Chapter XV: Section XXXVI: 2. 3 (3)

In violent grief, when tears flow, it is esteemed a good symptom; because then the actions caused by sensitive association take the place of those caused by volition; that is, they prevent the voluntary exertions of ideas, or muscular actions, which constitute insanity.

The sobbing and sighing attendant upon grief are not convulsive movements, they are occasioned by the sensorial power being so expended on the painful ideas, and their connections, that the person neglects to breathe for a time, and then a violent sigh or sob is necessary to carry on the blood, which oppresses the pulmonary vessels, which is then performed by deep or quick inspirations, and laborious expirations. Sometimes nevertheless the breath is probably for a while voluntarily held, as an effort to relieve pain. The paleness and ill health occasioned by long grief is spoken of in Class IV. 2. 1. 9.

The melioration of grief by time, and its being at length even attended with pleasure, depends on our retaining a distinct idea of the lost object, and forgetting for a time the idea of the loss of it. This pleasure of grief is beautifully described by Akenside. Pleasures of Imagination, Book II. l. 680.

----------Ask the faithful youth,
Why the cold urn of her, whom long he loved,
So often fills his arms; so often draws
His lonely footsteps at the silent hour
To pay the mournful tribute of his tears?
Oh! he will tell thee, that the wealth of worlds
Should ne'er seduce his bosom to forego
That sacred hour; when, stealing from the noise
Of care and envy, sweet remembrance soothes
With Virtue's kindest looks his aching breast,
And turns his tears to rapture.

M. M. Consolation is best supplied by the Christian doctrine of a happy immortality. In the pagan religion the power of dying was the great consolation in irremediable distress. Seneca says, "no one need be unhappy unless by his own fault." And the author of Telemachus begins his work by saying, that Calypso could not console herself for the loss of Ulysses, and found herself unhappy in being immortal. In the first hours of grief the methods of consolation used by uncle Toby, in Tristram Shandy, is probably the best; "he sat down in an arm chair by the bed of his distressed friend, and said nothing."

11. _Taedium vitae._ The inanity of sublunary things has afforded a theme to philosophers, moralists, and divines, from the earliest records of antiquity; "Vanity of vanities!" says the preacher, "all is vanity!" Nor is there any one, I suppose, who has passed the meridian of life, who has not at some moments felt the nihility of all things.

Weariness of life in its moderate degree has been esteemed a motive to action by some philosophers. See Sect. XXXIV. 2. 3. But in those men, who have run through the usual amusements of life early in respect to their age; and who have not industry or ability to cultivate those sciences, which afford a perpetual fund of novelty, and of consequent entertainment, are liable to become tired of life, as they suppose there is nothing new to be found in it, that can afford them pleasure; like Alexander, who is said to have shed tears, because he had not another world to conquer.

Mr. ----, a gentleman about fifty, of polished manners, who in a few months afterwards destroyed himself, said to me one day, "a ride out in the morning, and a warm parlour and a pack of cards in the afternoon, is all that life affords." He was persuaded to have an issue on the top of his head, as he complained of a dull head-ach, which being unskilfully managed, destroyed the pericranium to the size of an inch in diameter; during the time this took in healing, he was indignant about it, and endured life, but soon afterwards shot himself.

Mr. ----, a gentleman of Gray's Inn, some years ago was prevailed upon by his friends to dismiss a mistress, by whom he had a child, but who was so great a termagant and scold, that she was believed to use him very ill, and even to beat him. He became melancholy in two days from the want of his usual stimulus to action, and cut his throat on the third so completely, that he died immediately.

Mr. Anson, the brother to the late Lord Anson, related to me the following anecdote of the death of Lord Sc----. His Lordship sent to see Mr. Anson on the Monday preceding his death, and said, "You are the only friend I value in the world, I determined therefore to acquaint you, that I am tired of the insipidity of life, and intend to-morrow to leave it." Mr. Anson said, after much conversation, that he was obliged to leave town till Friday, and added, "As you profess a friendship for me, do me this last favour, I entreat you, live till I return." Lord Sc---- believed this to be a pious artifice to gain time, but nevertheless agreed, if he should return by four o'clock on that day. Mr. Anson did not return till five, and found, by the countenances of the domestics, that the deed was done. He went into his chamber and found the corpse of his friend leaning over the arm of a great chair, with the pistol on the ground by him, the ball of which had been discharged into the roof of his mouth, and passed into his brain.

Mr. ---- and Mr. ----, two young men, heirs to considerable fortunes, shot themselves at the age of four or five and twenty, without their friends being able to conjecture any cause for those rash actions. One of them I had long known to express himself with dissatisfaction of the world; at eighteen years of age he complained, that he could not entertain himself; he tried to study the law at Cambridge, and afterwards went abroad for a year or two by my advice; but returned dissatisfied with all things. As he had had an eruption for some years on a part of his face, which he probably endeavoured to remove by external applications; I was induced to ascribe his perpetual ennui to the pain or disagreeable sensation of a diseased liver. The other young gentleman shot himself in his bed-room, and I was informed that there was found written on a scrap of paper on his table, "I am impotent, and therefore not fit to live." From whence there was reason to conclude, that this was the hallucinatio maniacalis, the delirious idea, which caused him to destroy himself. The case therefore belongs to mania mutabilis, and not to taedium vitae.

