surface ofthe 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- tion. We have long, however, had various examples on record, and have lately been furnished with another by Mr Gillman, in which a dog chained up in a yard, and cut off from all medium of contamination by other animals, has occasionally been attacked with genuine lyssa, and exhibited its most decisive characters. Nevertheless, whilst we are thus establishing that the symptoms of rabies are 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. HI. p. 216. •iE. I.—SP.V11.J 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,t though neither of them seem to have been fatar. Meekren,f 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 :1f 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 horse.}! 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 hence it 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 felis, which is the domestic cat; it is probable, however, there are others belong- ing to different classes endowed with a like power ; and some wri- ters have attempted to bring instances from the horse, mule, ass, ox, and hog, yet they are not instances to be depended upon. In like manner, Plater, Doppert, and even Sauvages himself have asserted the same of mankind, and have brought forward a few casual cases • Ann. IX, X. app. p. 249. | Ann. 1702. p. 147. t Observ. Cap. LXVU. § Observ. Med. Chir. Lib. II. N. J. i; Prax. Admir. Lib. 111. Obs. 84. 88. ■; Recueil Periodique. II. p. 90. •• Samml. Med. Wahrnehm. B. II.p. ^ ft In Goekelu Consil. et Obs. N. 19. ±t Diss, de Epileps. freq. p. 15. •232 NEUROTICA [CL. IV.—OR. Itf. in support of such assertion. These, howe'ver, 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 predispo- nents, but the appeal in no instance rests upon any authority. That the stimulus of vehement rage will often produce a peculiar influ- ence on the saliva, and render it capable, by a bite, of exciting the most alarming symptoms of nervous irritation we have just shown; but these symptoms are not those of lyssa; and the virus, whatever it consists in, appears to be of a different kind. Putridity is, perhaps, the ordinary state in which dogs and cats obtain the offal, on which, for the most part, they feed : they show no disgust to it, and it offers a cause far too general for the purpose. In long voy- ages, again, when a crew has been without water, and reduced to short provisions, dogs have been, in innumerable instances, known to die both of thurst 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 1 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- dexed have been put to a direct test, and have explicitly proved their incompetency. Thus in the wards of the Veterinary School at Al- iort, 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 GE. I.—SP. VU.l NERVOUS VTJNCTIOM. o^-. its influence except when accompanied with a wound or inserted into the cutis; and that, even in this case, it usually requires iti mankind, and probably also in other animals, some auxiliary excite- ment to enable it to carry forward the process of assimilation: for it rarely happens that all the men or quadrupeds that are bitten by a rabid dog suffer from the inoculation. Mr. Hunter, indeed, gives an instance in which, out of twenty persons who were bitten by the same dog, only one received the disease. This is a happy circum- stance, as it affords an important interval for medical treatment, if we should ever be so fortunate as to hit upon any curative process that may be depended upon. At the same time I cannot avoid again to observe that as this virus is less volatile than most others, it is perhaps less indecomposible than any of them, and hence is capable of remaining in a dormant>and unaffected state, in any part of the system, into which it lias 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 front which it may be derived, there is no difficulty in accounting for*. such rapidity of spread without ascrilpng anomalies to the laws by which it is regulated, fleister, 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: butasin 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, communicated 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 state 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 ofthe 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. Cootagios. p. 266. Paris, 4to. 1518, Vob. HI^-G g 2£4 # NEUROTICA. [CL. IV.—OR. Ul 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; Baderasa fever siu generis.^ 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 gangrene, in others there is no inflammatory appearance whatever. Morgagni has examined and described bodies in both these states. Rolfine gives one or two decided eases of the latter sort:| while Ferriar notices examples in which the inflammation ofthe 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 of gangrene.|) In some cases the en- cephalon has appeared to be*as much diseased as the fauces; the vessels turgid; the plexus choroides blackish; the ventricles loaded with water. Sometimes the lungs have been inflamed, sometimes the liver, sometimes the vagina; while the blood, according to Sauvages, has been also found in a dissolved state, and according to Morgagni, in a state highly tenacious and coagulable. From all which we can only conclude, that owing to the violence of the dis- ease, every organ is greatly disturbed, and those the most so that in particular cases are most severely affected. Riedel asserts that among dogs a highly offensive fetor of a peculiar character is thrown forth from every part of the body:1i 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 Versuch einer neuen TheoKe, &c. £ Dissert. Anat. Lib. 1. cap. xii. § Medic. Facts and Observations, Vol. I. || N. Act. Nat. Cur. Vol. IV. Obs. 20. T Act. Acad. Moguat. Erf. 1757. GE. I.—SP. VH.] 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- nation, 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 of pain and inflammation in the bitten part, on the onset of the disease, does not occur from any virus which has hitherto been lying dor- mant there, but from the universal excitement alone. It may be observed, however, in opposition to such an opinion, that this local affection is in most instances a prelude to the general disease, and forms the punctum saliens from which it issues; as though the con- tagious ferment had remained dormant there, and was at length called into action by some exciting cause. There seems, nevertheless, to be a slight departure from the general character of the disease in a few cases, and particularly in those that are produced by the bite of a rabid cat, whether the latter have originated it, or received it from a rabid dog, as though by a passage through the domestic cat the virus undergoes a similar change to that which takes place in the virus of small-pox, when passing through the system of an individual which has previously submitted to the influence of cow-pox: for, upon the whole, the disease appears to evince somewhat less malignity, to be more disposed 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. £ Canina. The spastic constriction, for the most Canine Rabies. part, extending to the muscles of deglutition, which aro violently convulsed at the appearance or idea of liquids: produced by the bite of a rabid dog. 256 NEUROTICA. [CL. IV.