M. M. Opium a grain every night. Chalybeates in very small doses. Bark.
Sea-bathing.
5. _Insensibilitas artuum._ As in some paralytic limbs. A great
insensibility sometimes accompanies the torpor of the skin in cold fits of
agues. Some parts have retained the sense of heat, but not the sense of
touch. See Sect. XVI. 6.
M. M. Friction with flannel. A blister. Warmth.
6. _Dysuria insensitiva._ Insensibility of the bladder. A difficulty or
total inability to make water attends some fevers with great debility,
owing to the insensibility or inirritability of the bladder. This is a
dangerous but not always a fatal symptom.
M. M. Draw off the water with a catheter. Assist the patient in the
exclusion of it by compressing the lower parts of the abdomen with the
hands. Wine two ounces, Peruvian bark one dram in decoction, every three
hours alternately. Balsam of copaiva. Oil of almonds, with as much camphor
as can be dissolved in it, applied as a liniment rubbed on the region of
the bladder and perinaeum, and repeated every four hours, was used in this
disease with success by Mr. Latham. Med. Comment. 1791, p. 213.
7. _Accumulatio alvina._ An accumulation of feces in the rectum, occasioned
by the torpor, or insensibility, of that bowel. But as liquids pass by
these accumulations, it differs from the constipatio alvi, which is owing
to too great absorption of the alimentary canal.
Old milk, and especially when boiled, is liable to induce this kind of
costiveness in some grown persons; which is probably owing to their not
possessing sufficient gastric acid to curdle and digest it; for as both
these processes require gastric acid, it follows, that a greater quantity
of it is necessary, than in the digestion of other aliments, which do not
previously require being curdled. This ill digested milk not sufficiently
stimulating the rectum, remains till it becomes a too solid mass. On this
account milk seldom agrees with those, who are subject to piles, by
inducing costiveness and large stools.
M. M. Extract the hardened scybala by means of a marrow-spoon; or by a
piece of wire, or of whale-bone bent into a bow, and introduced. Injections
of oil. Castor oil, or oil of almonds, taken by the mouth. A large clyster
of smoak of tobacco. Six grains of rhubarb taken every night for many
months. Aloes. An endeavour to establish a habit of evacuation at a certain
hour daily. See Class I. 1. 3. 5.
* * * * *
ORDO III.
_Retrograde Sensitive Motions._
GENUS I.
_Of Excretory Ducts._
The retrograde action of the oesophagus in ruminating animals, when they
bring up the food from their first stomach for the purpose of a second
mastication of it, may probably be caused by agreeable sensation; similar
to that which induces them to swallow it both before and after this second
mastication; and then this retrograde action, properly belongs to this
place, and is erroneously put at the head of the order of irritative
retrograde motions. Class I. 3. 1. 1.
SPECIES.
1. _Ureterum motus retrogressus._ When a stone has advanced into the ureter
from the pelvis of the kidney, it is sometimes liable to be returned by the
retrograde motion of that canal, and the patient obtains fallacious ease,
till the stone is again pushed into the ureter.
2. _Urethrae motus retrogressus._ There have been instances of bougies
being carried up the urethra into the bladder most probably by an inverted
motion of this canal; for which some have undergone an operation similar to
that for the extraction of a stone. A case is related in some medical
publication, in which a catgut bougie was carried into the bladder, and
after remaining many weeks, was voided piece-meal in a semi-dissolved
state. Another case is related of a French officer, who used a leaden
bougie; which at length found its way into the bladder, and was, by
injecting crude mercury, amalgamated and voided.
In the same manner the infection from a simple gonorrhoea is probably
carried further along the course of the urethra; and small stones
frequently descend some way into the urethra, and are again carried up into
the bladder by the inverted action of this canal.
3. _Ductus choledochi motus retrogressus._ The concretions of bile, called
gall-stones, frequently enter the bile-duct, and give violent pain for some
hours; and return again into the gall-bladder, by the retrograde action of
this duct. May not oil be carried up this duct, when a gall-stone gives
great pain, by its retrograde spasmodic action? See Class I. 1. 3. 8.
M. M. Opium a grain and half.
* * * * *
_The Orders and Genera of the Third Class of Diseases._
* * * * *
CLASS III.
DISEASES OF VOLITION.
ORDO I.
_Increased Volition._
GENERA.
1. With increased actions of the muscles.
2. With increased actions of the organs of sense.
ORDO II.
_Decreased Volition._
GENERA.
1. With decreased actions of the muscles.
2. With decreased actions of the organs of sense.
* * * * *
_The Orders, Genera, and Species, of the Third Class of Diseases._
* * * * *
CLASS III.
DISEASES OF VOLITION.
ORDO I.
_Increased Volition._
GENUS I.
_With Increased Actions of the Muscles._
SPECIES.
1. _Jactitatio._ Restlessness.
2. _Tremor febrilis._ Febrile trembling.
3. _Clamor._ Screaming.
4. _Risus._ Laughter.
5. _Convulsio._ Convulsion.
---- _debilis._ ---- weak.
6. ---- _dolorifica._ ---- painful.
7. _Epilepsia._ Epilepsy.
8. ---- _dolorifica._ ---- painful.
9. _Somnambulismus._ Sleep-walking.
10. _Asthma convulsivum._ Asthma convulsive.
11. ---- _dolorificum._ ---- painful.
12. _Stridor dentium._ Gnashing of the teeth.
13. _Tetanus trismus._ Cramp of the jaw.
14. ---- _dolorificus._ ---- painful.
15. _Hydrophobia._ Dread of water.
GENUS II.
_With increased Actions of the Organs of Sense._
SPECIES.
1. _Mania mutabilis._ Mutable madness.
2. _Studium inane._ Reverie.
3. _Vigilia._ Watchfulness.
4. _Erotomania._ Sentimental love.
5. _Amor sui._ Vanity.
6. _Nostalgia._ Desire of home.
7. _Spes religiosa._ Superstitious hope.
8. _Superbia stemmatis._ Pride of family.
9. _Ambitio._ Ambition.
10. _Maeror._ Grief.
11. _Taedium vitae._ Irksomeness of life.
12. _Desiderium pulchritudinis._ Loss of beauty.
13. _Paupertatis timor._ Fear of poverty.
14. _Lethi timor._ ---- of death.
15. _Orci timor._ ---- of hell.
16. _Satyriasis._ Lust.
17. _Ira._ Anger.
18. _Rabies._ Rage.
19. _Citta._ Depraved appetite.
20. _Cacositia._ Aversion to food.
21. _Syphilis imaginaria._ Imaginary pox.
22. _Psora imaginaria._ ---- itch.
23. _Tabes imaginaria._ ---- tabes.
24. _Sympathia aliena._ Pity.
25. _Educatio heroica._ Heroic education.
ORDO II.
_Decreased Volition._
GENUS I.
_With decreased Actions of the Muscles._
SPECIES.
1. _Lassitudo._ Fatigue.
2. _Vacillatio senilis._ See-saw of old age.
3. _Tremor senilis._ Tremor of old age.
4. _Brachiorum paralysis._ Palsy of the arms.
5. _Raucedo paralytica._ Paralytic hoarseness.
6. _Vesicae urinariae paralysis._ Palsy of the bladder.
7. _Recti paralysis._ Palsy of the rectum.
8. _Paresis voluntaria._ Voluntary debility.
9. _Catalepsis._ Catalepsy.
10. _Hemiplegia._ Palsy of one side.
11. _Paraplegia._ Palsy of the lower limbs.
12. _Somnus._ Sleep.
13. _Incubus._ Night-mare.
14. _Lethargus._ Lethargy.
15. _Syncope epileptica._ Epileptic fainting.
16. _Apoplexia._ Apoplexy.
17. _Mors a frigore._ Death from cold.
GENUS II.
_With decreased Actions of the Organs of Sense._
SPECIES.
1. _Recollectionis jactura._ Loss of recollection.
2. _Stultitia voluntaria._ Voluntary folly.
3. _Credulitas._ Credulity.
* * * * *
CLASS III.
DISEASES OF VOLITION.
ORDO I.
_Increased Volition._
GENUS I.
_Increased Actions of the Muscles._
We now step forward to consider the diseases of volition, that superior
faculty of the sensorium, which gives us the power of reason, and by its
facility of action distinguishes mankind from brute animals; which has
effected all that is great in the world, and superimposed the works of art
on the situations of nature.
Pain is introduced into the system either by excess or defect of the action
of the part. (Sect. IV. 5.) Both which circumstances seem to originate from
the accumulation of sensorial power in the affected organ. Thus when the
skin is exposed to great cold, the activity of the cutaneous vessels is
diminished, and in consequence an accumulation of sensorial power obtains
in them, because they are usually excited into incessant motion by the
stimulus of heat, as explained in Sect. XII. 5. 2. Contrarywise, when the
vessels of the skin are exposed to great heat, an excess of sensorial power
is also produced in them, which is derived thither by the increase of
stimulus above what is natural.
This accounts for the relief which is received in all kinds of pain by any
violent exertions of our muscles or organs of sense; which may thus be in
part ascribed to the exhaustion of the sensorial power by such exertions.
But this relief is in many cases so instantaneous, that it seems
nevertheless probable, that it is also in part owing to the different
manner of progression of the two sensorial powers of sensation and
volition; one of them commencing at some extremity of the sensorium, and
being propagated towards the central parts of it; and the other commencing
in the central parts of the sensorium, and being propagated towards the
extremities of it; as mentioned in Sect. XI. 2. 1.
These violent voluntary exertions of our muscles or ideas to relieve the
sensation of pain constitute convulsions and madness; and are distinguished
from the muscular actions owing to increased sensation, as in sneezing, or
coughing, or parturition, or ejectio feminis, because they do not
contribute to dislodge the cause, but only to prevent the sensation of it.
In two cases of parturition, both of young women with their first child, I
have seen general convulsions occur from excess of voluntary exertion, as
above described, instead of the actions of particular muscles, which ought
to have been excited by sensation for the exclusion of the fetus. They both
became insensible, and died after some hours; from one of them the fetus
was extracted in vain. I have heard also of general convulsions being
excited instead of the actions of the musculi acceleratores in the ejectio
feminis, which terminated fatally. See Class III. 1. 1. 7.
These violent exertions are most frequently excited in consequence of those
pains, which originate from defect of the action of the part. See Sect.
XXXIV. 1. and 2. The pains from excess and defect of the action of the part
are distinguishable from each other by the former being attended with
increase of heat in the pained part, or of the whole body; while the latter
not only exist without increase of heat in the pained part, but are
generally attended with coldness of the extremities of the body.
As soon as these violent actions of our muscular or sensual fibres for the
purpose of relieving pain cease to be exerted, the pain recurs; whence the
reciprocal contraction and relaxation of the muscles in convulsion, and the
intervals of madness. Otherwise these violent exertions continue, till so
great a part of the sensorial power is exhausted, that no more of it is
excitable by the faculty of volition; and a temporary apoplexy succeeds,
with snoring as in profound sleep; which so generally terminates epileptic
fits.