M. M. Some restraint in exhausting the usual pleasures of the world early in life. The agreeable cares of a matrimonial life. The cultivation of science, as of chemistry, natural philosophy, natural history, which supplies an inexhaustible source of pleasurable novelty, and relieves ennui by the exertions it occasions.

In many of these cases, whence irksomeness of life has been the ostensible cause of suicide, there has probably existed a maniacal hallucination, a painful idea, which the patient has concealed even to his dying hour; except where the mania has evidently arisen from hereditary or acquired disease of the membranous or glandular parts of the system.

12. _Pulchritudinis desiderium._ The loss of beauty, either by disease, as by the small-pox, or by age, as life advances, is sometimes painfully felt by ladies, who have been much flattered on account of it. There is a curious case of this kind related in Le Sage's Bachelor of Salamanca, which is too nicely described to be totally imaginary.

In this situation some ladies apply to what are termed cosmetics under various names, which crowd the newspapers. Of these the white has destroyed the health of thousands; a calx, or magistery, of bismuth is supposed to be sold in the shops for this purpose; but it is either, I am informed, in part or entirely white lead or cerussa. The pernicious effects of the external use of those saturnine applications are spoken of in gutta rosea, Class II. 1. 4. 6. The real calx of bismuth would probably have the same ill effect. As the red paint is prepared from cochineal, which is an animal body, less if any injury arises from its use, as it only lies on the skin like other filth.

The tan of the skin occasioned by the sun may be removed by lemon juice evaporated by the fire to half its original quantity, or by diluted marine acid; which cleans the cuticle, by eroding its surface, but requires much caution in the application; the marine acid must be diluted with water, and when put upon the hand or face, after a second of time, as soon as the tan disappears, the part must be washed with a wet towel and much warm water. Freckles lie too deep for this operation, nor are they in general removeable by a blister, as I once experienced. See Class I. 2. 2. 9.

It is probable, that those materials which stain silk, or ivory, might be used to stain the cuticle, or hair, permanently; as they are all animal substances. But I do not know, that any trials of this kind have been made on the skin. I endeavoured in vain to whiten the back of my hand by marine acid oxygenated by manganese, which so instantly whitens cotton.

The cure therefore must be sought from moral writers, and the cultivation of the graces of the mind, which are frequently a more valuable possession than celebrated beauty.

13. _Paupertatis timor._ The fear of poverty is one kind of avarice; it is liable to affect people who have left off a profitable and active business; as they are thus deprived of their usual exertions, and are liable to observe the daily expenditure of money, without calculating the source from whence it flows. It is also liable to occur with a sudden and unexpected increase of fortune. Mr. ----, a surgeon, about fifty years of age, who was always rather of a parsimonious disposition, had a large house, with a fortune of forty thousand pounds, left him by a distant relation; and in a few weeks became insane from the fear of poverty, lamenting that he should die in a jail or workhouse. He had left off a laborious country business, and the daily perception of profit in his books; he also now saw greater expences going forwards in his new house, than he had been accustomed to observe, and did not so distinctly see the source of supply; which seems to have occasioned the maniacal hallucination.--This idea of approaching poverty is a very frequent and very painful disease, so as to have induced many to become suicides, who were in good circumstances; more perhaps than any other maniacal hallucination, except the fear of hell.

The covetousness of age is more liable to affect single men, than those who have families; though an accumulation of wealth would seem to be more desirable to the latter. But an old man in the former situation, has no personal connections to induce him to open his purse; and having lost the friends of his youth, and not easily acquiring new ones, feels himself alone in the world; feels himself unprotected, as his strength declines, and is thus led to depend for assistance on money, and on that account wishes to accumulate it. Whereas the father of a family has not only those connections, which demand the frequent expenditure of money, but feels a consolation in the friendship of his children, when age may render their good offices necessary to him.

M. M. I have been well informed of a medical person in good circumstances in London, who always carries an account of his affairs, as debtor and creditor, in his pocket-book; and looks over it frequently in a day, when this disease returns upon him; and thus, by counteracting the maniacal hallucination, wisely prevents the increase of his insanity. Another medical person, in London, is said to have cured himself of this disease by studying mathematics with great attention; which exertions of the mind relieved the pain of the maniacal hallucination.

Many moral writers have stigmatised this insanity; the covetous, they say, commit crimes and mortify themselves without hopes of reward; and thus become miserable both in this world and the next. Thus Juvenal:

Cum furor haud dubius, cum sit manifesta phrenitis,
Ut locuples moriaris, egenti vivere fato!

The covetous man thought he gave good advice to the spendthrift, when he said, "Live like me," who well answered him,

----------"Like you, Sir John?
"That I can do, when all I have is gone!"
POPE.

14. _Lethi timor._ The fear of death perpetually employs the thoughts of these patients; hence they are devising new medicines, and applying to physicians and quacks without number. It is confounded with hypochondriasis, Class I. 2. 4. 10. in popular conversation, but is in reality an insanity.

A young gentleman, whom I advised to go abroad as a cure for this disease, assured me, that during the three years he was in Italy and France he never passed a quarter of an hour without fearing he should die. But has now for above twenty years experienced the contrary.

The sufferers under this malady are generally at once discoverable by their telling you, amidst an unconnected description of their complaints, that they are nevertheless not afraid of dying. They are also easily led to complain of pains in almost any part of the body, and are thus soon discovered.