—OR. IB 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 attack- ed and wounded both by its teeth and claws. The symptoms took place four days after the bite, and were confined to spasms of the chest without hydrophobia; nor do these seem to have been of great violence, for they are described as " magna praecordiorum anxietas." Local and general bleedings were aseless : 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 rabid dog, are also to be found In the medical collections: of which Dr. Peter's case, recorded in the Philosophical Transactions^ affords a striking example, the pa- roxysm returning for many months afterwards, severely once a 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 every 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 ■water-dread; insomuch that the patient, far from resisting the use of the warm bath, sometimes called for it, expressed a high sense of the comfort it afforded him, and was able at times to dash the •water over his head with his own hands. It terminated, however, • Classis. VII. Order I. v. 6. f Phil. Trans. 1745. No. 475. GE. t.—SP. Vn.] NERVOUS FUNCTION. 237 fatally, and with the general symptoms of distress which we shall give presently.* In the Transactions ofthe Medical Society of London,! we have a highly interesting case of the same kind, which proved equally fatal, in seventy-four days from the time of receiving the injury, and fifty-eight hours from the commencement of the disease ; all the symptoms moreover exhibiting less violence than usually occurs in canine madness, with little or no water-dread, and consequently an ability to drink fluids to the close of the disease, though the mus- cles of deglutition, as well as those of the chest, evinced always some degree of constriction, with occasional exacerbations.:}: The patient was a young lady of eighteen years of age : the attack was made in the month of January, with both claws and teeth, by a do- mestic cat that was lurking under the bed, and which, though not known to be ill, had for 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 inflamed by the application of spirit of turpentine. The wounds healed and the general health of the patient continued perfect till the beginning of the ensuing April, when she was suddenly frighted 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 Belrage zur Natur und Arzney-wissenchaft. B. 111. 118. f Med. Obs. and Ioquir. Vol. V. •* Vol. I. Art. IV. p. 78. 8vo. 1810. 238 NEUROTICA. [CL. 1V.—OR. 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 canine rabies, all the above indica- tions are greatly aggravated, and the mind often participates in the disease, and hecomes 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 basin to basin, even a simple agitation of the air by a movement of the bed curtains, is a source of great disturbance, and will often bring on a paroxysm of general convulsions, or aggravate the tetanic constriction. The patient is tormented with thirst, but dares not drink; the sight or even idea of liquids making him shudder; his eye is haggard, fixed and turgid with blood from the violence of the struggle : his mouth filled with a tenacious saliva, in which, we have already shown, lurks the secreted and poisonous miasm, and he is perpetually en- deavouring to hauk it up and spit it away from him in every direc- tion ; often desiring those around him to stand aside, as conscious that he might hereby injure them. The sound which is thus made, from the great oppression he labours under and his vehement effort to excrete the tough and adhesive phlegm, is often of a very singu- lar kind : and, being sometimes more acute than at others, as well as quick and sudden, and also frequently repeated, like every other motion of the body, has occasionally, to a warm and prepossesed 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 ofthe 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 with all his fiirce, he cried out to us with the greatest eager- ness to order him to be let blood. His eyes were redder than the ge. i.—sp. vii.] Nervous function. £39 day before; and there was added to the whole look an appearance of horror and despair, greatly beyond what I had ever seen either in madness or in any other kind of delirium." The patient was, nevertheless, " perfectly in his' senses at this time ; and there was not the last 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 inritation 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 uneasines.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.!, In the first case, the patient's mind never wandered to the lust moment of life, which is a common character of the disease : in the second and third, both were furiously mad, bit themselves, the bed-clothes, and whatever else fell in their way. In all of them, however, there was a severe hydrophobia, and in all of them the pulse did not essentially vary from its common standard. The first died on the third day ; the two last recovered ; the one under a treatment which consisted principally of opium, and the other under that of salivation: leav- ing it therefore doubtful how far the recovery may be ascribed to the natural powers of the constitution, and how far to remedies so widely different in their nature. There is, also, in these three cases, an equal and most singular discrepancy in the interval between the infliction of the wound and the incursion of the disease. The first interval was about six weeks, which may be regarded as the ordinary term: the second was only five days : the third is not set down with any degree of precision: the patient is only stated to have been seized *• about the time that the second horse died" that had been bitten by the * Medical Transactions, Vol. II. A '. V. p. 5.1. | Id. Art. XII. p. 192. i Id. Art. XV. p. 222 240 NEUROTICA. [CL. IV.—OR. HI. same rabid dog : and hence this interval consisted probably of about a fortnight. This discrepancy seems to depend entirely upon the nature or presence of the predisponent or exciting cause that gives energy to the virus, and without which it may lie, as we have already ob- served, for an almost indeterminable period, dormant, but unde- composed, and still therefore as malignant as when first generated. In the lad who was soonest affected, there seems to have been a strong predisposition to the disease from the first moment, and which alone became an exciting cause; in the woman, who suffered about a fortnight afterwards, there was probably some degree of predispo- sition, but the immediate exciting cause appears to have been over- exertion in walking, for we are told that " she was seized as she was going on an errand on foot, and had walked about two miles." There is a like uncertainty among quadrupeds. We have just taken the interval of ten or twelve days as the common term ; but in the instance just referred to it may have been considerably longer. 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 : the second, that of an old man of seventy-three. Both terminated fatally : in the former case in six days, in the lat- ter, in seven from the onset of the disease. The academical journals, and monographic writers, nevertheless, have numerous instances of the malady appearing after a bite of many years standing; sometimes of 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. Bardslcy 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 the dog supposed to be mad. The pa- • Vol. I. p. 457, GE. I.—SP. VII.] NERVOUS FUNCTION. 