When these voluntary exertions become so connected with certain
disagreeable sensations, or with irritations, that the effort of the will
cannot restrain them, they can no longer in common language be termed
voluntary; but nevertheless belong to this class, as they are produced by
excess of volition, and may still not improperly be called depraved
voluntary actions. See Sect. XXXIV. 1. where many motions in common
language termed involuntary are shewn to depend on excess of volition.
When these exertions from excess of volition, which in common language are
termed involuntary motions, either of mind or body, are perpetually exerted
in weak constitutions, the pulse becomes quick; which is occasioned by the
too great expenditure of the sensorial power in these unceasing modes of
activity. In the same manner as in very weak people in fevers, the pulse
sometimes increases in frequency to 140 strokes in a minute, when the
patients stand up or endeavour to walk; and subsides to 110, when they lie
down again in their beds. Whence it appears, that when a very quick pulse
accompanies convulsion or insanity, it simply indicates the weakness of the
patient; that is, that the expenditure of sensorial power is too great for
the supply of it. But if the strength of the patient is not previously
exhausted, the exertions of the muscles are attended with temporary
increase of circulation, the reciprocal swellings and elongations of their
bellies push forwards the arterial blood, and promote the absorption of the
venous blood; whence a temporary increase of secretion and of heat, and a
stronger pulse.
SPECIES.
1. _Jactitatio._ Restlessness. There is one kind of restlessness attending
fevers, which consists in a frequent change of posture to relieve the
uneasiness of the pressure of one part of the body upon another, when the
sensibility of the system, or of some parts of it, is increased by
inflammation, as in the lumbago; which may sometimes be distinguished in
its early stage by the incessant desire of the patient to turn himself in
bed. But there is another restlessness, which approaches towards writhing
or contortions of the body, which is a voluntary effort to relieve pain;
and may be esteemed a slighter kind of convulsion, not totally
unrestrainable by opposite or counteracting volitions.
M. M. A blister. Opium. Warm bath.
2. _Tremor febrilis._ Reciprocal convulsions of the subcutaneous muscles,
originating from the pain of the sense of heat, owing to defect of its
usual stimulus, and consequent accumulation of sensorial power in it. The
actual deficiency of heat may exist in one part of the body, and the pain
of cold be felt most vividly in some other part associated with it by
sensitive sympathy. So a chillness down the back is first attended to in
ague-fits, though the disease perhaps commences with the torpor and
consequent coldness of some internal viscus. But in whatever part of the
system the defect of heat exists, or the sensation of it, the convulsions
of the subcutaneous muscles exerted to relieve it are very general; and, if
the pain is still greater, a chattering of the teeth is added, the more
suddenly to exhaust the sensorial power, and because the teeth are very
sensible to cold.
These convulsive motions are nevertheless restrainable by violent voluntary
counteraction; and as their intervals are owing to the pain of cold being
for a time relieved by their exertion, they may be compared to laughter,
except that there is no interval of pleasure preceding each moment of pain
in this as in the latter.
M. M. See I. 2. 2. 1.
3. _Clamor._ Screaming from pain. The talkative animals, as dogs, and
swine, and children, scream most, when they are in pain, and even from
fear; as they have used this kind of exertion from their birth most
frequently and most forcibly; and can therefore sooner exhaust the
accumulation of sensorial power in the affected muscular or sensual organs
by this mode of exertion; as described in Sect. XXXIV. 1. 3. This facility
of relieving pain by screaming is the source of laughter, as explained
below.
4. _Risus._ The pleasurable sensations, which occasion laughter, are
perpetually passing into the bounds of pain; for pleasure and pain are
often produced by different degrees of the same stimulus; as warmth, light,
aromatic or volatile odours, become painful by their excess; and the
tickling on the soles of the feet in children is a painful sensation at the
very time it produces laughter. When the pleasurable ideas, which excite us
to laugh, pass into pain, we use some exertion, as a scream, to relieve the
pain, but soon stop it again, as we are unwilling to lose the pleasure; and
thus we repeatedly begin to scream, and stop again alternately. So that in
laughing there are three stages, first of pleasure, then pain, then an
exertion to relieve that pain. See Sect. XXXIV. 1. 3.
Every one has been in a situation, where some ludicrous circumstance has
excited him to laugh; and at the same time a sense of decorum has forbid
the exertion of these interrupted screams; and then the pain has become so
violent, as to occasion him to use some other great action, as biting his
tongue, and pinching himself, in lieu of the reiterated screams which
constitute laughter.
5. _Convulsio._ Convulsion. When the pains from defect or excess of motion
are more distressing than those already described, and are not relievable
by such partial exertions, as in screaming, or laughter, more general
convulsions occur; which vary perhaps according to the situation of the
pained part, or to some previous associations formed by the early habits of
life. When these convulsive motions bend the body forwards, they are termed
emprosthotonoi; when they bend it backward, they are termed opisthotonoi.
They frequently succeed each other, but the opisthotonoi are generally more
violent; as the muscles, which erect the body, and keep it erect, are
naturally in more constant and more forcible action than their antagonists.
The causes of convulsion are very numerous, as from toothing in children,
from worms or acidity in their bowels, from eruption of the distinct
small-pox, and lastly, from breathing too long the air of an unventilated
bed-room. Sir G. Baker, in the Transactions of the College, described this
disease, and detected its cause; where many children in an orphan-house
were crowded together in one chamber without a chimney, and were almost all
of them affected with convulsion; in the hospital at Dublin, many died of
convulsions before the real cause was understood. See Dr. Beddoes's Guide
to Self-preservation. In a large family, which I attended, where many
female servants slept in one room, which they had contrived to render
inaccessible to every blast of air; I saw four who were thus seized with
convulsions, and who were believed to have been affected by sympathy from
the first who fell ill. They were removed into more airy apartments, but
were some weeks before they all regained their perfect health.
Convulsion is distinguished from epilepsy, as the patient does not intirely
lose all perception during the paroxysm. Which only shews, that a less
exhaustion of sensorial power renders tolerable the pains which cause
convulsion, than those which cause epilepsy. The hysteric convulsions are
distinguished from those, owing to other causes, by the presence of the
expectation of death, which precedes and succeeds them, and generally by a
flow of pale urine; these convulsions do not constantly attend the hysteric
disease, but are occasionally superinduced by the disagreeable sensation
arising from the torpor or inversion of a part of the alimentary canal.
Whence the convulsion of laughter is frequently sufficient to restrain
these hysteric pains, which accounts for the fits of laughter frequently
attendant on this disease.
M. M. To remove the peculiar pain which excites the convulsions.
Venesection. An emetic. A cathartic with calomel. Warm-bath. Opium in large
quantities, beginning with smaller ones. Mercurial frictions. Electricity.
Cold-bath in the paroxysm; or cold aspersion. See Memoirs of Med. Society,
Lon. V. 3. p. 147. a paper by Dr. Currie.
_Convulsio debilis._ The convulsions of dying animals, as of those which
are bleeding to death in the slaughter-house, are an effort to relieve
painful sensation, either of the wound which occasions their death, or of
faintness from want of due distention of the blood-vessels. Similar to this
in a less degree is the subsultus tendinum, or starting of the tendons, in
fevers with debility; these actions of the muscles are too weak to move the
limb, but the belly of the acting muscles is seen to swell, and the tendon
to be stretched. These weak convulsions, as they are occasioned by the
disagreeable sensation of faintness from inanition, are symptoms of great
general debility, and thence frequently precede the general convulsions of
the act of dying. See a case of convulsion of a muscle of the arm, and of
the fore-arm, without moving the bones to which they were attached, Sect.
XVII. 1. 8. See twitchings of the face, Class IV. 1. 3. 2.
6. _Convulsio dolorifica._ Raphania. Painful convulsion. In this disease
the muscles of the arms and legs are exerted to relieve the pains left
after the rheumatism in young and delicate people; it recurs once or twice
a-day, and has been mistaken for the chorea, or St. Vitus's dance; but
differs from it, as the undue motions in that disease only occur, when the
patient endeavours to exert the natural ones; are not attended with pain;
and cease, when he lies down without trying to move: the chorea, or dance
of St. Vitus, is often introduced by the itch, this by the rheumatism.
It has also been improperly called nervous rheumatism; but is distinguished
from rheumatism, as the pains recur by periods once or twice a day; whereas
in the chronic rheumatism they only occur on moving the affected muscles.
And by the warmth of a bed the pains of the chronic rheumatism are
increased, as the muscles or membranes then become more sensible to the
stimulus of the extraneous mucaginous material deposited under them.
Whereas the pains of the raphania, or painful convulsion, commence with
coldness of the part, or of the extremities. See Rheumatismus chronicus,
Class I. 1. 3. 12.
The pains which accompany the contractions of the muscles in this disease,
seem to arise from the too great violence of those contractions, as happens
in the cramp of the calf of the leg; from which they differ in those being
fixed, and these being reiterated contractions. Thus these convulsions are
generally of the lower limbs, and recur at periodical times from some
uneasy sensation from defect of action, like other periodic diseases; and
the convulsions of the limbs relieve the original uneasy painful sensation,
and then produce a greater pain from their own too vehement contractions.
There is however another way of accounting for these pains, when they
succeed the acute rheumatism; and that is by the coagulable lymph, which
may be left still unabsorbed on the membranes; and which may be in too
small quantity to affect them with pain in common muscular exertions, but
may produce great pain, when the bellies of the muscles swell to a larger
bulk in violent action.
M. M. Venesection. Calomel. Opium. Bark. One grain of calomel and one of
opium for ten successive nights. A bandage spread with emplastrum de minio
put tight on the affected part.
7. _Epilepsia_ is originally induced, like other convulsions, by a
voluntary exertion to relieve some pain. This pain is most frequently about
the pit of the stomach, or termination of the bile-duct; and in some cases
the torpor of the stomach, which probably occasioned the epileptic fits,
remains afterwards, and produces a chronical anorexia; of which a case is
related in Class II. 2. 2. 1. There are instances of its beginning in the
heel, of which a case is published by Dr. Short, in the Med. Essays, Edinb.
I once saw a child about ten years old, who frequently fell down in
convulsions, as she was running about in play; on examination a wart was
found on one ancle, which was ragged and inflamed; which was directed to be
cut off, and the fits never recurred.
When epilepsy first commences, the patients are liable to utter one scream
before they fall down; afterwards the convulsions so immediately follow the
pain, which occasions them, that the patient does not recollect or seem
sensible of the preceding pain. Thus in laughter, when it is not excessive,
a person is not conscious of the pain, which so often recurs, and causes
the successive screams or exertions of laughter, which give a temporary
relief to it.
Epileptic fits frequently recur in sleep from the increase of sensibility
at that time, explained in Sect. XVIII. 14. In two such cases, both of
young women, one grain of opium given at night, and continued many months,
had success; in one of them the opium was omitted twice at different times,
and the fit recurred on both the nights. In the more violent case,
described in Sect. XVIII. 15, opium had no effect.