M. M. As the maniacal hallucination has generally arisen in early infancy from some dreadful account of the struggles and pain of dying, I have sometimes observed, that these patients have received great consolation from the instances I have related to them of people dying without pain. Some of these, which I think curious, I shall concisely relate, as a part of the method of cure.

Mr. ----, an elderly gentleman, had sent for me one whole day before I could attend him; on my arrival he said he was glad to see me, but that he was now quite well, except that he was weak, but had had a pain in his bowels the day before. He then lay in bed with his legs cold up to the knees, his hands and arms cold, and his pulse scarcely discernible, and died in about six hours. Mr. ----, another gentleman about sixty, lay in the act of dying, with difficult respiration like groaning, but in a kind of stupor or coma vigil, and every ten or twelve minutes, while I sat by him, he waked, looked up, and said, "who is it groans so, I am sure there is somebody dying in the room," and then sunk again into a kind of sleep. From these two cases there appeared to be no pain in the act of dying, which may afford consolation to all, but particularly to those who are afflicted with the fear of death.

15. _Orci timor._ The fear of hell. Many theatric preachers among the Methodists successfully inspire this terror, and live comfortably upon the folly of their hearers. In this kind of madness the poor patients frequently commit suicide; although they believe they run headlong into the hell, which they dread! Such is the power of oratory, and such the debility of the human understanding!

Those, who suffer under this insanity, are generally the most innocent and harmless people; who are then liable to accuse themselves of the greatest imaginary crimes, and have so much intellectual cowardice, that they dare not reason about those things, which they are directed by their priests to believe, however contradictory to human apprehension, or derogatory to the great Creator of all things. The maniacal hallucination at length becomes so painful, that the poor insane flies from life to become free from it.

M. M. Where the intellectual cowardice is great, the voice of reason is ineffectual; but that of ridicule may save many from those mad-making doctors; though it is too weak to cure those, who are already hallucinated. Foot's Farces are recommended for this purpose.

16. _Satyriasis._ An ungovernable desire of venereal indulgence. The remote cause is probably the stimulus of the semen; whence the phallus becomes distended with blood by the arterial propulsion of it being more strongly excited than the correspondent venous absorption. At the same time a new sense is produced in the other termination of the urethra; which, like itching, requires some exterior friction to facilitate the removal of the cause of the maniacal actions, which may probably be increased in those cases by some associated hallucinations of ideas. It differs from priapismus chronicus in the desire of its appropriated object, which is not experienced in the latter, Class I. 1. 4. 6. and from the priapismus amatorius, Class II. 1. 7. 9. in the maniacal actions in consequence of desire. The furor uterius, or nymphomania, is a similar disease.

M. M. Venesection. Cathartics. Torpentia. Marriage.

17. _Ira._ Anger is caused by the pain of offended pride. We are not angry at breaking a bone, but become quite insane from the smallest stroke of a whip from an inferior. Ira furor brevis. Anger is not only itself a temporary madness, but is a frequent attendant on other insanities, and as, whenever it appears, it distinguishes insanity from delirium, it is generally a good sign in fevers with debility.

An injury voluntarily inflicted on us by others excites our exertions of self-defence or of revenge against the perpetrator of it; but anger does not succeed in any great degree unless our pride is offended; this idea is the maniacal hallucination, the pain of which sometimes produces such violent and general exertions of our muscles and ideas, as to disappoint the revenge we meditate, and vainly to exhaust our sensorial power. Hence angry people, if not further excited by disagreeable language, are liable in an hour or two to become humble, and sorry for their violence, and willing to make greater concessions than required.

M. M. Be silent, when you feel yourself angry. Never use loud oaths, violent upbraidings, or strong expressions of countenance, or gesticulations of the arms, or clenched fists; as these by their former associations with anger will contribute to increase it. I have been told of a sergeant or corporal, who began moderately to cane his soldiers, when they were awkward in their exercise, but being addicted to swearing and coarse language, he used soon to enrage himself by his own expressions of anger, till toward the end he was liable to beat the delinquents unmercifully.

18. _Rabies._ Rage. A desire of biting others, most frequently attendant on canine madness. Animals in great pain, as in the colica saturnina, are said to bite the ground they lie upon, and even their own flesh. I have seen patients bite the attendants, and even their own arms, in the epilepsia dolorifica. It seems to be an exertion to relieve pain, as explained in Sect. XXXIV. 1. 3. The dread of water in hydrophobia is occasioned by the repeated painful attempts to swallow it, and is therefore not an essential or original part of the disease called canine madness. See Class III. 1. 1. 15.

There is a mania reported to exist in some parts of the east, in which a man is said to run a muck; and these furious maniacs are believed to have induced their calamity by unlucky gaming, and afterwards by taking large quantities of opium; whence the pain of despair is joined with the energy of drunkenness; they are then said to sally forth into the most populous streets, and to wound and slay all they meet, till they receive their own death, which they desire to procure without the greater guilt, as they suppose, of suicide.

M. M. When there appears a tendency to bite in the painful epilepsy, the end of a rolled-up towel, or a wedge of soft wood, should be put into the mouth of the patient. As a bullet is said sometimes to be given to a soldier, who is to be severely flogged, that he may by biting it better bear his punishment.

19. _Citta._ A desire to swallow indigestible substances. I once saw a young lady, about ten years of age, who filled her stomach with the earth out of a flower-pot, and vomited it up with small stones, bits of wood, and wings of infects amongst it. She had the bombycinous complexion, and looked like a chlorotic patient, though so young; this generally proceeds from an acid in the stomach.