24t 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 deprebsion 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 done in various ways: for the lacerated part has been sometimes amputated or dissected ; and at other times totally destroyed by the actual or potential cautery. The actual cautery, by the means of irons heated to whiteness, was first adopted and recommended by Dioscorides,* and afterwards by Van Helmont, Morgagni,! and Stahl: the potential cautery seems to have been proposed as a less terrific mode of operation, and has usually been accomplished by the means of lapis infernalis or decarbonated soda. It is recommended by Schneck, Pouteau, and Dr. Mosely. A no- tion, however, has obtained from a 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. II. passim. Vol. III.—H h '242 NEUROTICA. [CL IV —OR. 111. 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 ofthe rattle-snake, and other venom- ous animals, and 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. t.E. I— SP. VII.] NERVOUS FUNCTION. 243 stimulants ; yet, in fact, they were rather employed from different motives, and fall within one or two of the principles of action which yet remain to be considered. But to this class of medicines, design- ed expressly to support the vital power, and enable nature herself to triumph in so severe a struggle, belong expressly the warm and cordial confections and theriacas that were at one time in almost universal estimation ; as also various kinds of pepper given in great abundance, oil of cajeput, different preparations of tin, copper and iron, and, in later periods, bark. In direct opposition to this stimulating and tonic plan, was that of suddenly debilitating and exhausting the system upon the hy- pothesis that the symptoms of canine rabies were those of violent and rapid inflammation. The practice of submersion in cold water, belongs mostly to this view of the subject, as used a century ago, though in the time of Celsus, it was employed in a much slighter degree to take off the spasm of hydrophobia, and to quench the thirst that accompanied it. " Miserrimum genus morbi; in quo simul zeger et siti et aquae metu cruciatur: quo oppressisin 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 if he can swim, and keep- ing hirn below till he is filled with 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 " 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 • Dc Medicine, Lib. V. Cap. XXVII. 6 C. i Cels. loco citato. 244 NEUROTICA. [CL. IV.—OR. Ill her own astonishment, as well as to that of the by-stander3, 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 perseveredin 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 of the lancet. Bleeding has lately been revived and carried to the extent of deliquium by large and rapid depletions, and the operation has been repeated almost as long as the powers of life would allow. Dr. Shoolbred, of Calcutta, had two patients who recovered under this process: but he employed mercury at the same time, and it is by no means certain either by the history of the patients, or of the dog by which they were bitten, that the disease was a genuine lyssa. Yet, whatever benefit this practice may possess, it has no pre- tensions to novelty : for there is not a single course of treatment ever invented for this intractable disease that has been for upwards of a century more extensively tried and retried, both moderately and profusely, or excited a warmer controversy upon its merits. Poupart, in 1699, espoused the practice, and gives the case of a woman, who perfectly recovered by bleeding her to deliquium, and afterwards confining her for a year on bread and water.^ Berger, in the same year, recommended bleeding, but advised that the blood should be taken from the forehead. In the Breslaw Collections for 1719, is the case of a cow supposed to be rabid and said to be cured by profuse bleeding. And the Philosophical 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 l'Academie Royale, Ann. 1709. f Hellot. An. de morsis a rabido Colocynthis ? Paris, 1676. $ Hist, de l'Academie des Sciences. Ann. 1709. GE. L—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 sick- ness, trepidation, a faultering speech and memory, and that, through the whole course ofthe disease, he attended, though with some dif- ficulty, 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 employed venesection freely in a case of his own, drawing off from twenty to thirty ounces at a time, and occasionally bleeding to deliquium.t But the symptoms are here also so doubtful that the result is of no importance. The practice, therefore, has not been 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. Plummer, in the Edinburgh Medical Essays;! but it is not much to be relied on, as not more than twenty ounces of blood were lost at a second and accidental bleeding, and only ten a day or two before by a prescribed venesection. Mr. Peters, however, who employed profuse and repeated bleedings, sometimes even to deli- quium, had, in his day, so little dependence on them alone, that he uniformly combined this remedy with opium and mithridate, or other cordials, and in the case which he hus introduced into the Philosophical Transactions, he ascribes the success which accom- panied his plan to this combined mode of treatment.§ In like man- ner, Mauchart, as quoted by Biihlmeier, while he advises bleed- ing, and to an extent proportioned to the length of the interval between the infliction of the wound and the attack of the paroxysm • Phil. Trans. Year 1737-8. f Vol. VI. p. 432. * Vol. V. Part II. * Phil. Trans. 1745. No. 47.-. 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 mithridate, theriaca, or rue, and a defensive plaster put over 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 venom- ous animals, and particularly serpents; and consequently, best to be opposed by the usual remedies and specifics to which these are found most effectually to yield. And hence, in the first place, the use of the radix Alungo of Kcempfer, (ophiorrhiza Mungos, Linn.) still supposed to be a specific for the bite of the cobra di capello and the rattle-snake. In India and Ceylon it is used to the present day as an antidote against the bite of the mad dog: Kocmpfer highly extols it, and Gremmius, who practised with great reputation 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; ,k as a cure," says he, "for the bite of a mad dog, let the patient drink vinegar, theriaca, and rue."t The general suffrage, however, was far more considerable in favour of the alkalies, and especially of ammonia or volatile alkali. There is some reason for this preference. It is well known that ammonia is a valuable medicine, whether applied externally or internally, in a variety of animal poisons. 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. f Exerc. Semiot. Pathol. Cap. 8. GE. I.—SP. VII.] NERVOUS FUNCTION. 247 ammonia prepared with quick-lime combined with rectified oil of amber, rendered more easily miscible by being rubbed into half its weight of soap. This was in general employed both externally and internally,* though in the Journal de Medicine, we have several reports of a successful use of it when confined to an internal trial alone: especially one related by M. Hervet,f and another by M. Rubiere.f 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 ofthe bite, and an antidote at the commencement ofthe 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 of the malady, recovered, and the rest died.§ His expe- riments on mankind are less complete: for they amount to not more than three, and in each of these the medicine was employ- ed as a preventive, shortly after the infliction of the bite; and hence, as the patients never become 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 ofthe 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 ever produced a cure, in whatever way it may have been employed. Kaltschmid, on the contrary, with an unjustifiable • Sage, Erfahrungen, &c. p. 49. Guettard, Memoires sur differentes parties des Sciences et Arts. Paris, 1768. p. 122. f Journ. de Medicine, torn. LX1I. i Id. torn. LXIV. * Phil. Trans. Vol. XXXIX. Year 1735-6, 248 NEUROTICA. |CL. IV.