Epileptic fits generally commence with setting the teeth, by which means
the tongue is frequently wounded; and with rolling the eyeballs in every
kind of direction; for the muscles which suspend the jaw, as well as those
which move the eyes, are in perpetual motion during our waking hours; and
yet continue subservient to volition; hence their more facile and forcible
actions for the purpose of relieving pain by the exhaustion of sensorial
power. See Section XXXIV. 1. 4.
Epileptic convulsions are not attended with the fear of death, as in the
hysteric disease, and the urine is of a straw colour. However it must be
noted, that the disagreeable sensations in hysteric diseases sometimes are
the cause of true epileptic convulsions, of syncope, and of madness.
The pain, which occasions some fits of epilepsy, is felt for a time in a
distant part of the system, as in a toe or heel; and is said by the patient
gradually to ascend to the head, before the general convulsions commence.
This ascending sensation has been called aura epileptica, and is said to
have been prevented from affecting the head by a tight bandage round the
limb. In this malady the pain, probably of some torpid membrane, or
diseased tendon, is at first only so great as to induce slight spasms of
the muscular fibres in its vicinity; which slight spasms cease on the
numbness introduced by a tight bandage; when no bandage is applied, the
pain gradually increases, till generally convulsions are exerted to relieve
it. The course of a lymphatic, as when poisonous matter is absorbed; or of
a nerve, as in the sciatica, may, by the sympathy existing between their
extremities and origins, give an idea of the ascent of an aura or vapour.
In difficult parturition it sometimes happens, that general convulsions are
excited to relieve the pain of labour, instead of the exertions of those
muscles of the abdomen and diaphragm, which ought to forward the exclusion
of the child. See Class III. 1. 1. That is, instead of the particular
muscular actions, which ought to be excited by sensation to remove the
offending cause, general convulsions are produced by the power of volition,
which still the pain, as in common epilepsy, without removing the cause;
and, as the parturition is not thus promoted, the convulsions continue,
till the sensorial power is totally exhausted, that is, till death. In
patients afflicted with epilepsy from other causes, I have seen the most
violent convulsions recur frequently during pregnancy without miscarriage,
as they did not tend to forward the exclusion of the fetus.
M. M. Venesection. A large dose of opium. Delivery.
The later in life epileptic fits are first experienced, the more dangerous
they may be esteemed in general; as in these cases the cause has generally
been acquired by the habits of the patient, or by the decay of some part,
and is thus probably in an increasing state. Whereas in children the
changes in the system, as they advance to puberty, sometimes removes the
cause. So in toothing, fits of convulsion with stupor frequently occur, and
cease when the tooth advances; but this is not to be expected in advanced
life. Sir ----, about sixty years of age, had only three teeth left in his
upper jaw, a canine tooth, and one on each side of it. He was seized with
epileptic fits, with pain commencing in these teeth. He was urged to have
them extracted, which he delayed too long, till the fits were become
habitual, and then had them extracted in vain, and in a few months sunk
under the disease.
Mr. F----, who had lived intemperately, and had been occasionally affected
with the gout, was suddenly seized with epileptic fits; the convulsions
were succeeded by apoplectic snoring; from which he was, in about 20
minutes, disturbed by fresh convulsions, and had continued in this
situation above four-and-twenty hours. About eight ounces of blood were
then taken from him; and after having observed, that the apoplectic's
torpor continued about 20 minutes, I directed him to be forcibly raised up
in bed, after he had thus lain about fifteen minutes, to gain an interval
between the termination of the sleep, and the renovation of convulsion. In
this interval he was induced to swallow forty drops of laudanum. Twenty
more were given him in the same manner in about half an hour, both which
evidently shortened the convulsion fits, and the consequent stupor; he then
took thirty more drops, which for the present removed the fits. He became
rather insane the next day, and after about three more days lost the
insanity, and recovered his usual state of health.
The case mentioned in Sect. XXVII. 2. where the patient was left after
epileptic fits with a suffusion of blood beneath the tunica adjunctiva of
the eye, was in almost every respect similar to the preceding, and
submitted to the same treatment. Both of them suffered frequent relapses,
which were relieved by the same means, and at length perished, I believe,
by the epileptic fits.
In those patients, who have not been subject to epilepsy before they have
arrived to about forty years of age, and who have been intemperate in
respect to spirituous potation, I have been induced to believe, that the
fits were occasioned by the pain of a diseased liver; and this became more
probable in one of the above subjects, who had used means to repel
eruptions on the face; and thus by some stimulant application had prevented
an inflammation taking place on the skin of the face instead of on some
part of the liver. Secondly, as in these cases insanity had repeatedly
occurred, which could not be traced from an hereditary source; there is
reason to believe, that this as well as the epileptic convulsions were
caused by spirituous potation; and that this therefore is the original
source both of epilepsy and of insanity in those families, which are
afflicted with them. This idea however brings some consolation with it; as
it may be inferred, that in a few sober generations these diseases may be
eradicated, which otherwise destroy the family.
M. M. Venesection. Opium. Bark. Steel. Arsenic. Opium one grain twice a day
for years together. See the preceding article.
8. _Epilepsia dolorifica._ Painful epilepsy. In the common epilepsy the
convulsions are immediately induced, as soon as the disagreeable sensation,
which causes them, commences; but in this the pain continues long with cold
extremities, gradually increasing for two or three hours, till at length
convulsions or madness come on; which terminate the daily paroxysm, and
cease themselves in a little time afterwards.
This disease sometimes originates from a pain about the lower edge of the
liver, sometimes in the temple, and sometimes in the pudendum; it recurs
daily for five or six weeks, and then ceases for several months. The pain
is owing to defect of action, that is, to the accumulation of sensorial
power in the part, which probably sympathizes with some other part, as
explained in Sect. XXXV. 2. XII. 5. 3. and Class II. 1. 1. 11. and IV. 2.
2. 3.
It is the most painful malady that human nature is liable to!--See Sect.
XXXIV. 1. 4.
Mrs. C---- was seized every day about the same hour with violent pain on
the right side of her bowels about the situation of the lower edge of the
liver, without fever, which increased for an hour or two, till it became
totally intolerable. After violent screaming she fell into convulsions,
which terminated sometimes in fainting, with or without stertor, as in
common epilepsy; at other times a tempory insanity supervened; which
continued about half an hour, and the fit ceased. These paroxysms had
returned daily for two or three weeks, and were at length removed by large
doses of opium, like the fits of reverie or somnambulation. About half an
hour before the expected return of the fit three or four grains of opium
were exhibited, and then tincture of opium was given in warm brandy and
water about 20 or 30 drops every half hour, till the eyes became somewhat
inflamed, and the nose began to itch, and by the sharp movements of the
patient, or quick speech, an evident intoxication appeared; and then it
generally happened that the pain ceased. But the effects of this large dose
of opium was succeeded by perpetual sickness and efforts to vomit, with
great general debility all the succeeding day.
The rationale of this temporary cure from the exhibition of opium and
vinous spirit depends on the great expenditure of sensorial power in the
increased actions of all the irritative motions, by the stimulus of such
large quantities of opium and vinous spirit; together with the production
of much sensation, and many movements of the organs of sense or ideas in
consequence of that sensation; and lastly, even the motions of the arterial
system become accelerated by this degree of intoxication, all which soon
exhausted so much sensorial power as to relieve the pain; which would
otherwise have caused convulsions or insanity, which are other means of
expending sensorial power. The general debility on the succeeding day, and
the particular debility of the stomach, attended in consequence with
sickness and frequent efforts to vomit, were occasioned by the system
having previously been so strongly stimulated, and those parts in
particular on which the opium and wine more immediately acted. This
sickness continued so many hours as to break the catenation of motions,
which had daily reproduced the paroxysm; and thus it generally happened,
that the whole disease ceased for some weeks or months from one great
intoxication, a circumstance not easily to be explained on any other
theory.
The excess or defect of motion in any part of the system occasions the
production of pain in that part, as in Sect. XII. 1. 6. This defect or
excess of fibrous action is generally induced by excess or defect of the
stimulus of objects external to the moving organ. But there is another
source of excessive fibrous action, and consequent pain, which is from
excess of volition, which is liable to affect those muscles, that have weak
antagonists; as those which support the under jaw, and close the mouth in
biting, and those of the calf of the leg; which are thus liable to fixed or
painful contractions, as in trismus, or locked jaw, and in the cramp of the
calf of the leg; and perhaps in some colics, as in that of Japan: these
pains, from contraction arising from excess of volition in the part from
the want of the counteraction of antagonist muscles, may give occasional
cause to epileptic fits, and may be relieved in the same way, either by
exciting irritative and sensitive motions by the stimulus of opium and
wine; or by convulsions or insanity, as described above, which are only
different methods of exhausting the general quantity of sensorial power.
Considering the great resemblance between this kind of painful epilepsy and
the colic of Japan, as described by Kemfer; and that that disease was said
to be cured by acupuncture, or the prick of a needle; I directed some very
thin steel needles to be made about three inches long, and of such a
temper, that they would bend double rather than break; and wrapped wax
thread over about half an inch of the blunt end for a handle. One of these
needles, when the pain occurred, was pushed about an inch into the painful
part, and the pain instantly ceased; but I was not certain, whether the
fear of the patient, or the stimulus of the puncture, occasioned the
cessation of pain; and as the paroxysm had continued some weeks, and was
then declining, the experiment was not tried again. The disease is said to
be very frequent in Japan, and its seat to be in the bowels, and that the
acupuncture eliminates the air, which is supposed to distend the bowel. But
though the aperture thus made is too small to admit of the eduction of air;
yet as the stimulus of so small a puncture may either excite a torpid part
into action, or cause a spasmodic one to cease to act; and lastly, as no
injury could be likely to ensue from so small a perforation, I should be
inclined at some future time to give this a fairer trial in similar
circumstances.
Another thing worth trial at the commencement of this deplorable disease
would be electricity, by passing strong shocks through the painful part;
which, whether the pain was owing to the inaction of that part, or of some
other membrane associated with it, might stimulate them into exertion; or
into inactivity, if owing to fixed painful contraction.
And lastly, the cold bath, or aspersions with cold water on the affected
part, according to the method of Dr. Currie in the Memoirs of a Med. Soc.
London, V. iii. p. 147, might produce great effect at the commencement of
the pain. Nevertheless opium duly administered, so as to precede the
expected paroxysm, and in such doses, given by degrees, as to induce
intoxication, is principally to be depended upon in this deplorable malady.
To which should be added, that if venesection can be previously performed,
even to but few ounces, the effect of the opium is much more certain; and
still more so, if there be time to premise a brisk cathartic, or even an
emetic. The effect of increased stimulus is so much greater after previous
defect of stimulus; and this is still of greater advantage where the cause
of the disease happens to consist in a material, which can be absorbed. See
Art. IV. 2. 8.
M. M. Venesection. An emetic. A cathartic. Warm bath. Opium a grain every
half hour. Wine. Spirit of wine. If the patient becomes intoxicated by the
above means, the fit ceases, and violent vomitings and debility succeed on
the subsequent day, and prevent a return. Blisters or sinapisms on the
small of the leg, taken off when they give much pain, are of use in
slighter convulsions. Acupuncture. Electricity. Aspersion with cold water
on the painful part.