M. M. A vomit. Magnesia alba. Armenian bole. Rhubarb. Bark. Steel. A blister. See Class I. 2. 4. 5.

20. _Cacositia._ Aversion to food. This may arise, without disease of the stomach, from connecting nauseous ideas to our usual food, as by calling a ham a hog's a----. This madness is much inculcated by the stoic philosophy. See Antoninus' Meditations. See two cases of patients who refused to take nourishment, Class III. 1. 2. 1.

Aversions to peculiar kinds of food are thus formed early in life by association of some maniacal hallucination with them. I remember a child, who on tasting the gristle of sturgeon, asked what gristle was? And being told it was like the division of a man's nose, received an ideal hallucination; and for twenty years afterwards could not be persuaded to taste sturgeon.

The great fear or aversion, which some people experience at the sight of spiders, toads, crickets, and the like, have generally had a similar origin.

M. M. Associate agreeable ideas with those which disgust; as call a spider ingenious, a frog clean and innocent; and repress all expressions of disgust by the countenance, as such expressions contribute to preserve, or even to increase, the energy of the ideas associated with them; as mentioned above in Species 17. Ira.

21. _Syphilis imaginaria._ The fear that they are infested with the venereal disease, when they have only deserved it, is a very common insanity amongst modest young men; and is not to be cured without applying artfully to the mind; a little mercury must be given, and hopes of a cure added weekly and gradually by interview or correspondence for six or eight weeks. Many of these patients have been repeatedly salivated without curing the mind!

22. _Psora imaginaria._ I have twice seen an imaginary itch, and twice an imaginary diabaetes, where there was not the least vestige of either of those diseases, and once an imaginary deafness, where the patient heard perfectly well. In all these cases the hallucinated idea is so powerfully excited, that it is not to be changed suddenly by occular sensation, or reason. Yet great perseverance in the frequently presenting contrary ideas will sometimes slowly remove this hallucination, or in great length of time oblivion, or forgetfulness, performs a cure, by other means in vain attempted.

23. _Tabes imaginaria._ This imaginary disease, or hallucination, is caused by the supposed too great frequency of parting with the semen, and had long imposed upon the physician as well as the patient, till Mr. John Hunter first endeavoured to shew, that in general the morbid effects of this pollution was in the imagination; and that those were only liable to those effects in general, who had been terrified by the villainous books, which pretend to prevent or to cure it, but which were purposely written to vend some quack medicine. Most of those unhappy patients, whom I have seen, had evidently great impression of fear and self-condemnation on their minds, and might be led to make contradictory complaints in almost any part of the body, and if their confessions could be depended on, had not used this pollution to any great excess.

M. M. 1. Assure them if the loss of the semen happens but twice a week, it will not injure them. 2. Marry them. The last is a certain cure; whether the disease be real or imaginary. Cold partial bath, and astringent medicines frequently taken, only recal the mind to the disease, or to the delinquency; and thence increase the imaginary effects and the real cause, if such exists. Mr. ---- destroyed himself to get free from the pain of fear of the supposed ill consequences of self-pollution, without any other apparent disease; whose parents I had in vain advised to marry him, if possible.

24. _Sympathia aliena._ Pity. Our sympathy with the pleasures and pains of others distinguishes men from other animals; and is probably the foundation of what is termed our moral sense and the source of all our virtues. See Sect. XXII. 3. 3. When our sympathy with those miseries of mankind, which we cannot alleviate, rises to excess, the mind becomes its own tormentor; and we add to the aggregate sum of human misery, which we ought to labour to diminish; as in the following eloquent lamentation from Akenside's Pleasures of Imagination, Book II. 1. 200.

----------------Dark,
As midnight storms, the scene of human things
Appear'd before me; deserts, burning sands,
Where the parch'd adder dies; the frozen south;
And desolation blasting all the west
With rapine and with murder. Tyrant power
Here sits enthroned in blood; the baleful charms
Of superstition there infect the skies,
And turn the sun to horror. Gracious Heaven!
What is the life of man? Or cannot these,
Not these portents thy awful will suffice?
That, propagated thus beyond their scope,
They rise to act their cruelties anew
In my afflicted bosom, thus decreed
The universal sensitive of pain,
The wretched heir of evils not its own!

A poet of antiquity, whose name I do not recollect, is said to have written a book describing the miseries of the world, and to have destroyed himself at the conclusion of his task. This sympathy, with all sensitive beings, has been carried so far by some individuals, and even by whole tribes, as the Gentoos, as not only to restrain them from killing animals for their support, but even to induce them to permit insects to prey upon their bodies. Such is however the condition of mortality, that the first law of nature is, "Eat or be eaten." We cannot long exist without the destruction of other animal or vegetable beings, either in their mature or their embryon state. Unless the fruits, which surround the seeds of some vegetables, or the honey stolen from them by the bee, may be said to be an exception to this assertion. See Botanic Garden, P. I. Cant. I. l. 278. Note. Hence, from the necessity of our nature, we may be supposed to have a right to kill those creatures, which we want to eat, or which want to eat us. But to destroy even insects wantonly shews an unreflecting mind or a depraved heart.