—OR. Hi confidence, calls it remedium indubium ;* and De Choiseula methode sure et facile.f In the fortieth volume ofthe Journal de Medicine there is a relation in which mercurial inunction seems to have been successful in a genuine case, and I have heard of one or two other instances, that have occurred in our own country As diuretics were supposed to possess a strong alcxipharmic power, or that of expurgating the system from animal poisons in general, these have also had their votaries, and been in high repu- tation, as a remedy for lyssa. Cantharides were at one time the favourite medicine under this head, or some other stimulant insect of the coleopterous order, as the meloe, lytta, or one or two species of scarabaeus; which, like mercury and ammonia, were sometimes taken internally alone, and sometimes applied topically also, to keep up a perpetual irritation. Bohadsch tells us gravely, that the dis- ease will always yield to ten cantharides powdered and introduced into the stomach :\ Monconys, that the powder should be continued from the bite to the time in which we may reasonably expect the symptom of hydrophobia; and adds, that this medicine, which was regarded as an arcanum in his day, was a remedy of publicity over all Greece.§ He might have extended his theatre; for Egypt was as well acquainted with the general principle of this practice as Greece or Hungary; and it is a positive exhortation of Avicenna, that whatever diuretic was employed should be carried to its utmost acrimony, even to the discharge of bloody urine.|| The ash-coloured liverwort, (lichen terrestris cinereus Raii,) was another diuretic of great popularity, and which seems at length to have triumphed over the stimulant insects, and to have superseded their use; on which account Linneus changed its trivial name from cinereus to caninus. In our own country, this medicine was at one time peculiarly in vogue. It was given in powder, with an equal quantity of black pepper, a drachm and a half of the two forming the dose for an adult, which was taken for four mornings fasting, in half a pint of warm cow's milk; the patient, however, 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 thje 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 ;1f while, at the earnest solicitation of Dr. Mead, • Dissertatio de Salivatione mercuriali, ceu indubio praeservationes et cura- tionis remedio adversus rebiem caninam. Jan. 1760. ■j- Nouvelle Methode, sure et facile, pour le traitement de spersonnes atta quees de la Kage. Paris, 1756. % Posit. Zoolog. in Klinkosch. Diss. Select. § Voyages, I. p. 406. H Lib IV. Fen. VI. Tr. iv. J Mechanical Account of Poisons, Art. 3. GE. I — SP. VII.] NERVOUS FUNCTION. £49 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.f 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 one 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 easy to resolve their palliative or remedial power into the principle of their being active antispasmodics, than to any other mode of action. The more direct antispasmodics and sedatives, however, employed in this malady were musk, opium, bella donna, nux vomica, and 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 with other medicines. Cullen seems doubtful of the powers of • Chirurg. parv. Niirub. &c. 8vo. 1643. M { Vol. IV. p. 348. Vol. Ill—I i 250 NEUROTICA. [CL. IV.—OR. in 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 Societfc Royale of Paris, who have taken much pains, and employed the most proper means for ascertaining the practice in this disease."* With respect to musk he admits, however, that Dr. Johnston has given us two facts that are very much in favour of its power : and " I have," says he, " been informed of an instance in this country, of some large doses of musk having proved a cure after symptoms of hydrophobia had come on."t Hilary says, " In these cases it acts as a sudorific;" and Gemelin 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.1! But a late experiment of Professor Dupuytren of the Hotel-Dieu, has given a still more striking and incontrovertible proof 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 a3 the constriction ofthe throat prevented it from being given by the mouth, a gum- my solution was injected into the veins, for which the saphaena and cephalic were alternately made use of. Two grains of the extract were in this manner thrown in, and the patient was in some degree tranquillized for an hour or two : the dose was doubled towards the evening of the same day. It was repeated at intervals, and at length increased to eight grains at a dose. The relief it afforded, how- ever, was never more than temporary : and he expired on the fifth day from the incursion.** From this inefficiency of opium and musk separately, they have often been united to strengthen their effect; or either of them has been combined with camphor, oil of amber, inunction with olive • Materia Medica, Vol. II. p. 252. 380. j- Id. t Diss', de specifico antidoto novo adversus effectrs morsfis canis rabidi. Tub. 1750. § Dantic, Gazette de Sante, 1777. p. 51. I Annalen, IX. p. 33. 1 Med. Observ. and Inquiries, Vol. V. '' Orfila, Traite sur les Poisons, &c. ^E,l.—SP. VU.] NERVOUS FUNCTION. 551 oil,* or bleeding. Musk was also at one time very generally com- bined with cinnebar, 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 CobUi or Tunguinensis, consisted of six- teen grains of musk with forty-eight grains of cinnabar, mixed in a gill ot arrack. This taken at a dose la, said to have thrown the pa- tient into a sound sleep and perspiration m the course of two or three hours; and where it did no , the dose w*« repeated till such effect was produced. And this medicine also wa» regarded as a specific during the short career of its triumph, and a cure was commonly supposed to follow the administration of the medicine. The sedative power of several of the preparations of arsenic, however, had perhaps a fairer pretension than any of these, and especially as, like mercury, it has for ages been employed with de- cided benefit in Asia, in the case of syphilis. Agricola mentions its use in his day,t but the forms in which it was then employe^ were rude and incommodious, and they do not appear to have beea 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 yeara 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 1 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 sm.ill 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 connemplated the specific virus to be an acid, for the basis of this preparation is • Vater, Pr. de Olei Olivarum efficacia contra nsorsum oftnis rabiosi expe* rimento Cresdx facto, adstructa, Viteb. 1950. t Comment, in Popp. p. 54. 25 2 NEUROTICA. [CL, IV.—OR. Ill unquestionably an alkaline earth. And with regard to its occasion- al efficacy, the latter writer, following the general current of opi- nion of the day, informs us that this has been so thoroughly estab- lished by experience, that there can be no room to doubt it. Dr. Heysham himself, however, admits of various cases in which it failed, while in many instances his successful ones do not afford proofs of an existence of the genuine disease.