Put but your toes into cold water,Your correspondent teeth will clatter.Prior.
Put but your toes into cold water,Your correspondent teeth will clatter.Prior.
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 diarrhœa, 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 ClassI. 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 œsophagus 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 œsophagus 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 ClassI. 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.
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.
Quicquid agunt homines, votum, timor, ira, voluptas,Gaudia, discursus, nostri est farrago libelli.Juven.I. 85.
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. SeeIII. 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 mæror 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!
————Pol! me occidistis, amici,Non servastis, ait, cui sic extorta voluptas,Et demptus per vim mentis gratissimus error!
————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 ClassIII. 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.
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 storgè, 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 ClassIII. 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 ClassIII. 1. 1. 9. and ClassIII. 1. 2. 2.
M. M. Large doses of opium given before the expected paroxysm, as in epilepsia dolorifica, ClassIII. 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 ClassIII. 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 SpeciesI. 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, fagosAssiduè veniebat, ibi hæc incondita solusMontibus et sylvis studio jactabat inani.
Tantum inter densas, umbrosa cacumina, fagosAssiduè veniebat, ibi hæc incondita solusMontibus et sylvis studio jactabat inani.
Tantum inter densas, umbrosa cacumina, fagos
Assiduè veniebat, ibi hæc 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 inultæ?—At moriamur, ait,—sic, sic, juvat ire sub umbras!
—————Moriamur inultæ?—At moriamur, ait,—sic, sic, juvat ire sub umbras!
—————Moriamur inultæ?—
At moriamur, ait,—sic, sic, juvat ire sub umbras!
The story of Medæa 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.
Earth has no rage like love to hatred turn'd,Nor hell a fury like a woman scorn'd.Dryden.
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.
Dear is that shed, to which his soul conforms,And dear that hill, which lifts him to the storms.Goldsmith.
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.