Nevertheless mankind may be well divided into the selfish and the social; that is, into those whose pleasures arise from gratifying their appetites, and those whose pleasures arise from their sympathizing with others. And according to the prevalence of these opposing propensities we value or dislike the possessor of them.

In conducting the education of young people, it is a nice matter to inspire them with so much benevolent sympathy, or compassion, as may render them good and amiable; and yet not so much as to make them unhappy at the sight of incurable distress. We should endeavour to make them alive to sympathize with all remediable evils, and at the same time to arm them with fortitude to bear the sight of such irremediable evils, as the accidents of life must frequently present before their eyes. About this I have treated more at large in a plan for the conduct of a boarding school for ladies, which I intend to publish in the course of the next year.

25. _Educatio heroica._ From the kinds and degrees of insanities already enumerated, the reader will probably recollect many more from his own observation; he will perceive that all extraordinary exertions of voluntary action in consequence of some false idea or hallucination, which strongly affects us, may philosophically, though not popularly, be termed an insanity; he will then be liable to divide these voluntary exertions into disagreeable, pernicious, detestable, or into meritorious, delectable, and even amiable, insanities. And will lastly be induced to conceive, that a good education consists in the art of producing such happy hallucinations of ideas, as may be followed by such voluntary exertions, as may be termed meritorious or amiable insanities.

The old man of the mountain in Syria, who governed a small nation of people called Assassines, is recorded thus to have educated those of his army who were designed to assassinate the princes with whom he was at war. A young man of natural activity was chosen for the purpose, and thrown into a deep sleep by opium mixed with his food; he was then carried into a garden made to represent the paradise of Mahomet, with flowers of great beauty and fragrance, fruits of delicious flavor, and beautiful houries beckoning him into the shades. After a while, on being a second time stupified with opium, the young enthusiast was reconveyed to his apartment; and on the next day was assured by a priest, that he was designed for some great exploit, and that by obeying the commands of their prince, immortal happiness awaited him.

Hence it is easy to collect how the first impressions made on us by accidental circumstances in our infancy continue through life to bias our affections, or mislead our judgments. One of my acquaintance can trace the origin of his own energies of action from some such remote sources; which justifies the observation of M. Rousseau, that the seeds of future virtues or vices are oftener sown by the mother, than the tutor.

* * * * *

ORDO II.

_Decreased Volition._

GENUS I.

_With decreased Actions of the Muscles._

Our muscles become fatigued by long contraction, and cease for a time to be excitable by the will; owing to exhaustion of the sensorial power, which resides in them. After a short interval of relaxation the muscle regains its power of voluntary contraction; which is probably occasioned by a new supply of the spirit of animation. In weaker people these contractions cease sooner, and therefore recur more frequently, and are attended with shorter intervals of relaxation, as exemplified in the quickness of the pulse in fevers with debility, and in the tremors of the hands of aged or feeble people.

After a common degree of exhaustion of the sensorial power in a muscle, it becomes again gradually restored by the rest of the muscle; and even accumulated in those muscles, which are most frequently used; as in those which constitute the capillaries of the skin after having been rendered torpid by cold. But in those muscles, which are generally obedient to volition, as those of locomotion, though their usual quantity of sensorial power is restored by their quiescence, or in sleep (for sleep affects these parts of the system only), yet but little accumulation of it succeeds. And this want of accumulation of the sensorial power in these muscles, which are chiefly subservient to volition, explains to us one cause of their greater tendency to paralytic affection.

It must be observed, that those parts of the system, which have been for a time quiescent from want of stimulus, as the vessels of the skin, when exposed to cold, acquire an accumulation of sensorial power during their inactivity; but this does not happen at all, or in much less quantity, from their quiescence after great expenditure of sensorial power by a previous excessive stimulus, as after intoxication. In this case the muscles or organs of sense gradually acquire their natural quantity of sensorial power, as after sleep; but not an accumulation or superabundance of it. And by frequent repetitions of exhaustion by great stimulus, these vessels cease to acquire their whole natural quantity of sensorial power; as in the schirrous stomach, and schirrous liver, occasioned by the great and frequent stimulus of vinous spirit; which may properly be termed irritative paralysis of those parts of the system.

In the same manner in common palsies the inaction of the paralytic muscle seems not to be owing to defect of the stimulus of the will, but to exhaustion of sensorial power. Whence it frequently follows great exertion, as in Sect. XXXIV. 1. 7. Thus some parts of the system may cease to obey the will, as in common paralysis; others may cease to be obedient to sensation, as in the impotency of age; others to irritation, as in schirrous viscera; and others to association, as in impediment of speech; yet though all these may become inexcitable, or dead, in respect to that kind of stimulus, which has previously exhausted them, whether of volition, or sensation, or irritation, or association, they may still in many cases be excited by the others.

SPECIES.

1. _Lassitudo._ Fatigue or weariness after much voluntary exertion. From the too great expenditure of sensorial power the muscles are with difficulty brought again into voluntary contraction; and seem to require a greater quantity or energy of volition for this purpose. At the same time they still remain obedient to the stimulus of agreeable sensation, as appears in tired dancers finding a renovation of their aptitude to motion on the acquisition of an agreeable partner; or from a tired child riding on a gold-headed cane, as in Sect. XXXIV. 2. 6. These muscles are likewise still obedient to the sensorial power of association, because the motions, when thus excited, are performed in their designed directions, and are not broken into variety of gesticulation, as in St. Vitus's dance.