* The second of the anomalous remedies I have just referred to, 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 the bite of a rattle-snake, where it seems to rival the imprescriptible claims of the ophiorrhiza Mungos, though its juice is generally given in combination with that of the common horehound—an ad- dition that certainly does not promise much accession to its strength. This species of alyssum has for some ages been a popular remedy for canine madness, especially in the north of Europe : and in a late communication to Sir Walter Farquhar in the Russian tongue, translated and published in Mr. Brande's 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 Ea-.F. HI.—sp.n.] NERVOUS PUNCTION. 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 scarce a moment's remission, by which she complains of great and universal soreness. No words can convey an adequate idea of her odd appearance : and I 10 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- sell applies to it, perhaps in imitation of Sauvages, the name of hieronosos. The predisponent cause of this disease is an irritability of the nervous system chiefly dependent upon debility, and particularly a debility of the stomach and its collatitious organs. Most of the diseases 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 being 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 case in weakly habits, the irritation assumes a morbid character, and is exacerbated by a con- gestive state ofthe vessels that constitute its more immediate seat: and chorea takes its rise from this cause. In effect, where the predisponent cause of an irritable state of the nervous system is very active and predominant, a local or 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,t by a wound penetrating the brain through the orbit of the eye,|: by an improper use of lea'd, mercury, or some other metal,§ and by sup- pressed cutaneous eruptions.|| From this view of the 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 acrimony, • Edinb. Med. Comment. Vol. IV. p. 326. f Stoll, Rat. Med Part. III. p. 405, * Gcash, Phil. Trans. Vol. LUl. 1763. § De Haen. Rat. Med. Part III. p. 202. B Wendt, Nachricht von dem Krankeninstitut zu Erlangen, 1785. 294 NEUROTICA. [CL. IV.—OR. Hi 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 bf irritation applied to the same organ, by exciting a new action, will be the most effectual way of taking off or preventing such effect. And it is upon this ground alone that we often endeavour to cure rabies, trismus, and tetanus, by laying open the original wound to a considerable extent, or the application of some new stimulus that may answer the same purpose. The principle being a general one, it does not seem of much con- sequence what purgative is employed, provided it be sufficiently powerful : though, where worms are suspected, the essential oil of turpentine, from its being a good anthelmintic, as well as a good cathartic, will be found one of the best. It seems, indeed to have been occasionally serviceable where worms have not been the cause, for Dr. Powell relates a case in which he completely effected a cure in a girl of seventeen by a single dose of 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 pi n with great activity through sixty cases ofthe 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 remc- • Transact. Medico-Chir. Soc. Vol. V. p. 358. GE. III.—SP. U.] 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 deriv ble trom these seems to be merely palliative ; and the stimulant tonics and alterants promise abetter success. The cuckoo-flower, or ladyVsmock,cardaminc/iw™.w.s.so com- mon to the meadows of our own country, was at one time supposed to be of essential service in the cure of this and various other spasmodic affections. Michaelis, who is a great advocate for its 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. Thev were first recommended to De Ilaen 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 elixer: 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 and oxydes 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 staten.ent 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 lie employed in the form of an extract from the juice ofthe root ; giving it from a sixth to a quarter of a grain every quarter of an hour, and, as he affirms, wilh very great advantage. • Mat. Med. Part II. Chap. VI. p. 246. f Richter Chirurg. Bibl. H. v. p. 120. t Disscrtatio Medical naug. de Zinco. Aut. Jacob. Hart. Ludg. Bat. 4to. 296 NEUROTICA. [CL. IV.—OR. IU. For the information of practitioners in general, however, it should be noticed that when the stomach has reached it-> 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 eitner of these without n.iusea ; yet it has been found that the same stomach will continue at case 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 form of pills, from one to five or six grains to a dose. Yetjhe 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 ofthe 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, ammoniated tincture of valerian, castor, muriated tincture of iron, bark, and opium had all failed.\ I am inclined, however, to think that reports of a successful use of medicines unc!er the circumstances here stated should be received with some degree of caution ; for first, the very repose itself from so active a campaign of the Materia Medica, may have proved the best means of cure ; and next some mortal blow, though it did not immediately show itself, may have been given to the disease from so extensive an assault, before the plan of attack was changed, and • Letter from Dr. Ocier to Dr. A. Duncan, Edin. Med. Com. III. p. 191, t Mat. Med. Part II. chap. II. p. 112. \ Medic. Transact. Vol. V. p. 192, >.e. in.—sp. ii.] NERVOUS FUNCTION. 29: the general charge, so to speak, converted into an affair of outposts. And hence the musk, as being the last medicine employed, may have run off with the claim of victory, as an empiric often does when called in at the lucky moment for him in which a disease is on the point of yielding to the plan of a more skilful, though dis- carded, practitioner. How far in this disease voltaism or electricity, as warmly recom- mended by De Haen, may be depended upon it, is difficult to deter- mine. Like the preceding remedies, either appears to have been ser- viceable in some cases, butthey 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 recall 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 the ridiculous extreme we had occasion to notice afew pages above. SPECIES III. SYNCLONUS BALLISMUS. Slialu'ua=|)«ilsi>. PERMANENT agitation of the head ou 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. Parkinson.* The genus Tantarismus of Ba- glivi, 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 sounder the present arrangement. The term Ballismus (/3«AAt*s,) is not used in a medical sense by the Greek writers, but occurs in Athenaeus and various other authors, in the literal sense of tripudiatio, or " tripping, capering, curvetting on the toes:" from /9*APi, " tripudio, pedibus plaudo ;" and is hence, well designed to express the characteristic feature of the patient's being thrown involuntarily, when he attempts to walk • Essay on the Shaking Palsy. Vol. Ill—P p COS NECROTIC A. [CL. IV.—OR. 1IC. "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 characterized. 