9. _Somnambulismus._ Sleep-walking is a part of reverie, or studium inane,
described in Sect. XIX. In this malady the patients have only the general
appearance of being asleep in respect to their inattention to the stimulus
of external objects, but, like the epilepsies above described, it consists
in voluntary exertions to relieve pain. The muscles are subservient to the
will, as appears by the patient's walking about, and sometimes doing the
common offices of life. The ideas of the mind also are obedient to the
will, because their discourse is consistent, though they answer imaginary
questions. The irritative ideas of external objects continue in this
malady, because the patients do not run against the furniture of the room;
and when they apply their volition to their organs of sense, they become
sensible of the objects they attend to, but not otherwise, as general
sensation is destroyed by the violence of their voluntary exertions. At the
same time the sensations of pleasure in consequence of ideas excited by
volition are vividly experienced, and other ideas seem to be excited by
these pleasurable sensations, as appears in the case of Master A. Sect.
XXXIV. 3. 1. where a history of a hunting scene was voluntarily recalled,
with all the pleasurable ideas which attended it. In melancholy madness the
patient is employed in voluntarily exciting one idea, with those which are
connected with it by voluntary associations only, but not so violently as
to exclude the stimuli of external objects. In reverie variety of ideas are
occasionally excited by volition, and those which are connected with them
either by sensitive or voluntary associations, and that so violently as to
exclude the stimuli of external objects. These two situations of our
sensual motions, or ideas, resemble convulsion and epilepsy; as in the
former the stimulus of external objects is still perceived, but not in the
latter. Whence this disease, so far from being connected with sleep, though
it has by universal mistake acquired its name from it, arises from excess
of volition, and not from a suspension of it; and though, like other kinds
of epilepsy, it often attacks the patients in their sleep, yet those two,
whom I saw, were more frequently seized with it while awake, the
sleep-walking being a part of the reverie. See Sect. XIX. and XXXIV. 3. and
Class II. 1. 7. 4. and III. 1. 2. 18.
M. M. Opium in large doses before the expected paroxysm.
10. _Asthma convulsivum._ The fits of convulsive asthma return at periods,
and are attended with cold extremities, and so far resemble the access of
an intermittent fever; but, as the lungs are not sensible to the pain of
cold, a shivering does not succeed, but instead of it violent efforts of
respiration; which have no tendency, as in the humoral asthma, to dislodge
any offending material, but only to relieve the pain by exertion, like the
shuddering in the beginning of ague-fits, as explained Class III. 1. 1. 2.
The insensibility of the lungs to cold is observable on going into frosty
air from a warm room; the hands and face become painfully cold, but no such
sensation is excited in the lungs; which is another argument in favour of
the existence of a peculiar set of nerves for the purpose of perceiving the
universal fluid matter of heat, in which all things are immersed. See Sect.
XIV. 6. Yet are the lungs nevertheless very sensible to the deficiency of
oxygen in the atmosphere, as all people experience, when they go into a
room crowded with company and candles, and complain, that it is so close,
they can scarcely breathe; and the same in some hot days in summer.
There are two diseases, which bear the name of asthma. The first is the
torpor or inability of the minute vessels of the lungs, consisting of the
terminations of the pulmonary and bronchial arteries and veins, and their
attendant lymphatics; in this circumstance it resembles the difficulty of
breathing, which attends cold bathing. If this continues long, a congestion
of fluid in the air-cells succeeds, as the absorbent actions cease
completely before the secerning ones; as explained in Class I. 1. 2. 3. And
the coldness, which attends the inaction of these vessels, prevents the
usual quantity of exhalation. Some fits cease before this congestion takes
place, and in them no violent sweating nor any expuition of phlegm occurs.
This is the humoral asthma, described at Class II. 1. 1. 7.
The second kind of asthma consists in the convulsive actions in consequence
of the disagreeable sensations thus induced; which in some fits of asthma
are very great, as appears in the violent efforts to raise the ribs, and to
depress the diaphragm, by lifting the shoulders. These, so long as they
contribute to remove the cause of the disease, are not properly
convulsions, but exertions immediately caused by sensation; but in this
kind of asthma they are only efforts to relieve pain, and are frequently
preceded by other epileptic convulsions.
These two kinds of asthmas have so many resembling features, and are so
frequently intermixed, that it often requires great attention to
distinguish them; but as one of them is allied to anasarca, and the other
to epilepsy, we shall acquire a clearer idea of them by comparing them with
those disorders. A criterion of the humoral or hydropic asthma is, that it
is relieved by copious sweats about the head and breast, which are to be
ascribed to the sensitive exertions of the pulmonary vessels to relieve the
pain occasioned by the anasarcous congestion in the air-cells; and which is
effected by the increased absorption of the mucus, and its elimination by
the retrograde action of those lymphatics of the skin, whose branches
communicate with the pulmonary ones; and which partial sweats do not easily
admit of any other explanation. See Class I. 3. 2. 8. Another criterion of
it is, that it is generally attended with swelled legs, or other symptoms
of anasarca. A criterion of the convulsive asthma may be had from the
absence of these cold clammy sweats of the upper part of the body only, and
from the patient having occasionally been subject to convulsions of the
limbs, as in the common epilepsy.
It may thus frequently happen, that in the humoral asthma some exertions of
the lungs may occur, which may not contribute to discharge the anasarcous
lymph, but may be efforts simply to relieve pain; besides those efforts,
which produce the increased absorption and elimination of it; and thus we
have a bodily disease resembling in this circumstance the reverie, in which
both sensitive and voluntary motions are at the same time, or in
succession, excited for the purpose of relieving pain.
It may likewise sometimes happen, that the disagreeable sensation,
occasioned by the congestion of lymph in the air-cells in the humoral or
hydropic asthma, may induce voluntary convulsions of the respiratory organs
only to relieve the pain, without any sensitive actions of the pulmonary
absorbents to absorb and eliminate the congestion of serous fluid; and thus
the same cause may occasionally induce either the humoral or convulsive
asthma.
The humoral asthma has but one remote cause, which is the torpor of the
pulmonary vessels, like that which occurs on going into the cold bath; or
the want of absorption of the pulmonary lymphatics to take up the lymph
effused into the air-cell. Whereas the convulsive asthma, like other
convulsions, or epilepsies, may be occasioned by pain in almost any remote
part of the system. But in some of the adult patients in this disease, as
in many epilepsies, I have suspected the remote cause to be a pain of the
liver, or of the biliary ducts.
The asthmas, which have been induced in consequence of the recess of
eruptions, especially of the leprous kind, countenance this opinion. One
lady I knew, who for many years laboured under an asthma, which ceased on
her being afflicted with pain, swelling, and distortion of some of her
large joints, which were esteemed gouty, but perhaps erroneously. And a
young man, whom I saw yesterday, was seized with asthma on the
retrocession, or ceasing of eruptions on his face.
The convulsive asthma, as well as the hydropic, are more liable to return
in hot weather; which may be occasioned by the less quantity of oxygen
existing in a given quantity of warm air, than of cold, which can be taken
into the lungs at one inspiration. They are both most liable to occur after
the first sleep, which is therefore a general criterion of asthma. The
cause of this is explained in Sect. XVIII. 15. and applies to both of them,
as our sensibility to internal uneasy sensation increases during sleep.
When children are gaining teeth, long before they appear, the pain of the
gums often induces convulsions. This pain is relieved in some by sobbing
and screaming; but in others a laborious respiration is exerted to relieve
the pain; and this constitutes the true asthma convulsivum. In other
children again general convulsions, or epileptic paroxysms, are induced for
this purpose; which, like other epilepsies, become established by habit,
and recur before the irritation has time to produce the painful sensation,
which originally caused them.
The asthma convulsivum is also sometimes induced by worms, or by acidity in
the stomachs of children, and by other painful sensations in adults; in
whom it is generally called nervous asthma, and is often joined with other
epileptic symptoms.
This asthma is distinguished from the peripneumony, and from the croup, by
the presence of fever in the two latter. It is distinguished from the
humoral asthma, as in that the patients are more liable to run to the cold
air for relief, are more subject to cold extremities, and experience the
returns of it more frequently after their first sleep. It is distinguished
from the hydrops thoracis, as that has no intervals, and the patient sits
constantly upright, and the breath is colder; and, where the pericardium is
affected, the pulse is quick and unequal. See Hydrops Thoracis, I. 2. 3.
14.
M. M. Venesection once. A cathartic with calomel once. Opium. Assafoetida.
Warm bath. If the cause can be detected, as in toothing or worms, it should
be removed. As this species of asthma is so liable to recur during sleep,
like epileptic fits, as mentioned in Section XVIII. 15. there was reason to
believe, that the respiration of an atmosphere mixed with hydrogen, or any
other innocuous air, which might dilute the oxygen, would be useful in
preventing the paroxysms by decreasing the sensibility of the system. This,
I am informed by Dr. Beddoes, has been used with decided success by Dr.
Ferriar. See Class II. 1. 1. 7.
11. _Asthma dolorificum._ Angina pectoris. The painful asthma was first
described by Dr. Heberden in the Transactions of the College; its principal
symptoms consist in a pain about the middle of the sternum, or rather
lower, on every increase of pulmonary or muscular exertion, as in walking
faster than usual, or going quick up a hill, or even up stairs; with great
difficulty of breathing, so as to occasion the patient instantly to stop. A
pain in the arms about the insertion of the tendon of the pectoral muscle
generally attends, and a desire of resting by hanging on a door or branch
of a tree by the arms is sometimes observed. Which is explained in Class I.
2. 3. 14. and in Sect. XXIX. 5. 2.
These patients generally die suddenly; and on examining the thorax no
certain cause, or seat, of the disease has been detected; some have
supposed the valves of the arteries, or of the heart, were imperfect; and
others that the accumulation of fat about this viscus or the lungs
obstructed their due action; but other observations do not accord with
these suppositions.
Mr. W----, an elderly gentleman, was seized with asthma during the hot part
of last summer; he always waked from his first sleep with difficult
respiration, and pain in the middle of his sternum, and after about an hour
was enabled to sleep again. As this had returned for about a fortnight, it
appeared to me to be an asthma complicated with the disease, which Dr.
Heberden has called angina pectoris. It was treated by venesection, a
cathartic, and then by a grain of opium given at going to bed, with ether
and tincture of opium when the pain or asthma required, and lastly with the
bark, but was several days before it was perfectly subdued.
This led me to conceive, that in this painful asthma the diaphragm, as well
as the other muscles of respiration, was thrown into convulsive action, and
that the fibres of this muscle not having proper antagonists, a painful
fixed spasm of it, like that of the muscles in the calf of the leg in the
cramp, might be the cause of death in the angina pectoris, which I have
thence arranged under the name of painful asthma, and leave for further
investigation.