A lassitude likewise frequently occurs with yawning at the beginning of ague-fits; where the production of sensorial power in the brain is less than its expenditure. For in this case the torpor may either originate in the brain, or the torpor of some distant parts of the system may by sympathy affect the brain, though in a less proportionate degree than the parts primarily affected.

2. _Vacillatio senilis._ Some elderly people acquire a see-saw motion of their bodies from one side to the other, as they sit, like the oscillation of a pendulum. By these motions the muscles, which preserve the perpendicularity of the body, are alternately quiescent, and exerted; and are thus less liable to fatigue or exhaustion. This therefore resembles the tremors of old people above mentioned, and not those spasmodic movements of the face or limbs, which are called tricks, described in Class IV. 1. 3. 2. which originate from excess of sensorial power, or from efforts to relieve disagreeable sensation, and are afterwards continued by habit.

3. _Tremor senilis._ Tremor of old age consists of a perpetual trembling of the hands, or of the head, or of other muscles, when they are exerted; and is erroneously called paralytic; and seems owing to the small quantity of animal power residing in the muscular fibres. These tremors only exist when the affected muscles are excited into action, as in lifting a glass to the mouth, or in writing, or in keeping the body upright; and cease again, when no voluntary exertion is attempted, as in lying down. Hence these tremors evidently originate from the too quick exhaustion of the lessened quantity of the spirit of animation. So many people tremble from fear or anger, when too great a part of the sensorial power is exerted on the organs of sense, so as to deprive the muscles, which support the body erect, of their due quantity.

4. _Brachiorum paralysis._ A numbness of the arms is a frequent symptom in hydrops thoracis, as explained in Class I. 2. 3. 14. and in Sect. XXIX. 5. 2.; it also accompanies the asthma dolorificum, Class III. 1. 1. 11. and is owing probably to the same cause in both. In the colica saturnina a paralysis affects the wrists, as appears on the patient extending his arm horizontally with the palm downwards, and is often attended with a tumor on the carpal or metacarpal bones. See Class IV. 1. 2. 10.

Mr. M----, a miner and well-sinker, about three years ago, lost the power of contracting both his thumbs; the balls or muscles of the thumbs are much emaciated, and remain paralytic. He ascribes his disease to immersing his hands too long in cold water in the execution of his business. He says his hands had frequently been much benumbed before, so that he could not without difficulty clench them; but that they recovered their motion, as soon as they began to glow, after he had dried and covered them.

In this case there existed two injurious circumstances of different kinds; one the violent and continued action of the muscles, which destroys by exhausting the sensorial power; and the other, the application of cold, which destroys by defect of stimulus. The cold seems to have contributed to the paralysis by its long application, as well as the continued exertion; but as during the torpor occasioned by the exposure to cold, if the degree of it be not so great as to extinguish life, the sensorial power becomes accumulated; there is reason to believe, that the exposing a paralytic limb to the cold for a certain time, as by covering it with snow or iced water for a few minutes, and then covering it with warm flannel, and this frequently repeated, might, by accumulation of sensorial power, contribute to restore it to a state of voluntary excitability. As this accumulation of sensorial power, and consequent glow, seems, in the present case, several times to have contributed to restore the numbness or inability of those muscles, which at length became paralytic. See Class I. 2. 3. 21.

M. M. Ether externally. Friction. Saline warm bath. Electricity.

5. _Raucedo paralytica._ Paralytic hoarseness consists in the almost total loss of voice, which sometimes continues for months, or even years, and is occasioned by inability or paralysis of the recurrent nerves, which serve the muscles of vocality, by opening or closing the larynx. The voice generally returns suddenly, even so as to alarm the patient. A young lady, who had many months been affected with almost a total loss of voice, and had in vain tried variety of advice, recovered her voice in an instant, on some alarm as she was dancing at an assembly. Was this owing to a greater exertion of volition than usual? like the dumb young man, the son of Croesus, who is related to have cried out, when he saw his father's life endangered by the sword of his enemy, and to have continued to speak ever afterwards. Two young ladies in this complaint seemed to be cured by electric shocks passed through the larynx every day for a fortnight. See Raucedo catarrhalis, Class II. 1. 3. 5.

M. M. An emetic. Electric shocks. Mustard-seed, a large spoonful swallowed whole, or a little bruised, every morning. Valerian. Burnt sponge. Blisters on each side of the larynx. Sea-bathing. A gargle of decoction of seneca. Friction. Frequent endeavours to shout and sing.

6. _Vesicae urinariae paralysis._ Paralysis of the bladder is frequently a symptom in inirritative fever; in this case the patient makes no water for a day or two; and the tumor of the bladder distended with urine may be seen by the shape of the abdomen, as if girt by a cord below the navel, or distinguished by the hand. Many patients in this situation make no complaint, and suffer great injury by the inattention of their attendants; the water must be drawn off once or twice a day by means of a catheter, and the region of the bladder gently pressed by the hand, whilst the patient be kept in a sitting or erect posture.

M. M. Bark. Wine. Opium, a quarter of a grain every six hours. Balsam of copaiva or of Peru. Tincture of cantharides 20 drops twice a day, or repeated small blisters.