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 proncness 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 twelve months, from their first being observed, the patient, particularly while walking, bends himself forward. Soon after this his legs suffer similar agitations and loss of power vvith the hands or arms. " As the disease advances, the limbs become less and icss 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 unvviliingly to adopt a running pace, in danger of falling on his face at every step. In the more ad- vanced stage ofthe 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 Pbys. Part II. Book III. ch. iii. MCCCLIII. CE. HI.—SP. III.] NERVOUS FUNCTION. 299 % others. The tcrpid 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 immovably 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 a damp vapour, by lying from night to night on the bare earth, in a close unvcntilatcd 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 the daily ex- halation of metallic vapours, and especially those of mercury, arc frequent and severe sufferers, of which Hornung has adduced many interesting examples from the quarrymen in Carniola.* It has also followed upon worms in the intestines ;t and in this case, has some- times assumed a periodical typcf The part of the nervous organ more immediately affected has also afforded some ground for controversy. Bonet ascribes it to a diseased state of some portion of the cerebrum, and has given ex- amples of its being found, on dissection, to contain, in various quar- ters, proofs of serum, sanies, and other morbid secretions.§ But the misfortune is here, as we have already observed in similar appear- ances after mania, that it is impossible for us to determine whether these diseased fluids give rise to the disease or the disease to them. And hence Mr. Parkinson seems to pay no attention to them, at least as a cause, and fixes the seat of the affection in the cervical part of the spinal marrow, from which he supposes it to shoot up by degrees to the medulla oblongata. We have already show* suffi- ciently in the Physiological Proem to the present Class, that the nervous fibres which ramify over the extremities, whether sensific or motific, originate from the chain of the spinal marrow ; and we have also shown, in discussing the diseases of trismus, tetanus, and lyssa, how acutely one extremity of a chain of any kind, and parti- cularly of a continuous fibrous chain, sympathizes with another: and there can be no difficulty, therefore, in conceiving that wher- ever the cutaneous ends of the nerves of motion are torpified, or • Cista, p. 280. f Com mere. Liter. Nor. 1743. p. 55. t Act. Nat. Cur. Vol. 11. Obs. 143. $ Sepul. Lib. I. Sect. XIV, Obs. 7,9 300 NEUROTICA. [CL. IV—OH. Iff otherwise affected by any of the causes just adverted to, the verte- bral column must itself very seriously participate in the mischief, and consequently the upper or cervical part of this column : and that from this point the disease must ramify to the brain before the general functions 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 of the spine. Beyond this an active purgative system, as strongly recommended by Ried- lin, has certainly been found efficacious ;* and the solution of arsenic bids as fair for a favourable result here as in the preceding species. Stark tried musk, and carried it to very large doses frequently repeated every day :t but it does not seem to have produced any decisive success. Friction of the affected extremities resolutely persevered in by a skilful rubber, with stimulant embrocations of camphor or am- monia, should also be tried in an early stage of the disease, and be alternated with the use of the voltaic trough. Here, too, we may expect to derive advantage from a free use of diaphoretic and alter- ant apozems, as the decoction of the woods, and especially where the disease is suspected to be of a rheumatic origin:—to which may be added a regular course of bathing at the Bath springs. SPECIES IV. RAPHANIA. itaRhanfa. spastic contraction of the joints; with trembling and , ^ PERIODICAL 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 Rafihaniatrum, a wild radish 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 Hermann and Camerarius, it has been ascribed to the use of darnel or ryej infested with the spur, or • Lin. Med. 4695. p. 101. f Klinische und Anatomische Bemerkungen. * Abhandlung von der Kriebelkrankheit, &c. Cassel, 1775-8 De Lall. Lolio. temulento. Tubing. 1710. CE. III.—SP.rV.] NERVOUS FUNCTION. 101 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 moktification (gangramaas/a/agi'nea/ and erythematous plague (pestis ery thematic a.)\ 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 cither of these,\ and Lentin ascribes it to the honey-dew of various plants,§ concerning which we shall have to speak in the fourth vo- lume, under paruria meltita. 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 ofthe habit into which it is introduced, we have frequently had occasion to notice already, and particularly under the head of eruptive sur- feit, (colica cibaria efflorescens.)|| This is particularly the case with several of the deleterious agarics or funguses, some of which seem to operate chiefly on the sensific nerves, and produce a gene- ral stupor; and others on the motory, and produce palpitations, cramps, or convulsions, over the whole system.H It is very 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 Academical,** furnished by Dr. Rothman, a pupil of Linneus, from which the disease seems to be not unfrequently epidemical, and always to commence in the autumn. It is found, howeVer, only among the lower orders of people, and, in the epidemic referred to, is sufficiently traced to impure admixtures with their grain, and the employment of this vitiated grain in too new a state. Dr. Roth- man delineates the disease from actual observation, and does not believe it to be a new malady, as generally supposed, but thinks he has traced it in the writings of various authors from the year 1596 to 1727 ; which would establish, moreover, that it has been common to other parts of Europe as well as to Sweden. And in confirmation • Vol. II. p. 608. f Id. p. 427. i Wichmann, Beytrag. zur Geschichteder Kriebelkrankheit, Leips. 1/71-8. § Beobachtungen einiger Krankheiten, Sic. || Vol. 1. p. 141. T See Heberden, Med. Trans. II. 218 •» Tom. VI. Art. CXXIH 1763. 302 NEUROTICA. [CL. IV.—OR. 111. 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,"! 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- Sible- V The disease commences with cold chills and lassitude, pain in the head, and anxiety about the pi-Eecordia. These symptoms are followed by spasmodic twitchings and afterwards rigid contractions ofthe 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 Dippel's Animal oil.l Camphorated vinegar, as employ- ed by other practitioners, would probably be found a more useful embrocation.§ Towards the close of the disease purple exanthems or vesica- tions are said to be sometimes thrown out, which approximate it to mildew-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 II. Book HI. Chap. iii. MCCCLIII. i Abhandl. von der Kriebelkrankheit. § Nechricht von der Kriebelkrankheit, GE. HI—SP. V.3 NERVOUS FUNCTION. 3uS SPECIES V. SYNCLONUS BERIBERIA. ifrrfterg. itarlners. spasmodic rigidity of the lower limbs impeding locomotion; OFTEN SHOOTING TO THE CHEST, AND OBSTRUCTING THE RESPIRA- TION AND THE VOICE; TREMBLING AND PAINFUL STUPOR OF THE EXTREMITIES; GENERAL EDEMATOUS INTUMESCENCE. Bontius seems first to have introduced the term beriberi or be- riberia into medical nomenclature, and tells us of its oriental ori- gin ;* and Sauvages has hence copied it into his list of " nomina bar- bara, seu nee Graeca, nee Latina." Mangetus affirms that the dis- ease was known to Erasistratus, but certainly not under this name. Eustathius, however, has fiitfty, 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 "U or N-n, pa-a or onma 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 pas- turage 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 lo ,g as the rainy season continues. Thus we learn from Mr. Christie that the 72d * De Medicina Indorum. Cap. I. 304 NECROTIC A. [CL. IV.