I 79r *

REMARKABLE

CASE OF MADNESS,

WITH THE

DIET AND MEDICINES,

tTJED IN,THE

CURE.

WILLIAM PERFECT, M. D.OF WEST-MALLING, IN KENT,

AMD MEMBER OF THE LONDON MEDICAL SOCIETY.

/ «

Morbi non Eloquentia fed Remediis curantur.

ROCHESTER,PRINTED FOR THE AUTHOR. AND SOLD BY W. GILLMAN,

J. Murray, Fleet-Street, J. Evans, Pater-Noster-Rowand C. Forster, Poultry, London.

DEDICATIONT O

Dr. WILLIAM ROWLEY,Member of the Univerjity ofOxford, theRoyal College ofFhyfcians , in London,

&c, &c, &c.

S I R,THE fubfequent Cafe is

a proof of the Utility of thofe Methodsyou have recommended for the Treat-ment of mental derangements, in yourexcellent Treatife, on Female, Nervous,Bilious Difeafes, &c. I therefore begleave to dedicate this little performanceto you, as a fmall Teftimony of the Re-fpecl due to a Phylician, whofe wholeLife has been engaged in improving theArt of Medicine.

And am, Sir,Your molt obedient.

humble Servant,William Perfect.

A

REMARKABLE

CASE OF

MADNESS.

TX HE records of medicine cannot

perhaps afford an inftance fimilar to theprefent, nor do we find in the differentwriters, who have profeffedly treatedon affections, one cafe wherein,at fo early a period as the age of elevenyears, the diforder has appeared withmarks fo clear and intelligible. Andit is as fingular in this inflance that

6 A REMARKABLE

there Teems no clue leading to the caufe,as predilpofing to infanity, no tranflationof the difeafed matter of any part to

the membranes of the brain producingdelirium &c, nor dijfufwn of bile, fad-

den fublidence of cutaneous eruptions,

abfortion of matter from ahfcejfesiwounds, or ulcers , no fcrophulous or

cancerous taint of the juices, no exhibi-tion of deleterious vegetables or mercurialpreparations, no fudden fright, acci-dental blow, fall, or any hereditarypredifpolition to mania. No one of hisfamily on the fide of either father ormother having ever been rememberedto have been the leafl affeded withmental difeafe ; in fhort there was noobvious caufe to which the complaintcould be rationally affigned. The child

CASE OF MADNESS, 7was looked upon as poiTelfed of no ex-

traordinary (hare of genius, ability,nor a&ivity of imagination, nor washe fo fprightly as mod boys of that age,but rather of a thoughtful, melancholicdifpolition, very little inclined to pue-rile amufements and diverhons; butrather docile and tra£lable, he had al-ways been healthy, had never (hewn awanton propenfity to hard and indegidi-ble aliment, he had never been too muchindulged, nor compelled to any intenfeapplication of mind. It was his cudom inthe morning to go withother children to

a fchool at fome didance from his home,and to return in the evening. On thetwenty ninth of January, 1789,he return-

ed unufually low and dull, little noticewas then taken of the alteration in his

8 A REMARKABLE

appearance ; but upon his return fromfchool the following day, the depreffionand lownefs being much more vifible,a ferious enquiry took place, as to thecaufe of his complaint, but his anfwersfeemed rather extorted, were vague,unconne&ed, and inconclufivejie feem-ed hurried at the fight of ftrangers, ofteno o *

turned pale,trembled,had an angry acute

flaiing look, with dilated pupils, anddieadful apprehenfions,frequently look-ed fearfully about,as if he fufpe&ed fomeill defign, fometimes he appeared timidand diflrefied.fi ghed much, and hadnotmore than a quarter oi an hours deepthroughout the whole night. January31Ji, from a fuppofition of coftivenefs,fome marina was difTolved and (riven

him, which operated once, but did not

CASE OF MADNESS. 9relieve him in the lead, he appeared allthe day unufually dra? ge in his manner

and actions. Fear, didrefs, andfhame,alternately occupied his mind but hedid not at any time advert to any oneobject in particular,nor upon the driftedexamination could it be found that hehad been lately terrified, or undergonethe lead degree of fcholadic admoni-tory difcipiine. or that his temperhad been ruffled in any ihape whatever.He was fat up with, had very little deep,not more than two hours in the wholenight. In the morning, February \JI, he

i

fpoke rather more rationally than he haddone before, but complained of a painin his head with giddinefs, weaknefs,and rather a dimnefs of that hiso J

eyes ached and were painful, and that

IO A REMARKABLE

he fcarcely knew where he was, andfaid he was very fleepy ; he laid downto deep, but was fo rehlefs and dihreffcdin mind, as not to get any, and if a

wordwere fpoken,it made him peevifh,and petulant, and the lead motion fromthe bye handers became an immediateobject of frefli inquietude and vexation.

