experience, and in the common manner of employing warm bathing I have found it rather hurtful to maniacs.

1572.] According to my supposition that the disease depends upon an increased excitement of the brain, especially with respect to the animal functions, opium, so commonly powerful in inducing sleep, or a considerable collapse as to these functions, should be a powerful remedy of mania. That it has truly proved such, I believe from the testimony of Bernard Huet, whose practice is narrated at the end of Wepferi Historia Apoplecticorum. I leave to my readers to study this in the work I have referred to, where every part of the practice is fully, and it appears to me, very judiciously delivered. I have never indeed carried the trial so far as seems to be requisite to an entire cure: but I have frequently employed in some maniacal cases large doses of opium; and when they had the effect of inducing sleep, it was manifestly with advantage. At the same time, in some cases, from doubts, whether the disease might not depend upon some organic lesions of the brain, when the opium would be superfluous; and in other cases, from doubts, whether there might not be some inflammatory affection joined with the mania, when the opium would be hurtful, I have never pushed this remedy to the extent that might be necessary to make an entire cure.

1573.] Camphire has been recommended as a remedy of mania, and there are instances alledged of its having performed an entire cure. As it appears from the experiments of Beccaria that this substance is possessed of a sedative and narcotic virtue, these cures are not altogether improbable but in several trials, and even in large doses, I have found no benefit from it; and excepting those in the Philosophical Transactions, No. 400. I have hardly met with any other testimonies in its favor.

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1574.] I have been informed that some maniacs have been cured by being compelled to constant and even hard labor; and as a forced attention to the conduct of any bodily exercise is a very certain means of diverting the mind from pursuing any train of thought, it is highly probable that such exercise may be useful in many cases of mania.

I must conclude this subject with observing, that even in several cases of complete mania, I have known a cure take place in the course of a journey carried on for some length of time.

1575]. These are the remedies which have been chiefly

employed in the mania that has been above described, and I believe they have been employed promiscuously without supposing that the mania was to be distinguished into different species. Indeed I am not ready to say how far it is to be so distinguished, but I shall offer one observation which may possibly merit attention.

It appears to me that there are two different cases of mania that are especially different according to the original temperament of the persons whom the disease affects. It perhaps occurs most frequently in persons of a melancholic or atrabilarian temperament; but it certainly does also often occur in persons of that very opposite temperament which physicians have named the Sanguine. According as the disease happens to occur in persons of the one or other of these temperaments, I apprehend it may be considered as of a different nature; and I believe, that accurate observation, employed upon a sufficient number of cases, would discern some pretty constant difference, either of the symptoms, or at least of the state of the symptoms, in the two cases. I imagine that false imaginations, particular aversions and resentments, are more fixed and steady in the melancholic than in the sanguine; and that somewhat inflammatory is more commonly joined with mania in the sanguine than in the melancholic. If such difference, however, does truly take place, it will be obvious, that it may be proper to make some difference also in the practice. I am of opinion, that in the mania of sanguine persons, bloodletting and other antiphlogistic measures are more proper, and have been more useful, than in the melancholic. I likewise apprehend that cold bathing is more useful in the sanguine than in the melancholic: but I have not had experience enough to ascertain these points with sufficient confidence.

I have only to add to this other observation, that maniacs of the sanguine temperament recover more frequently and more entirely than those of the melancholic.

CHAPTER III.

OF MELANCHOLY AND OTHER FORMS OF INSANITY.

1576.] Medered as partial insanity; and as such it is

ELANCHOLY has been commonly consi

defined in my Nosology: but I now entertain doubts if this be altogether proper. By a partial insanity, I understand a false and mistaken judgment upon one particular subject, and what relates to it; whilst, on every other subject, the person affected judges as the generality of other men do. Such cases have certainly occurred; but, I believe, few in which the partial insanity is strictly limited. In many cases of general insanity, there is one subject of anger or fear, upon which the false judgment more particularly turns, or which is at least more frequently than any other the prevailing object of delirium: and though, from the inconsistency which this principal object of delirium must produce, there is therefore also a great deal of insanity with regard to most other objects; yet this last is invery different degrees, both in different persons, and in the same person at different times. Thus persons considered as generally insane, will, however, at times, and in some cases, pretty constantly judge properly enough of present circumstances and incidental occurrences; though, when these objects engaging attention are not presented, the operations of imagination may readily bring back a general confusion, or recal the particular object of the delirium. From these considerations, I am inclined to conclude, that the limits between general and partial insanity cannot always be so exactly assigned, as to determine when the partial affection is to be considered as giving a peculiar species of disease, different from a more general insanity.