—OR. HI. 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, 1798, 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 ofthe 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 Voya- ges ; by W. Hunter, A. M. &c. Lord Valentia's Travels, Vol. I. p. 318. GE. III.—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 ipecacuan seems better calculated for the purpose, ss containing a sedative 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 formicating 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 spirit, and laudanum, which it is found sometimes necessary to continue for several weeks. In convalescence the patients should be removed as soon as may be to a drier and more equable temperature, and be put upon the ordinary plan of tonics, regular exercise, and nutritive diet. In milder cases they generally recover with the shifting of the mon- soon, which carries off the remote cause of the disease, and brings a change of temperature home to them. Beribery has not been hitherto described as existing in any other part of the world, and if it should be found it will probably exhibit a modification of some of the symptoms according to the quarter in which it appears. I am induced to make this remark from observ- ing in the Transactions of the Medico Chirurgical Society,* an account of a very singular spasmodic disease by Dr. Bostock, which evidently belongs to the present genus, and seems to be a variety of the present species assuming a chronic form. The patient, who was in the middle of life, was first attacked with achings in the lower limb on one side, accompanied with a difficulty and irregu- larity of motion, which soon spread to the other side, and then gra- dually to the throat, so as to hinder deglutition except with great pain and severe exertion: the larynx next became affected so as to prevent speech, and afterwards the back of the neck, \he muscles affected being the voluntary alone. From the spastic rigidity of the limbs, they were both bent and straightened with a like diffi- culty. The pricking pain like that of pins, or of a limb awaking from stupor, common to the extremities in beribery. was present here * Vol. IX. Art. I. p. 1. Vol.. III.—Q q 306 NEUROTICA. [CL. IV.—OR. III. also, though apparently without stupor, or edematous swellings. Yet the intellectual powers were at length affected aBd weakened; the failure of understanding gradually increasing, but principally showing itself in paroxysms, during one of which the patient died. No cause of the disease could be traced before death, or by dissec tion afterwards. CLASS IV. NEUROTICA. ORDER IV. SYSTATICA. Mseases affecting several or all the sensorial ftotoers simultaneously 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 number, the intellectual, the sensific, and the motory. Thus far we have only contemplated these as they are affected singly, or, where more are affected than one, as influencing the rest only secondarily of 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 ord'-r is hence de- nominated systatica, a Greek compound from o-vyio-rv/tt/, " congre- dior, consocio." Syncofitica might have been employed, and upon as large a scale, so as to denote increased as well as diminished action, impellentia as well as concidentia; but that this term is usually limited to express maladies of the latter kind, and conse- quently might have produced confusion, since the present order, like all the preceding, includes diseases evincing different and even opposite states of action. 30ff NEUROTICA. [CL. IV.—OR. 1 •' GENUS I. AGRYPNIA. Sleeplessness. DIFFICULTY OR INABILITY OF OBTAINING SLEEP. Agrypnia («sy§t>5rv/«) is a Greek term significant of the English sleeplessness, by which it is here rendered. The affection is not intro meed 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 claims 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.-------pertejesa. chronic wakefulness. SPECIES I. AGRYPNIA EXCITATA. Xrritatffce OTafeef ulness. 3LKEP RETARDED BY MENTAL EXCITEMENT: LISTLESSNESS TO SUR- ROUNDING OBJECTS. On the physiology of sleep and dreaming, wq briefly touched under the genus pakoniiua or sleep-disturbanoe, in the first order of the present class, but the subject is of great extent and perplexity, and cannot be followed up into any detailed explanation in a work of pathology. At prtstnt, 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 undoubtedly may, as produced by other causes. Now it often happens that, from an energetic bent of the mind to a particular subject, the sensorial power continues to be secreted not only in a more than usual quantity, but for a more than usual term of time j and, in consequence of this additional supply, there QE. I.—SP. I.] NERVOUS FUNCTION. 309 is no exhaustion at the ordinary period, and, therefore, no sleep. Severe grief is often a stimulus of this kind; during which a morbid redundancy of sensorial power continues to be secreted, followed by a morbid excitement ofthe system generally, from day to day, and from night to night, till the frame is worn out by the protracted watchlulness, 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 of the 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 j 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 tar 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 intenta, or mental abstraction. The cure of this species of sleeplessness is to be accomplished by allaying the menial 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 PERTHES A. <£hronfc Wakefulness. 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 ofthe 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, must tranquilly resign itself to the general intention. Where uneasiness of this kind has been permitted to continue for several nights in succession, the sleeplessness is apt to become chronic and to be converted into a habit. We have hence had ex- amples, as noticed with their appropriate references in the volume of Nosology, in which vigilance or sleeplessness has continued for a month without intermission ;* for six months ;t and even for three years.| 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 happened in the seventy-third year of his ai*e. H • had a kind of dozing 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 • Gruiling'. Cent. IV. Obs. 90. f Panarol, Pentecost. V. Obs. 4; * Plinii Lib. V. vii. Cap 51. § Medicinal and CbLrurgical Observations, &c, 8vo. CE. I.—SP. II.] NERVOUS FUNCTION. 311 cause, for if we can get rid of the organic disquiet on which it de- pends, v*c 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 effi- cacy as the pillows ofthe 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,f and vari- ous other writers.^ Mosch 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 prxcor- 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 prac- titioners 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 alternately stupid and delirious for several hours: but in six hours from the attack, he was pretty well recovered from every symp- tom.