From the history of the case of the late much lamented John Hunter, and
from the appearances after death, the case seems to have been of this kind,
complicated with vertigo and consequent affection of the stomach. The
remote cause seems to have arisen from ossifications of the coronary
arteries; and the immediate cause of his death from fixed spasm of the
heart. Other histories and dissections are still required to put this
matter out of doubt; as it is possible, that either a fixed spasm of the
diaphragm, or of the heart, which are both furnished with but weak
antagonists, may occasion sudden death; and these may constitute two
distinct diseases.
Four patients I have now in my recollection, all of whom I believed to
labour under the angina pectoris in a great degree; which have all
recovered, and have continued well three or four years by the use, as I
believe, of issues on the inside of each thigh; which were at first large
enough to contain two pease each, and afterwards but one. They took besides
some slight antimonial medicine for a while, and were reduced to half the
quantity or strength of their usual potation of fermented liquor.
The use of femoral issues in angina pectoris was first recommended by Dr.
Macbride, physician at Dublin, Med. Observ. & Enquir. Vol. VI. And I was
further induced to make trial of them, not only because the means which I
had before used were inadequate, but from the ill effect I once observed
upon the lungs, which succeeded the cure of a small sore beneath the knee;
and argued conversely, that issues in the lower limbs might assist a
difficult respiration.
Mrs. L----, about fifty, had a small sore place about the size of half a
pea on the inside of the leg a little below the knee. It had discharged a
pellucid fluid, which she called a ley-water, daily for fourteen years,
with a great deal of pain; on which account she applied to a surgeon, who,
by means of bandage and a saturnine application, soon healed the sore,
unheedful of the consequences. In less than two months after this I saw her
with great difficulty of breathing, which with universal anasarca soon
destroyed her.
The theory of the double effect of issues, as above related, one in
relieving by their presence the asthma dolorificum, and the other in
producing by its cure an anasarca of the lungs, is not easy to explain.
Some similar effects from cutaneous eruptions and from blisters are
mentioned in Class I. 1. 2. 9. In these cases it seems probable, that the
pain occasioned by issues, and perhaps the absorption of a small quantity
of aerated purulent matter, stimulate the whole system into greater energy
of action, and thus prevent the torpor which is the beginning of so many
diseases. In confirmation of this effect of pain on the system, I remember
the case of a lady of an ingenious and active mind, who, for many of the
latter years of her life, was perpetually subject to great pains of her
head from decaying teeth. When all her teeth were gone, she became quite
low spirited, and melancholy in the popular sense of that word, and after a
year or two became universally dropsical and died.
M. M. Issues in the thighs. Five grains of rhubarb, and one sixth of a
grain of emetic tartar every night for some months, with or without half a
grain of opium. No stronger liquor than small beer, or wine diluted with
twice its quantity of water. Since I wrote the above I have seen two cases
of hydrops thoracis, attended with pain in the left arm, so as to be
mistaken for asthma dolorificum, in which femoral issues, though applied
early in the disease, had no effect.
12. _Stridor dentium._ The clattering of the teeth on going into cold
water, or in the beginning of ague-fits, is an exertion along with the
tremblings of the skin to relieve the pain of cold. The teeth and skin
being more sensible to cold than the more internal parts, and more exposed
to it, is the reason that the muscles, which serve them, are thrown into
exertion from the pain of cold rather than those of respiration, as in
screaming from more acute pain. Thus the poet,
Put but your toes into cold water,
Your correspondent teeth will clatter.
PRIOR.
In more acute pains the jaws are gnashed together with great vehemence,
insomuch that sometimes the teeth are said to have been broken by the
force. See Sect. XXXIV. 1. 3. In these cases something should be offered to
the patient to bite, as a towel, otherwise they are liable to tear their
own arms, or to bite their attendants, as I have witnessed in the painful
epilepsy.
13. _Tetanus trismus._ Cramp. The tetanus consists of a fixed spasm of
almost all the muscles of the body; but the trismus, or locked jaw, is the
most frequent disease of this kind. It is generally believed to arise from
sympathy with an injured tendon. In one case where it occurred in
consequence of a broken ankle from a fall from a horse, it was preceded by
evident hydrophobia. Amputation was advised, but not submitted to; two
wounds were laid into one with scissors, but the patient died about the
seventh day from the accident. In this case the wounded tendon, like the
wounds from the bite of a mad dog, did not produce the hydrophobia, and
then the locked jaw, till several days after the accident.
I twice witnessed the locked jaw from a pain beneath the sternum, about the
part where it is complained of in painful asthma, or angina pectoris, in
the same lady at some years distance of time. The last time it had
continued two days, and she wrote her mind, or expressed herself by signs.
On observing a broken tooth, which made a small aperture into her mouth, I
rolled up five grains of opium like a worm about an inch long, and
introducing it over the broken tooth, pushed it onward by means of a small
crow-quill; as it dissolved I observed she swallowed her saliva, and in
less than half an hour, she opened her mouth and conversed as usual.
Men are taught to be ashamed of screaming from pain in their early years;
hence they are prone to exert the muscles of the jaws instead, which they
have learnt to exert frequently and violently from their infancy; whence
the locked jaw. This and the following spasm have no alternate relaxations,
like the preceding ones; which is perhaps owing, first, to the weakness of
their antagonist muscles, those which elevate the jaw being very strong for
the purpose of biting and masticating hard substances, and for supporting
the under jaw, with very weak antagonist muscles; and secondly, to their
not giving sufficient relief even for a moment to the pain, or its
preceding irritation, which excited them.
M. M. Opium in very large quantities. Mercurial ointment used extensively.
Electricity. Cold bath. Dilate the wound, and fill it with lint moistened
with spirit of turpentine; which inflames the wound, and cures or prevents
the convulsions. See a case, Transact. of American Society, Vol. II. p.
227.
Wine in large quantities in one case was more successful than opium; it
probably inflames more, which in this disease is desirable. Between two or
three ounces of bark, and from a quart to three pints of wine a day,
succeeded better than opium. Ib.
14. _Tetanus dolorificus._ Painful cramp. This kind of spasm most
frequently attacks the calf of the leg, or muscles of the toes; it often
precedes paroxysms of gout, and appears towards the end of violent
diarrhoea, and from indigestion, or from acid diet. In these cases it seems
to sympathize with the bowels, but is also frequently produced by the pain
of external cold, and to the too great previous extension of the muscles,
whence some people get the cramp in the extensor muscles of the toes after
walking down hill, and of those of the calf of the leg after walking up a
steep eminence. For the reason why these cramps commence in sleep, see
Sect. XVIII. 15.
The muscle in this disease contracts itself to relieve some smaller pain,
either from irritation or association, and then falls into great pain
itself, from the too great action of its own fibres. Hence any muscle, by
being too vehemently exerted, falls into cramp, as in swimming too forcibly
in water, which is painfully cold; and a secondary pain is then induced by
the too violent contraction of the muscle; though the pain, which was the
cause of the contraction, ceases. Which accounts for the continuance of the
contraction, and distinguishes this disease from other convulsions, which
are relaxed and exerted alternately. Hence whatever may be the cause of the
primary pain, which occasions the cramp of the calf of the leg, the
secondary one is relievable by standing up, and thus by the weight of the
body on the toes forcibly extending the contracted muscles. For the cause,
which induces these muscles of the calf of the leg to fall into more
violent contraction than other spasmodic muscles, proceeds from the
weakness of their antagonist muscles; as they are generally extended again
after action by the weight of the body on the balls of the toes. See the
preceding article.
M. M. Rub the legs with camphor dissolved in oil, and let the patient wear
stockings in bed. If a foot-board be put at the bed's feet, and the bed be
so inclined, that he will rest a little with his toes against the
foot-board, that pressure is said to prevent the undue contractions of the
musculi gastrocnemii, which constitute the calf of the leg. In gouty
patients, or where the bowels are affected with acidity, half a grain of
opium, and six grains of rhubarb, and six of chalk, every night. Flesh-meat
to supper. A little very weak warm spirit and water may be taken for
present relief, when these cramps are very troublesome to weak or gouty
patients.
15. _Hydrophobia._ Dread of water generally attending canine madness. I was
witness to a case, where this disease preceded the locked jaw from a wound
in the ankle, occasioned by a fall from a horse; as mentioned in the
preceding article. It came on about the sixth day after the accident; when
the patient attempted to swallow fluids, he became convulsed all over from
the pain of this attempt, and spurted them out of his mouth with violence.
It is also said to happen in some hysterical cases. Hence it seems rather
the immediate consequence of a pained tendon, than of a contagious poison.
And is so far analogous to tetanus, according with the opinions of Doctor
Rusch and Doctor Percival.
In other respects, as it is produced by the saliva of an enraged animal
instilled into a wound, it would seem analogous to the poison of venomous
animals. And from the manner of its access so long after the bite, and of
its termination in a short time, it would seem to resemble the progress of
contagious fevers. See Sect. XXII. 3. 3.
If the patient was bitten in a part, which could be totally cut away, as a
finger, even after the hydrophobia appears, it is probable it might cure
it; as I suspect the cause still remains in the wounded tendon, and not in
a diffused infection tainting the blood. Hence there are generally uneasy
sensations, as cold or numbness, in the old cicatrix, before the
hydrophobia commences. See a case in Medical Communications, Vol. II. p.
190.
If the diseased tendon could be inflamed without cutting it out, as by
cupping, or caustic, or blister after cupping, and this in the old wound
long since healed, after the hydrophobia commences, might prevent the
spasms about the throat. As inflaming the teeth by the use of mercury is of
use in some kinds of hemicrania. Put spirit of turpentine on the wound,
wash it well. See Class I. 3. 1. 11. IV. 1. 2. 7.
M. M. Wine, musk, oil, internally. Opium, mercurial ointment, used
extensively. Mercurial fumigation. Turpeth mineral. To salivate the patient
as soon as possible. Exsection or a caustic on the scar, even after the
appearance of hydrophobia. Put a tight bandage on the limb above the scar
of the old wound to benumb the pained tendon, however long the wound may
have been healed. Could a hollow catheter of elastic gum, caoutchouc, be
introduced into the oesophagus by the mouth or nostril, and liquid
nourishment be thus conveyed into the stomach? See Desault's Journal, Case
I. where, in an ulcer of the mouth, such a catheter was introduced by the
nostril, and kept in the oesophagus for a month, by which means the patient
was nourished and preserved.
It is recommended by Dr. Bardsley to give oil internally by a similar
method contrived by Mr. John Hunter. He covered a probang with the skin of
a small eel, or the gut of a lamb or cat. It was tied up at one end above
and below the sponge, and a slit made above the upper ligature; to the
other end of the eel-skin or gut was fixed a bladder and pipe. The probang
thus covered was introduced into the stomach, and the liquid food or
medicine was put into the bladder and squeezed down through the eel-skin.
Mem. of Society at Manchester. See Class I. 2. 3. 25.
Dr. Bardsley has endeavoured to prove, that dogs never experience the
hydrophobia, or canine madness, without having been previously bitten or
infected; and secondly, that the disease in this species of animal always
shews itself in five or six weeks; and concludes from hence, that this
dreadful malady might be annihilated by making all the dogs in Great
Britain perform a kind of quarantine, by shutting them up for a certain
number of weeks. Though the disease from the bite of the mad dog is perhaps
more analogous to those from the wounds inflicted by venomous animals than
to those from other contagious matter, yet these observations are well
worthy further attention; which the author promises.