1577.] When insanity, neither strictly partial nor entirely nor constantly general, occurs in persons of a sanguine temperament, and is attended with agreeable, rather than with angry or gloomy emotions, I think such a disease. must be considered as different from the Mania described above; and also, though partial, must be held as different from the proper Melancholia to be mentioned hereafter.

1578.] Such a disease, as different from those described (1555.) requires, in my opinion, a different administration of remedies; and it will be proper for me to take particular notice of this here.

Although it may be necessary to restrain such insane. persons as we have mentioned (1577.) from pursuing the objects of their false imagination or judgment, it will hardly be requisite to employ the same force of restraint that is necessary in the impetuous and angry mania. It will be generally sufficient to acquire some awe over them, that may

be employed, and sometimes even be necessary, to check the rambling of their imagination, and incoherency of judgment.

1579.] The restraint just now mentioned as necessary will generally require the patient's being confined to one place, for the sake of excluding the objects, and more particularly the persons, that might excite ideas connected with the chief objects of their delirium. At the same time, however, if it can be perceived there are objects or persons that can call off their attention from the pursuit of their own disordered imagination, and fix it a little upon some others, these last may be frequently presented to them: and for this reason, a journey, both by its having the effect of interrupting all train of thought, and by presenting objects engaging attention, may often be useful. In such cases also, when the insanity, though more especially fixed upon one mistaken subject, is not confined to this alone, but is further apt to ramble over other subjects with incoherent ideas, I apprehend the confining or forcing such persons to some constant uniform Jabor, may prove an useful remedy.

1580.] When such cases as in 1577, occur in sanguine temperaments, and may therefore approach more nearly to Phrenitic Delirium; so, in proportion as the symptoms of this tendency are more evident and considerable, bloodletting and purging will be the more proper and necessary.

1581.] To this species of insanity, when occurring in sanguine temperaments, whether it be more or less partial, I apprehend that cold bathing is particularly adapted; while in the partial insanity of melancholic persons, as I shall show hereafter, it is hardly admissible.

1582.] Having thus treated of a species of insanity, different, in my apprehension, from both the Mania and Melancholia, I proceed to consider what seems more properly to belong to this last.

1583.] The disease which I name Melancholia is very often a partial insanity only. But as in many instances, though the false imagination or judgment seems to be with respect to one subject only; yet it seldom happens that this does not produce much inconsistency in the other intellectual operations and as, between a very general and a very partial insanity, there are all the possible intermediate degrees; so it will be often difficult, or perhaps improper, to distinguish melancholia by the character of Par

tial Insanity alone. If I mistake not, it must be chiefly distinguished by its occurring in persons of a melancholic temperament, and by its being always attended with some seemingly groundless, but very anxious fear,

1584.] To explain the cause of this, I must observe, that persons of a melancholic temperament are for the most part of a serious, thoughtful disposition, and disposed to fear and caution, rather than to hope and temerity. Persons of this cast are less moveable than others by any impressions and are therefore capable of a closer or more continued attention to one particular object, or train of thinking. They are even ready to be engaged in a constant application to one subject; and are remarkably tenacious of whatever emotions they happen to be affected with. 1585.] These circumstances of the melancholic character, seem clearly to shew, that persons strongly affected with it may be readily seized with an anxious fear; and that this, when much indulged, as is natural to such persons, may easily grow into a partial insanity.

1586.] Fear and dejection of mind, or a timid and desponding disposition, may arise in certain states, or upon certain occasions of mere debility and it is upon this footing, that I suppose it sometimes to attend dyspepsia. But in these cases, I believe the despondent disposition hardly ever arises to a considerable degree, or proves so obstinately fixed as when it occurs in persons of a melancholic temperament. In these last, although the fear proceeds from the same dyspeptic feelings as in the other case, yet it will be obvious, that the emotion may rise to a more considerable degree; that it may be more anxious, more fixed, and more attentive; and therefore may exhibit all the various circumstances which I have mentioned in 1222, to take place in the disease named HYPOCHONDRIASIS.

1587.] In considering this subject formerly in distinguishing Dyspepsia from Hypochondriasis, although the symptoms affecting the body be very much the same in both, and even those affecting the mind be somewhat similar, I found no difficulty in distinguishing the latter disease, merely from its occurring in persons of a melancholic temperament. But I must now acknowledge, that I am at a loss to determine how in all cases hypochondriasis and melancholia may be distinguished from one another, whilst the same temperament is common to both.