^ 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, torn. XXXVI. t Ansert. Abhandl. B. I. IV. St. 45. § Medinische und Chirurgische Bemerkungen, &c. B Libellulus quo continuantur Experimenta, &c. * Mat. Med. Part II. Ch. V. 312 NEUROTICA. (CL. IV__OR. W 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 ofthe vessels perhaps that took a share in the general energy ofthe middle of life, is obliterated, and the wear and tear of those that remain are much less. The pulse beats feeoly; the muscles of respiration are less forcibly distended ; the stomach digests a smaller portion of food, for only a smaller portion is required; the intellect is less active ; the corporeal senses less lively, and a minuter quan- tity 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 us a symptom in excessive fatigue, violent pain of any kind, inflammation, fevers, and various affections of the brain. GENUS II. DYSPHORIA. Restlessness. troublesome and restless uneasiness of the muscles; in- creased sensibility; inability of fixing the attention. This is the inguietudo of many authors, which the Greeks express- ed by the generic term now chosen, importing literally, " tolerandi 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. Moleata sensatio, says Sauvages, quae ad jectigationem cogit, sed quomodo ab affinibus morbis discrepit, dicant qui expo'ti sunt. The genus embraces two species as exhibiting restlessness or inquietude, chiefly confined to the sensific or the irritable fibres; or as dependent upon the state ofthe mind. 1. dysphoria simplex. fidgets. 2. i - anxietas. anxiety. GE. II.—SP.I] NERVOUS FUNCTION. 31G SPECIES I, DYSPHORIA SIMPLEX. iFOrflets. restlessness general, and accompanied with a perpetual desire 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 Latin term is titubatio; and, indeed, most languages have some peculiar term to express this troublesome and irritable sensation, though it has been rarely introduced as a disease into the nosological catalogue. The actual cause seems to consist in an undue accu- mulation of sensorial power, wnich 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 jactitatio, " a restless uneasiness from the accumulation of irritative power in his muscles, which were before in continual and violent exertion from his habit of life, and in this. situation finds relief by perpetually jumping about his cage to 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 secreted constitutionally, which is apt, on various occasions, to show Vol. Ill__R r 314 NEUROTICA. [CL. IV.—OR. IV. itself by a perpetual restlessness or jactitation as troublesome to those who are ofthe 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 senilis, and especially in a part of the body that we cannot conveniently get at to scratch: and hence ascarides in the rectum or pudendum, into which last organ they have sometimes been found to creep, is a most distress- ing, and, in some cases, a maddening cause. A course of cooling purgatives, warm bathing, or increased ex- ercise, will probably be found most serviceable in this harassing complaint; with an attention to the primary disease where it is sympathetic. SPECIES II. DYSPHORIA ANXIETAS. ^nrietg. THE RESTLESSNESS OHIEFLY AFFECTING THE PR^CORDIA \ WITH DE- 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 praecordia, and most powerfully and most distressingly in lyssa or canine madness. It has been ascribed to the wantof a free passage for the blood through the heart, in consequence of a polypous concretion or some other obstruction ; to a similar difficulty of its passage through the lungs: and to a constriction of the vena portae, producing a like impedi- ment in the lower belly; and the anxiety has been denominated precordial, pulmonary, or epigastric, according to the part affected, which, however, we cannot always trace out. The complaint is par- ticularly noticed by Hippocrates, who distinguishes it by the name of alysmus («At/o?t<>s,) 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 Epidemischen Krankheiten. p. 47. GE. II.—SP. II.] NERVOUS FUNCTION. 315 displaying, according to the idiosyncrasy, the symptoms of chorea, hypochondrias, or lyssa; and has occasionally, as 1 lave reason to believe, been mistaken for lyssa, wheie the morbid mind has pored incessantly on the recollection of son/e 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. INTERNAL HORROR AT THE PRESENCE OF PARTICULAR OBJECTS OR SUBJECTS; WITH GREAT RESTLESSNESS OR DELiqUIUM. Antipathia (xvrtirxDm, from xvTiirx6e*>, « naturalem repugnantiam habeo,") does noi occur in Dr. Culien's classification, but enters into his supplementary catalogue, " morborum a nobis omissorum quos omississe fortassis non oportebat;" or, as he ex pies-is v in another place, of diseases which were either forgotten when the arrangement was settled, or for which no fit plice it wa's Vol. Ill—3 I 434 NEUROTICA. [CL. IV.—or. rv. gradually increased to six grains. It now produced a powerful sense of intoxication, but with clonic agitation, instead of a tetanic spasm ofthe 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 t<> the power of the nux vomica. But so far as I have seen, I think we may come to the following conclusions: First, that when only small doses can be given without seriously affecting the head, as in cases of great general, or nervous debility, the effect is a clonic instead of an entastic or tetanic spasm. Secondly, that under this effect it is not calculated to do any permanent good, and often produces mischief. And thirdly, that it is most serviceable in entonic hemiplegia, after the patient has been sufficiently reduced from a state of high ener- getic health, and especially energetic plethora, to a subdued and temperate state of pulse; in which state it may very frequently be employed in doses sufficient to excite strong or entohic 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 byfevers.§ Nor * Camerar. Memorab. Cent. V. No. 30. Paulini. Cent. III. 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 Wahrnemungen. Band. VI. p. 152. GE. VIII.—SP. VI.] NERVOUS FUNCTION. 435 can I do otherwise than think that one of the most rational and efficacious means of cure in many instances of paralysis, and es- pecially where no great inroad has been made upon the general strength of the constitution, would be a journey into the Hundreds of Essex or some other marshy district, for the purpose of obtaining a sharp attack of a tertian ague, which would most effectually, and I apprehend at the least expense, give us all the advantage of entastic spasm and reaction in regular and repeated tides, that we could wish for, and which have already appeared to be so desirable. In treating of the tertian intermittent, we observed from Dr. Fordyce, that it has often a tendency to carry off a variety of obstinate and chronic diseases, to which the constitution has been long subject, and to restore it to the possession of a better and firmer degree of health. And where paralysis is capable of removal, there seems to be few complaints on which it is likely to operate with a more favourable issue. The author has for some time been waiting for an opportunity of making the experiment, and at present merely throws out the hint with much deference to the medical world at large. In a few cases hemiplegia is said to have ceased spontaneously by the mere remedial energy of nature, and without any apparent 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 for 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. f Vol. I. p. 132. END OF VOL. III. NATIONAL LIBRARY OF «tt;.'i.- .........-m.. , ■ - v'C" I. T? liJC-T**'**""-' NLM D3E77nn fl f^ra NLM032779198