* * * * *
ORDO I.
_Increased Volition._
GENUS II.
_With increased Actions of the Organs of Sense._
In every species of madness there is a peculiar idea either of desire or
aversion, which is perpetually excited in the mind with all its
connections. In some constitutions this is connected with pleasurable ideas
without the exertion of much muscular action, in others it produces violent
muscular action to gain or avoid the object of it, in others it is attended
with despair and inaction. Mania is the general word for the two former of
these, and melancholia for the latter; but the species of them are as
numerous as the desires and aversions of mankind.
In the present age the pleasurable insanities are most frequently induced
by superstitious hopes of heaven, by sentimental love, and by personal
vanity. The furious insanities by pride, anger, revenge, suspicion. And the
melancholy ones by fear of poverty, fear of death, and fear of hell; with
innumerable others.
Quicquid agunt homines, votum, timor, ira, voluptas,
Gaudia, discursus, nostri est farrago libelli.
JUVEN. I. 85.
This idea, however, which induces madness or melancholy, is generally
untrue; that is, the object is a mistaken fact. As when a patient is
persuaded he has the itch, or venereal disease, of which he has no symptom,
and becomes mad from the pain this idea occasions. So that the object of
madness is generally a delirious idea, and thence cannot be conquered by
reason; because it continues to be excited by painful sensation, which is a
stronger stimulus than volition. Most frequently pain of body is the cause
of convulsion, which is often however exchanged for madness; and a painful
delirious idea is most frequently the cause of madness originally, but
sometimes of convulsion. Thus I have seen a young lady become convulsed
from a fright, and die in a few days; and a temporary madness frequently
terminates the paroxysms of the epilepsia dolorifica, and an insanity of
greater permanence is frequently induced by the pains or bruises of
parturition.
Where the patient is debilitated a quick pulse sometimes attends insane
people, which is nevertheless generally only a symptom of the debility,
owing to the too great expenditure of sensorial power; or of the paucity of
its production, as in inirritative, or in sensitive inirritated fever. See
III. 1. 1.
But nevertheless where the quick pulse is permanent, it shews the presence
of fever; and as the madness then generally arises from the disagreeable
sensations attending the fever, it is so far a good symptom; because when
the fever is cured, or ceases spontaneously, the insanity most frequently
vanishes at the same time.
The stimulus of so much volition supports insane people under variety of
hardships, and contributes to the cure of diseases from debility, as
sometimes occurs towards the end of fevers. See Sect. XXXIV. 2. 5. And, on
the same account, they bear large doses of medicines to procure any
operation on them; as emetics, and cathartics, which, before they produce
their effect in inverting the motions of the stomach in vomiting, or of the
absorbents of the bowels in purging, must first weaken the natural actions
of those organs, as shewn in Sect. XXXV. 1. 3.
From these considerations it appears, that the indications of cure must
consist in removing the cause of the pain, whether it arises from a
delirious idea, or from a real fact, or from bodily disease; or secondly,
if this cannot be done, by relieving the pain in consequence of such idea
or disease. The first is sometimes effected by presenting frequently in a
day contrary ideas to shew the fallacy, or the too great estimation, of the
painful ideas. 2dly. By change of place, and thus presenting the stimulus
of new objects, as a long journey. 3dly. By producing forgetfulness of the
idea or object, which causes their pain; by removing all things which recal
it to their minds; and avoiding all conversation on similar subjects. For I
suppose no disease of the mind is so perfectly cured by other means as by
forgetfulness.
Secondly, the pain in consequence of the ideas or bodily diseases above
described is to be removed, first, by evacuations, as venesection, emetics,
and cathartics; and then by large doses of opium, or by the vertigo
occasioned by a circulating swing, or by a sea-voyage, which, as they
affect the organs of sense as well as evacuate the stomach, may contribute
to answer both indications of cure.
Where maniacs are outrageous, there can be no doubt but coercion is
necessary; which may be done by means of a straight waistcoat; which
disarms them without hurting them; and by tying a handkerchief round their
ankles to prevent their escape. In others there can be no doubt, but that
confinement retards rather than promotes their cure; which is forwarded by
change of ideas in consequence of change of place and of objects, as by
travelling or sailing.
The circumstances which render confinement necessary, are first, if the
lunatic is liable to injure others, which must be judged of by the outrage
he has already committed. 2dly. If he is likely to injure himself; this
also must be judged of by the despondency of his mind, if such exists.
3dly. If he cannot take care of his affairs. Where none of these
circumstances exist, there should be no confinement. For though the
mistaken idea continues to exist, yet if no actions are produced in
consequence of it, the patient cannot be called insane, he can only be
termed delirious. If every one, who possesses mistaken ideas, or who puts
false estimates on things, was liable to confinement, I know not who of my
readers might not tremble at the sight of a madhouse!
The most convenient distribution of insanities will be into general, as
mania mutabilis, studium inane, and vigilia; and into partial insanities.
These last again may be subdivided into desires and aversions, many of
which are succeeded by pleasurable or painful ideas, by fury or dejection,
according to the degree or violence of their exertions. Hence the analogy
between the insanities of the mind, and the convulsions of the muscles
described in the preceding genus, is curiously exact. The convulsions
without stupor, are either just sufficient to obliterate the pain, which
occasions them; or are succeeded by greater pain, as in the convulsio
dolorifica. So the exertions in the mania mutabilis are either just
sufficient to allay the pain which occasions them, and the patient dwells
comparatively in a quiet state; or those exertions excite painful ideas,
which are succeeded by furious discourses, or outrageous actions. The
studium inane, or reverie, resembles epilepsy, in which there is no
sensibility to the stimuli of external objects. Vigilia, or watchfulness,
may be compared to the general writhing of the body; which is just a
sufficient exertion to relieve the pain which occasions it. Erotomania may
be compared to trismus, or other muscular fixed spasm, without much
subsequent pain; and maeror to cramp of the muscles of the leg, or other
fixed spasm with subsequent pain. All these coincidences contribute to
shew, as explained in Sect. III. 5, that our ideas are motions of the
immediate organs of sense obeying the same laws as our muscular motions.
The violence of action accompanying insanity depends much on the education
of the person; those who have been proudly educated with unrestrained
passions, are liable to greater fury; and those, whose education has been
humble, to greater despondency. Where the delirious idea, above described,
produces pleasurable sensations, as in personal vanity or religious
enthusiasm; it is almost a pity to snatch them from their fool's paradise,
and reduce them again to the common lot of humanity; lest they should
complain of their cure, like the patient described in Horace,
--------Pol! me occidistis, amici,
Non servastis, ait, cui sic extorta voluptas,
Et demptus per vim mentis gratissimus error!
The disposition to insanity, as well as to convulsion, is believed to be
hereditary; and in consequence to be induced in those families from
slighter causes than in others. Convulsions have been shewn to have been
most frequently induced by pains owing to defect of stimulus, as the
shuddering from cold, and not from pains from excess of stimulus, which are
generally succeeded by inflammation. But insanities are on the contrary
generally induced by pains from excess of stimulus, as from the too violent
actions of our ideas, as in common anger, which is an insanity of short
duration; for insanities generally, though not always, arise from pains of
the organs of sense; but convulsions generally, though not always, from
pains of the membranes or glands. And it has been previously explained,
that though the membrane and glands, as the stomach and skin, receive great
pain from want of stimulus; yet that the organs of sense, as the eye and
ear, receive no pain from defect of stimulus.
Hence it follows, that the constitutions most liable to convulsion, are
those which most readily become torpid in some part of the system, that is,
which possess less irritability; and that those most liable to insanity,
are such as have excess of sensibility; and lastly, that these two
circumstances generally exist in the same constitution; as explained in
Sect. XXXI. 2. on Temperaments. These observations explain why epilepsy and
insanity frequently succeed or reciprocate with each other, and why
inirritable habits, as scrophulous ones, are liable to insanity, of which I
have known some instances.
In many cases however there is no appearance of the disposition to epilepsy
or insanity of the parent being transmitted to the progeny. First, where
the insanity has arisen from some violent disappointment, and not from
intemperance in the use of spirituous liquors. Secondly, where the parent
has acquired the insanity or epilepsy by habits of intoxication after the
procreation of his children. Which habits I suppose to be the general cause
of the disposition to insanity in this country. See Class III. 1. 1. 7.
As the disposition to gout, dropsy, epilepsy, and insanity, appears to be
produced by the intemperate use of spirituous potation, and is in all of
them hereditary; it seems probable, that this disposition gradually
increases from generation to generation, in those families which continue
for many generations to be intemperate in this respect; till at length
these diseases are produced; that is, the irritability of the system
gradually is decreased by this powerful stimulus, and the sensibility at
the same time increased, as explained in Sect. XXXI. 1. and 2. This
disposition is communicated to the progeny, and becomes still increased, if
the same stimulus be continued, and so on by a third and fourth generation;
which accounts for the appearance of epilepsy in the children of some
families, where it was never known before to have existed, and could not be
ascribed to their own intemperance. A parity of reasoning shews, that a few
sober generations may gradually in the same manner restore a due degree of
irritability to the family, and decrease the excess of sensibility.
From hence it would appear probable, that scrophula and dropsy are diseases
from inirritability; but that in epilepsy and insanity an excess of
sensibility is added, and the two faulty temperaments are thus conjoined.
SPECIES.
1. _Mania mutabilis._ Mutable madness. Where the patients are liable to
mistake ideas of sensation for those from irritation, that is, imaginations
for realities, if cured of one source of insanity, they are liable in a few
months to find another source in some new mistaken or imaginary idea, and
to act from this new idea. The idea belongs to delirium, when it is an
imaginary or mistaken one; but it is the voluntary actions exerted in
consequence of this mistaken idea, which constitute insanity.
In this disease the patient is liable carefully to conceal the object of
his desire or aversion. But a constant inordinate suspicion of all people,
and a carelessness of cleanliness, and of decency, are generally
concomitants of madness. Their designs cannot be counteracted, till you can
investigate the delirious idea or object of their insanity; but as they are
generally timid, they are therefore less to be dreaded.
Z. Z. called a young girl, one of his maid-servants, into the parlour, and,
with cocked pistols in his hands, ordered her to strip herself naked; he
then inspected her with some attention, and dismissed her untouched. Then
he stripped two of his male servants in the same manner, to the great
terror of the neighbourhood. After he was secured, with much difficulty he
was persuaded to tell me, that he had got the itch, and had examined some
of his servants to find out from whom he had received it; though at the
same time there was not a spot to be seen on his hands, or other parts. The
outrages in consequence of this false idea were in some measure to be
ascribed to the pride occasioned by unrestrained education, affluent
wealth, and dignified family.