7. _Recti paralysis._ Palsy of the rectum. The rectum intestinum, like the urinary bladder in the preceding article, possesses voluntary power of motion; though these volitions are at times uncontrollable by the will, when the acrimony of the contained feces, or their bulk, stimulate it to a greater degree. Hence it happens, that this part is liable to lose its voluntary power by paralysis, but is still liable to be stimulated into action by the contained feces. This frequently occurs in fevers, and is a bad sign as a symptom of general debility; and it is the sensibility of the muscular fibres of this and of the urinary bladder remaining, after the voluntarity has ceased, which occasions these two reservoirs so soon to regain, as the fever ceases, their obedience to volition; because the paralysis is thus shewn to be less complete in those cases than in common hemiplegia; as in the latter the sense of touch, though perhaps not the sense of pain, is generally destroyed in the paralytic limb.

M. M. A sponge introduced within the sphincter ani to prevent the constant discharge, which should have a string put through it, by which it may be retracted.

8. _Paresis voluntaria._ Indolence; or inaptitude to voluntary action. This debility of the exertion of voluntary efforts prevents the accomplishment of all great events in life. It often originates from a mistaken education, in which pleasure or flattery is made the immediate motive of action, and not future advantage; or what is termed duty. This observation is of great value to those, who attend to the education of their own children. I have seen one or two young married ladies of fortune, who perpetually became uneasy, and believed themselves ill, a week after their arrival in the country, and continued so uniformly during their stay; yet on their return to London or Bath immediately lost all their complaints, and this repeatedly; which I was led to ascribe to their being in their infancy surrounded with menial attendants, who had flattered them into the exertions they then used. And that in their riper years, they became torpid for want of this stimulus, and could not amuse themselves by any voluntary employment; but required ever after, either to be amused by other people, or to be flattered into activity. This I suppose, in the other sex, to have supplied one source of ennui and suicide.

9. _Catalepsis_ is sometimes used for fixed spasmodic contractions or tetanus, as described in Sect. XXXIV. 1. 5. and in Class III. 1. 1. 13. but is properly simply an inaptitude to muscular motion, the limbs remaining in any attitude in which they are placed. One patient, whom I saw in this situation, had taken much mercury, and appeared universally torpid. He sat in a chair in any posture he was put, and held a glass to his mouth for many minutes without attempting to drink, or withdrawing his hand. He never spoke, and it was at first necessary to compel him to drink broth; he recovered in a few weeks without relapse.

10. _Hemiplegia._ Palsy of one side consists in the total disobedience of the affected muscles to the power of volition. As the voluntary motions are not perpetually exerted, there is little sensorial power accumulated during their quiescence, whence they are less liable to recover from torpor, and are thus more frequently left paralytic, or disobedient to the power of volition, though they are sometimes still alive to painful sensation, as to the prick of a pin, and to heat; also to irritation, as in stretching and yawning; or to electric shocks. Where the paralysis is complete the patient seems gradually to learn to use his limbs over again by repeated efforts, as in infancy; and, as time is required for this purpose, it becomes difficult to know, whether the cure is owing to the effect of medicines, or to the repeated efforts of the voluntary power.

The dispute, whether the nerves decussate or cross each other before they leave the cavities of the skull or spine, seems to be decided in the affirmative by comparative anatomy; as the optic nerves of some fish have been shewn evidently to cross each other; as seen by Haller, Elem. Physiol. t. v. p. 349. Hence the application of blisters, or of ether, or of warm fomentations, should be on the side of the head opposite to that of the affected muscles. This subject should nevertheless be nicely determined, before any one should trepan for the hydrocephalus internus, when the disease is shewn to exist only on one side of the brain, by a squinting affecting but one eye; as proposed in Class I. 2. 5. 4. Dr. Sommering has shewn, that a true decussation of the optic nerves in the human subject actually exists, Elem. of Physiology by Blumenbach, translated by C. Caldwell, Philadelphia. This further appears probable from the oblique direction and insertion of each optic nerve, into the side of the eye next to the nose, in a direct line from the opposite side of the brain.

The vomiting, which generally attends the attack of hemiplegia, is mentioned in Sect. XX. 8. and is similar to that attending vertigo in sea-sickness, and at the commencement of some fevers. Black stools sometimes attend the commencement of hemiplegia, which is probably an effusion of blood from the biliary duct, where the liver is previously affected; or some blood may be derived to the intestines by its escaping from the vena cava into the receptacle of chyle during the distress of the paralytic attack; and may be conveyed from thence into the intestines by the retrograde motions of the lacteals; as probably sometimes happens in diabaetes. See Sect. XXVII. 2. Palsy of one side of the face is mentioned in Class II. 1. 4. 6. Paralysis of the lacteals, of the liver, and of the veins, which are described in Sect. XXVIII. XXX. and XXVII. do not belong to this class, as they are not diseases of voluntary motions.

M. M. The electric sparks and shocks, if used early in the disease, are frequently of service. A purge of aloes, or calomel. A vomit. Blister. Saline draughts. Then the bark. Mercurial ointment or sublimate, where the liver is evidently diseased; or where the gutta rosea has previously existed. Sudden alarm. Frequent voluntary efforts. Externally ether. Volatile alcali. Fomentation on the head. Friction. When children, who have suffered an hemiplegia, begin to use the affected arm, the other hand should be tied up for half an hour three or four times a day; which obliges them at their play to use more frequent voluntary efforts with the diseased limb, and thus sooner to restore the dissevered associations of motion.