Madness is sometimes produced by bodily pain, particularly I believe of a
diseased liver, like convulsion and epilepsy; at other times it is caused
by very painful ideas occasioned by external circumstances, as of grief or
disappointment; but the most frequent cause of insanity arises from the
pain of some imaginary or mistaken idea; which may be termed hallucinatio
maniacalis. This hallucination of one of the senses is often produced in an
instant, and generally becomes gradually weakened in process of time, by
the perpetual stimulus of external objects, or by the successions of other
catenations of ideas, or by the operations of medicines; and when the
maniacal hallucination ceases, or is forgotten, the violent exertions
cease, which were in consequence of it, and the disease is cured.
Mr. ----, a clergyman, about forty years of age, who was rather a weak man,
happened to be drinking wine in jocular company, and by accident swallowed
a part of the seal of a letter, which he had just then received; one of his
companions seeing him alarmed, cried out in humour, "It will seal your
bowels up." He became melancholy from that instant, and in a day or two
refused to swallow any kind of nourishment. On being pressed to give a
reason for this refusal, he answered, he knew nothing would pass through
him. A cathartic was given, which produced a great many evacuations, but he
still persisted, that nothing passed through him; and though he was
frightened into taking a little broth once or twice by threats, yet he soon
ceased intirely to swallow any thing, and died in consequence of this
insane idea.
Miss ----, a sensible and ingenious lady, about thirty, said she had seen
an angel; who told her, that she need not eat, though all others were under
the necessity of supporting their earthly existence by food. After
fruitless persuasions to take food, she starved herself to death.--It was
proposed to send an angel of an higher order to tell her, that now she must
begin to eat and drink again; but it was not put into execution.
Mrs. ----, a lady between forty and fifty years of age, imagined that she
heard a voice say to her one day, as she was at her toilet, "Repent, or you
will be damned." From that moment she became melancholy, and this
hallucination affected her in greater or less degree for about two years;
she then recovered perfectly, and is now a cheerful old woman.
Mrs. ----, a farmer's wife, going up stairs to dress, found the curtains of
her bed drawn, and on undrawing them, she believed that she saw the corpse
of her sister, who was then ill at the distance of twenty miles, and became
from that time insane; and as her sister died about the time, she could not
be produced to counteract the insane hallucination, but she perfectly
recovered in a few months.
Mrs. ----, a most elegant, beautiful, and accomplished lady, about
twenty-two years of age, had been married about two months to an elegant,
polished, and affluent young man, and it was well known to be a love-match
on both sides. She suddenly became melancholy, and yet not to so great a
degree, but that she could command herself to do the honours of her table
with grace and apparent ease. After many days intreaty, she at length told
me, that she thought her marrying her husband had made him unhappy; and
that this idea she could not efface from her mind day or night. I withstood
her being confined, as some had advised, and proposed a sea-voyage to her,
with expectation that the sickness, as well as change of objects, might
remove the insane hallucination, by introducing other energetic ideas; this
was not complied with, but she travelled about England with her friends and
her husband for many months, and at length perfectly recovered, and is now
I am informed in health and spirits.
These cases are related to shew the utility of endeavouring to investigate
the maniacal idea, or hallucination; as it may not only acquaint us with
the probable designs of the patient, from whence may be deduced the
necessity of confinement; but also may some time lead to the most effectual
plan of cure.
I received good information of the truth of the following case, which was
published a few years ago in the newspapers. A young farmer in
Warwickshire, finding his hedges broke, and the sticks carried away during
a frosty season, determined to watch for the thief. He lay many cold hours
under a hay-stack, and at length an old woman, like a witch in a play,
approached, and began to pull up the hedge; he waited till she had tied up
her bottle of sticks, and was carrying them off, that he might convict her
of the theft, and then springing from his concealment, he seized his prey
with violent threats. After some altercation, in which her load was left
upon the ground, she kneeled upon her bottle of sticks, and raising her
arms to heaven beneath the bright moon then at the full, spoke to the
farmer already shivering with cold, "Heaven grant, that thou never mayest
know again the blessing to be warm." He complained of cold all the next
day, and wore an upper coat, and in a few days another, and in a fortnight
took to his bed, always saying nothing made him warm, he covered himself
with very many blankets, and had a sieve over his face, as he lay; and from
this one insane idea he kept his bed above twenty years for fear of the
cold air, till at length he died.
M. M. As mania arises from pain either of our muscles or organs of sense,
the arts of relieving pain must constitute the method of cure. See Sect.
XXXIV. 3. 4. Venesection. Vomits of from five grains to ten of emetic
tartar, repeated every third morning for three or four times; with solution
of gum-ammoniac, and soluble tartar, so as to purge gently every day.
Afterwards warm bath for two or three hours a day. Opium in large doses.
Bark. Steel.
Dr. Binns gave two scruples (40 grains) of solid opium at a dose, and
twenty grains four hours afterwards; which restored the patient. Dr.
Brandreth gave 400 drops of laudanum to a maniac in the greatest possible
furor, and in a few hours he became calm and rational. Med. Comment for
1791, p. 384.
_Prognostic._
The temporary quick pulse attending some maniacal cases is simply a symptom
of debility, and is the consequence of too great exertions; but a permanent
quick pulse shews the presence of fever, and is frequently a salutary sign;
because, if the life of the patient be safe, when the fever ceases, the
insanity generally vanishes along with it, as mentioned above. In this case
the kind of fever must direct the method of curing the insanity; which must
consist of moderate evacuations and diluents, if the pulse be strong; or by
nutrientia, bark, and small doses of opium, if the pulse be weak.
Where the cause is of a temporary nature, as in puerperal insanity, there
is reason to hope, that the disease will cease, when the bruises, or other
painful sensations attending this state, are removed. In these cases the
child should be brought frequently to the mother, and applied to her
breast, if she will suffer it, and this whether she at first attends to it
or not; as by a few trials it frequently excites the storge, or maternal
affection, and removes the insanity, as I have witnessed.
When the madness is occasioned by pain of the teeth, which I believe is no
uncommon case, these must be extracted; and the cure follows the extinction
of the pain. There is however some difficulty in detecting the delinquent
tooth in this case, as in hemicrania, unless by its apparent decay, or by
some previous information of its pain having been complained of; because
the pain of the tooth ceases, as soon as the exertions of insanity
commence.
When a person becomes insane, who has a family of small children to solicit
his attention, the prognostic is very unfavourable; as it shews the
maniacal hallucination to be more powerful than those ideas which generally
interest us the most.
2. _Studium inane._ Reverie consists of violent voluntary exertions of
ideas to relieve pain, with all the trains or tribes connected with them by
sensations or associations. It frequently alternates with epileptic
convulsions; with which it corresponds, in respect to the insensibility of
the mind to the stimuli of external objects, in the same manner as madness
corresponds with common convulsion, in the patient's possessing at the same
time a sensibility of the stimuli of external objects.
Some have been reported to have been involved in reverie so perfectly, as
not to have been disturbed by the discharge of a cannon; and others to have
been insensible to torture, as the martyrs for religious opinions; but
these seem more properly to belong to particular insanities than to
reverie, like nostalgia and erotomania.
Reverie is distinguished from madness as described above; and from
delirium, because the trains of ideas are kept consistent by the power of
volition, as the person reasons and deliberates in it. Somnambulismus is a
part of reverie, the latter consisting in the exertions of the locomotive
muscles, and the former of the exertions of the organs of sense; see Class
III. 1. 1. 9. and Sect. XIX. both which are mixed, or alternate with each
other, for the purpose of relieving pain.
When the patients in reverie exert their volition on their organs of sense,
they can occasionally perceive the stimuli of external objects, as
explained in Sect. XIX. And in this case it resembles sometimes an
hallucination of the senses, as there is a mixture of fact and imagination
in their discourse; but may be thus distinguished: hallucinations of the
lenses are allied to delirium, and are attended generally with quick pulse,
and other symptoms of great debility; but reverie is without fever, and
generally alternates with convulsions; and so much intuitive analogy (see
Sect. XVII. 3. 7.) is retained in its paroxysms, as to preserve a
consistency in the trains of ideas.
Miss G----, whose case is related in Sect. III. 5. 8. said, as I once sat
by her, "My head is fallen off, see it is rolled to that corner of the
room, and the little black dog is nibbling the nose off." On my walking to
the place which she looked at, and returning, and assuring her that her
nose was unhurt, she became pacified, though I was doubtful whether she
attended to me. See Class III. 1. 1. 9. and Class III. 1. 2. 2.
M. M. Large doses of opium given before the expected paroxysm, as in
epilepsia dolorifica, Class III. 1. 1. 8.
The hallucinatio studiosa, or false ideas in reverie, differ from maniacal
hallucinations above described, as no insane exertions succeed, and in the
patients whom I have seen they have always been totally forgotten, when the
paroxysm was over.
Master ----, a school-boy about twelve years old, after he came out of a
convulsion fit and sat up in bed, said to me, "Don't you see my father
standing at the feet of the bed, he is come a long way on foot to see me."
I answered, no: "What colour is his coat!" He replied, "A drab colour."
"And what buttons?" "Metal ones," he answered, and added, "how sadly his
legs are swelled." In a few minutes he said, with apparent surprise, "He is
gone," and returned to his perfect mind. Other cases are related in Sect.
XIX. and XXXIV. 3. and in Class III. 1. 2. 2. with further observations on
this kind of hallucination; which however is not the cause of reverie, but
constitutes a part of it, the cause being generally some uneasy sensation
of the body.
3. _Vigilia._ Watchfulness consists in the unceasing exertion of volition;
which is generally caused by some degree of pain either of mind or of body,
or from defect of the usual quantity of pleasurable sensation; hence if
those, who are accustomed to wine at night, take tea instead, they cannot
sleep. The same happens from want of solid food for supper, to those who
are accustomed to use it; as in these cases there is pain or defect of
pleasure in the stomach.
Sometimes the anxiety about sleeping, that is the desire to sleep, prevents
sleep; which consists in an abolition of desire or will. This may so far be
compared to the impediment of speech described in Sect. XVII. 1. 10. as the
interference of the will prevents the effect desired.
Another source of watchfulness may be from the too great secretion of
sensorial power in the brain, as in phrenzy, and as sometimes happens from
the exhibition of opium, and of wine; if the exhaustion of sensorial power
by the general actions of the system occasioned by the stimulus of these
drugs can be supposed to be less than the increased secretion of it.
M. M. 1. Solid food to supper. Wine. Opium. Warm bath. 2. The patient
should be told that his want of sleep is of no consequence to his health.
3. Venesection by cupping. Abstinence from wine. 4. A blister by
stimulating the skin, and rhubarb by stimulating the bowels, will sometimes
induce sleep. Exercise. An uniform sound, as of a pausing drop of water, or
the murmur of bees. Other means are described in Sect. XVIII. 20.