Dr. J. Alderson has lately much recommended the leaves of rhus toxicodendon (sumach), from one gr. to iv. of the dried powder to be taken three or four times a day. Essay on Rhus Toxic. Johnson, London, 1793. But it is difficult to know what medicine is of service, as the movements of the muscles must be learned, as in infancy, by frequent efforts.

11. _Paraplegia._ A palsy of the lower half of the body divided horizontally. Animals may be conceived to have double bodies, one half in general resembling so exactly the other, and being supplied with separate sets of nerves; this gives rise to hemiplegia, or palsy of one half of the body divided vertically; but the paraplegia, or palsy of the lower parts of the system, depends on an injury of the spinal marrow, or that part of the brain which is contained in the vertebrae of the back; by which all the nerves situated below the injured part are deprived of their nutriment, or precluded from doing their proper offices; and the muscles, to which they are derived, are in consequence disobedient to the power of volition.

This sometimes occurs from an external injury, as a fall from an eminence; of which I saw a deplorable instance, where the bladder and rectum, as well as the lower limbs, were deprived of so much of their powers of motion, as depended on volition or sensation; but I suppose not of that part of it, which depends on irritation. In the same manner as the voluntary muscles in hemiplegia are sometimes brought into action by irritation, as in stretching or pendiculation, described in Sect. VII. 1. 3.

But the most frequent cause of paraplegia is from a protuberance of one of the spinal vertebrae; which is owing to the innutrition or softness of bones, described in Class I. 2. 2. 17. The cure of this deplorable disease is frequently effected by the stimulus of an issue placed on each side of the prominent spine, as first published by Mr. Pott. The other means recommended in softness of bones should also be attended to; both in respect to the internal medicines, and to the mechanical methods of supporting, or extending the spine; which last, however, in this case requires particular caution.

12. _Somnus._ In sleep all voluntary power is suspended, see Sect. XVIII. An unusual quantity of sleep is often produced by weakness. In this case small doses of opium, wine, and bark, may be given with advantage. For the periods of sleep, see Class IV. 2. 4. 1.

The subsequent ingenious observations on the frequency of the pulse, which sometimes occurs in sleep, are copied from a letter of Dr. Currie of Liverpool to the author.

"Though rest in general perhaps renders the healthy pulse slower, yet
under certain circumstances the contrary is the truth. A full meal
without wine or other strong liquor does not increase the frequency of
my pulse, while I sit upright, and have my attention engaged. But if I
take a recumbent posture after eating, my pulse becomes more frequent,
especially if my mind be vacant, and I become drowsy; and, if I
slumber, this increased frequency is more considerable with heat and
flushing.

"This I apprehend to be a general truth. The observation may be
frequently made upon children; and the restless and feverish nights
experienced by many people after a full supper are, I believe, owing to
this cause. The supper occasions no inconvenience, whilst the person is
upright and awake; but, when he lies down and begins to sleep,
especially if he does not perspire, the symptoms above mentioned occur.
Which may be thus explained in part from your principles. When the
power of volition is abolished, the other sensorial actions are
increased. In ordinary sleep this does not occasion increased frequency
of the pulse; but where sleep takes place during the process of
digestion, the digestion itself goes on with increased rapidity. Heat
is excited in the system faster than it is expended; and operating on
the sensitive actions, it carries them beyond the limitation of
pleasure, producing, as is common in such cases, increased frequency of
pulse.

"It is to be observed, that in speaking of the heat generated under
these circumstances, I do not allude to any chemical evolution of heat
from the food in the process of digestion. I doubt if this takes place
to any considerable degree, for I do not observe that the parts
incumbent on the stomach are increased in heat during the most hurried
digestion. It is on some parts of the surface, but more particularly on
the extremities of the body, that the increased heat excited by
digestion appears, and the heat thus produced arises, as it should
seem, from the sympathy between the stomach and the vessels of the
skin. The parts most affected are the palms of the hands and the soles
of the feet. Even there the thermometer seldom rises above 97 or 98
degrees, a temperature not higher than that of the trunk of the body;
but three or four degrees higher than the common temperature of these
parts, and therefore producing an uneasy sensation of heat, a sensation
increased by the great sensibility of the parts affected.

"That the increased heat excited by digestion in sleep is the cause of
the accompanying fever, seems to be confirmed by observing, that if an
increased expenditure of heat accompanies the increased generation of
it (as when perspiration on the extremities or surface attends this
kind of sleep) the frequent pulse and flushed countenance do not occur,
as I know by experiment. If, during the feverish sleep already
mentioned, I am awakened, and my attention engaged powerfully, my pulse
becomes almost immediately slower, and the fever gradually subsides."

From these observations of Dr. Currie it appears, that, while in common sleep the actions of the heart, arteries, and capillaries, are strengthened by the accumulation of sensorial power during the suspension of voluntary action, and the pulse in consequence becomes fuller and slower; in the feverish sleep above described the actions of the heart, arteries, and capillaries, are quickened as well as strengthened by their consent with the increased actions of the stomach, as well as by the stimulus of the new chyle introduced into the circulation. For the stomach, and all other parts of the system, being more sensible and more irritable during sleep, Sect. XVIII. 15. and probably more ready to act from association, are now exerted with greater velocity as well as strength, constituting a temporary fever of the sensitive irritated kind, resembling the fever excited by wine in the beginning of intoxication; or in some people by a full meal in their waking hours. Sect. XXXV. 1.