4. _Erotomania._ Sentimental love. Described in its excess by
romance-writers and poets. As the object of love is beauty, and as our
perception of beauty consists in a recognition by the sense of vision of
those objects, which have before inspired our love, by the pleasure they
have afforded to many of our senses (Sect. XVI. 6); and as brute animals
have less accuracy of their sense of vision than mankind (ib.); we see the
reason why this kind of love is not frequently observable in the brute
creation, except perhaps in some married birds, or in the affection of the
mother to her offspring. Men, who have not had leisure to cultivate their
taste for visible objects, and who have not read the works of poets and
romance-writers, are less liable to sentimental love; and as ladies are
educated rather with an idea of being chosen, than of choosing; there are
many men, and more women, who have not much of this insanity; and are
therefore more easily induced to marry for convenience or interest, or from
the flattery of one sex to the other.
In its fortunate gratification sentimental love is supposed to supply the
purest source of human felicity; and from the suddenness with which many of
those patients, described in Species I. of this genus, were seized with the
maniacal hallucination, there is reason to believe, that the most violent
sentimental love may be acquired in a moment of time, as represented by
Shakespeare in the beginning of his Romeo and Juliet.
Some have endeavoured to make a distinction between beauty and grace, and
have made them as it were rivals for the possession of the human heart; but
grace may be defined beauty in action; for a sleeping beauty cannot be
called graceful in whatever attitude she may recline; the muscles must be
in action to produce a graceful attitude, and the limbs to produce a
graceful motion. But though the object of love is beauty, yet the idea is
nevertheless much enhanced by the imagination of the lover; which appears
from this curious circumstance, that the lady of his passion seldom appears
so beautiful to the lover after a few months separation, as his ideas had
painted her in his absence; and there is, on that account, always a little
disappointment felt for a minute at their next interview from this
hallucination of his ideas.
This passion of love produces reverie in its first state, which exertion
alleviates the pain of it, and by the assistance of hope converts it into
pleasure. Then the lover seeks solitude, lest this agreeable reverie should
be interrupted by external stimuli, as described by Virgil.
Tantum inter densas, umbrosa cacumina, fagos
Assidue veniebat, ibi haec incondita solus
Montibus et sylvis studio jactabat inani.
When the pain of love is so great, as not to be relieved by the exertions
of reverie, as above described; as when it is misplaced on an object, of
which the lover cannot possess himself; it may still be counteracted or
conquered by the stoic philosophy, which strips all things of their
ornaments, and inculcates "nil admirari." Of which lessons may be found in
the meditations of Marcus Antoninus. The maniacal idea is said in some
lovers to have been weakened by the action of other very energetic ideas;
such as have been occasioned by the death of his favourite child, or by the
burning of his house, or by his being shipwrecked. In those cases the
violence of the new idea for a while expends so much sensorial power as to
prevent the exertion of the maniacal one; and new catenations succeed. On
this theory the lover's leap, so celebrated by poets, might effect a cure,
if the patient escaped with life.
The third stage of this disease I suppose is irremediable; when a lover has
previously been much encouraged, and at length meets with neglect or
disdain; the maniacal idea is so painful as not to be for a moment
relievable by the exertions of reverie, but is instantly followed by
furious or melancholy insanity; and suicide, or revenge, have frequently
been the consequence. As was lately exemplified in Mr. Hackman, who shot
Miss Ray in the lobby of the playhouse. So the poet describes the passion
of Dido,
----------Moriamur inultae?--
At moriamur, ait,--sic, sic, juvat ire sub umbras!
The story of Medaea seems to have been contrived by Ovid, who was a good
judge of the subject, to represent the savage madness occasioned by
ill-requited love. Thus the poet,
Earth has no rage like love to hatred turn'd,
Nor hell a fury like a woman scorn'd.
DRYDEN.
5. _Amor sui._ Vanity consists of an agreeable reverie, and is well
ridiculed in the story of Narcissus, who so long contemplated his own
beautiful image in the water, that he died from neglect of taking
sustenance. I once saw a handsome young man, who had been so much flattered
by his parents, that his vanity rose so near to insanity, that one might
discern by his perpetual attention to himself, and the difficulty with
which he arranged his conversation, that the idea of himself intruded
itself at every comma or pause of his discourse. In this degree vanity must
afford great pleasure to the possessor; and when it exists within moderate
bounds, may contribute much to the happiness of social life.
My friend Mr. ---- once complained to me, that he was much troubled with
bashfulness in company, and believed that it arose from his want of
personal vanity; on this account he determined on a journey to Paris, when
Paris was the center of politeness; he there learnt to dress, to dance, and
to move his hands gracefully in conversation; and returned a most
consummate coxcomb. But after a very few years he relapsed into rusticity
of dress and manners.
M. M. The cure of vanity may be attempted by excess of flattery, which will
at length appear ridiculous, or by its familiarity will cease to be
desired. I remember to have heard a story of a nobleman in the court of
France, when France had a court, who was so disagreeably vain in
conversation, that the king was pleased to direct his cure, which was thus
performed. Two gentlemen were directed always to attend him, one was to
stand behind his chair, and the other at a respectful distance before him;
whenever his lordship began to speak, one of them always pronounced, "Lord
Gallimaufre is going to say the best thing in the world." And, as soon as
his lordship had done speaking, the other attendant pronounced, "Lord
Gallimaufre has spoken the best thing in the world." Till in a few weeks
this noble lord was so disgusted with praise that he ceased to be vain; and
his majesty dismissed his keepers.
6. _Nostalgia._ Maladie de Pais. Calenture. An unconquerable desire of
returning to one's native country, frequent in long voyages, in which the
patients become so insane as to throw themselves into the sea, mistaking it
for green fields or meadows. The Swiss are said to be particularly liable
to this disease, and when taken into foreign service frequently to desert
from this cause, and especially after hearing or singing a particular tune,
which was used in their village dances, in their native country, on which
account the playing or singing this tune was forbid by the punishment of
death. Zwingerus.
Dear is that shed, to which his soul conforms,
And dear that hill, which lifts him to the storms.
GOLDSMITH.
7. _Spes religiosa._ Superstitious hope. This maniacal hallucination in its
milder state produces, like sentimental love, an agreeable reverie; but
when joined with works of supererogation, it has occasioned many
enormities. In India devotees consign themselves by vows to most painful
and unceasing tortures, such as holding up their hands, till they cannot
retract them; hanging up by hooks put into the thick skin over their
shoulders, sitting upon sharp points, and other self torments. While in our
part of the globe fasting and mortification, as flagellation, has been
believed to please a merciful deity! The serenity, with which many have
suffered cruel martyrdoms, is to be ascribed to this powerful reverie.
Mr. ----, a clergyman, formerly of this neighbourhood, began to bruise and
wound himself for the sake of religious mortification, and passed much time
in prayer, and continued whole nights alone in the church. As he had a wife
and family of small children, I believed the case to be incurable; as
otherwise the affection and employment in his family connections would have
opposed the beginning of this insanity. He was taken to a madhouse without
effect, and after he returned home, continued to beat and bruise himself,
and by this kind of mortification, and by sometimes long fasting, he at
length became emaciated and died. I once told him in conversation, that
"God was a merciful being, and could not delight in cruelty, but that I
supposed he worshipped the devil." He was struck with this idea, and
promised me not to beat himself for three days, and I believe kept his word
for one day. If this idea had been frequently forced on his mind, it might
probably have been of service.
When these works of supererogation have been of a public nature, what
cruelties, murders, massacres, has not this insanity introduced into the
world!--A commander, who had been very active in leading and encouraging
the bloody deeds of St. Bartholomew's day at Paris, on confessing his sins
to a worthy ecclesiastic on his death-bed, was asked, "Have you nothing to
say about St. Bartholomew?" "On that day," he replied, "God Almighty was
obliged to me!"--The fear of hell is another insanity, which will be spoken
of below.
8. _Superbia stemmatis._ Pride of family has frequently formed a maniacal
hallucination, which in its mild state has consisted in agreeable reverie,
but when it has been so painful as to demand homage from others, it has
frequently induced insane exertions. This insanity seems to have existed in
the flourishing state of Rome, as now all over Germany, and is attacked by
Juvenal with great severity, a small part of which I shall here give as a
method of cure. Sat. 8.
Say, what avails the pedigree, that brings
Thy boasted line from heroes or from kings;
Though many a mighty lord, in parchment roll'd,
Name after name, thy coxcomb hands unfold;
Though wreathed patriots crowd thy marble halls,
Or steel-clad warriors frown along the walls;
While on broad canvas in the gilded frame
All virtues flourish, and all glories flame?--
Say,--if ere noon with idiot laugh you lie
Wallowing in wine, or cog the dubious die,
Or act unshamed, by each indignant bust,
The midnight orgies of promiscuous lust!--
Go, lead mankind to Virtue's holy shrine,
With morals mend them, and with arts refine,
Or lift, with golden characters unfurl'd,
The flag of peace, and still a warring world!--
--So shall with pious hands immortal Fame
Wreathe all her laurels round thy honour'd name,
High o'er thy tomb with chissel bold engrave,
"THE TRULY NOBLE ARE THE GOOD AND BRAVE."
9. _Ambitio._ Inordinate desire of fame. A carelessness about the opinions
of others is said by Xenophon to be the source of impudence; certainly a
proper regard for what others think of us frequently incites us to virtuous
actions, and deters us from vicious ones; and increases our happiness by
enlarging our sphere of sympathy, and by flattering our vanity.
Abstract what others feel, what others think,
All pleasures sicken, and all glories sink.
POPE.
When this reverie of ambition excites to conquer nations, or to enslave
them, it has been the source of innumerable wars, and the occasion of a
great devastation of mankind. Caesar is reported to have boasted, that he
had destroyed three millions of his enemies, and one million of his
friends.
The works of Homer are supposed to have done great injury to mankind by
inspiring the love of military glory. Alexander was said to sleep with them
always on his pillow. How like a mad butcher amid a flock of sheep appears
the hero of the Iliad, in the following fine lines of Mr. Pope, which
conclude the twentieth book.
His fiery coursers, as the chariot rolls,
Tread down whole ranks, and crush out heroes' souls;
Dash'd from their hoofs, as o'er the dead they fly,
Black bloody drops the smoaking chariot dye;--
The spiky wheels through heaps of carnage tore,
And thick the groaning axles dropp'd with gore;
High o'er the scene of death ACHILLES stood,
All grim with dust, all horrible with blood;
Yet still insatiate, still with rage on flame,
Such is the lust of never-dying fame!
The cure must be taken from moral writers. Woolaston says, Caesar conquered
Pompey; that is, a man whose name consisted of the letters C. a. e. s. a.
r. conquered a long time ago a man, whose name consisted of the letters P.
o. m. p. e. y. and that this is all that remains of either of them. Juvenal
also attacks this mode of insanity, Sat. X. 166.
--I, demens, et saevas curre per alpes,
Ut pueris placeas, et declamatio fias!
Which is thus translated by Dr. Johnson,
And left a name, at which the world grew pale,
To point a moral, or adorn a tale!
10. _Maeror._ Grief. A perpetual voluntary contemplation of all the
circumstances of some great loss, as of a favourite child. In general the
painful ideas gradually decrease in energy, and at length the recollection
becomes more tender and less painful. The letter of Sulpicius to Cicero on
the loss of his daughter is ingenious. The example of David on the loss of
his child is heroic.