Having fome degree of rigor, and hislegs and feet feeling very cold, by thedirections of hi« mother, they were veryjudiciouhy immerfed in warm water,and he was put to bed again, when thefame dihrefsful ideas occahoned thefame watchfulnefs as before, and heflept not fomuch as an hour in the wholenight,often waking in great perturbationof mind, fometimes fighing, as if he la-boured under great affliction and at in-

CASE OF MADNESS. 11

tervals incelfantly talking and ramblingwith quick tranfition from one fubjeftto another, without the lead reafon orcoherence whatever. February 2d, thefamily apothecary Was fent for, whofound him in the (late as before defended with an alienation of mind withouta fever; the fkin harlh and dry,he had had little or no perfpirationfrom the time he Was taken, fometimesvery wakeful and loquacious, at othersdupid, abfent, and mufmg, and thepulferather below the natural ftandard at

his age ; finapifms were ordered to thefeet, and a blider to the back, whichwere applied in the evening; he padedthe night in a more uneafy and relllefsmanner thanbefore, and in the morning,at the particular requed of the apothe-

12 A REMARKABLE

cary, another praftitioner was confulted.February his fleep during the n 1 irhthad been lefs difturbed, but of veryfhort duration, at moil not more thanten or fifteen minutes at a time, andin the intervals frequently interruptedwith fighs and ftartings, February \th9

all the former figns of mental derange-ment recurred, and there appeared not

the lead alteration for the better, theblifter had di(charged but little, and hehaving been coflive, for fome time,four flimulant clyfters were fuccefhvelyinje&ed; but returned again, juft tingedwith the feces, and without any apparentgood effe6l. Until February btk, hecontinued alternately in a filent ftupid or

diftrefsfully obftreperous Rate; but at

intervals began to fhew fome figns of

CASE OJf MADNESS. 13returning reafon, which continued to

furnifh hopes of recovery, until Febru-ary when he reverted entirely in-to his former bad Hate, had a miferablydiilreflinsr night, with the a^^ravatedooJ oO

fymptomsof dißorted eyes, and oppref-fed re fpi ration; neither was he in the leadbetter all that Day nor the followingnight; the blißer at his back di(chargedtolerably well, was kept open, andan iiTue was alfb opened in his arm.February 15th, &c, he took emetics twice,which had no manner of effect eitherupwards or downwards; boluffes of cam-

phor were pre(bribed and given; butRill he remained in a gloomy and per-turbed Rate of mind without any feveruntil February ic)lh, when becomingmuch worfe in every refpect, and by

A REMARKABLE14way of revulfion, it was thought necehfary to apply blifters to the legs, whichwas done, and a very bad night enfued ;

for it was with much difficulty he was

kept in bed; befides the ordinaryfymptoms of melancholy, he was at

times more irafcible and furious thanat any former period of his illnefs.February 20tk, all day he appeared to

labour under the mod excruciating andintenfe fenfations of anxiety and an-

guiffi, and palled a dreadful night.February 21[ft. the fame fymptoms con-tinued without the lead; mitigation, un-til toward the morning, when a fallenfilence and referve, accompanied withfome degree of deep fupervened, relax-ing from which, for fome hours, heappeared rational, and more calm and

CASE OF MADNESS, *5compofed than he had been for fometime before ; but this was an intervalof ffiort duration, for February 22d, hegrew much worfe, with cold ffiudder-ing, great difficulty of breathing, wasfurious, and became quite raving, fothat two ftrong people could not holdhim, down in his bed, without muchexertion, and in this date, with verylittle variation, he continued untilFebruary 27th. when foon after fomeloofe feces, procured by a laxativemedicine, he fuddenly became more

eafy and compofed, paffed more water

than he had done for feveral days be-fore, flept with much lefs interruption,feemed to be more rational, and infome degree, recoverd his ufual fpi-rits, but February 28th. he reverted to

A REMA R K A RLE

his former hale of horror and dejection*and feemed fcarcely to know or attendat all to external objeds. March \JI. bewas apparently lefs diftreffed and agi-tated in his mind.. March 2d, producedhome comfortable hopes that he was

getting better, which in fome degreealleviated the painful feelings ofmaternalaffedlion, that had fo long been uponthe rack on account of his fulferings ;

but this celfation of parental folicitudc,was only protradled until March yth,when he again appeared low and fad,and much deranged in mind, and com-

plained of a pain and weight in his head,which was directed to be fhaved andembrocated with diftilled vinegar, anda blifler to the head was alfo advifed as

effentially necelfary; but the idea of its

CASE OF MADNESS. 17application was fodillreffingtohis friends,as topreclude for the prefent all thoughtsof it; another emetic much flronger thaneither oftheformer was next thought ofand adminiftered accordingly; but prov-ed as inefficacious in its operation as ei-ther ofthe preceding, neither occafioningnaufea, vomiting, or purging ; but fomefmall degree of dampnefs on the fkinwas thought to be in confequence of it.Hitherto every medical effort had pro-ved fruitlefs, and the poor little foffererobtained no palliation of the fymptoms.March gth. Still a vicfim to the ravagesand returns of this mercilefs malady,he was feized with difmal apprehen-iions, and groundlefs fears. The facul-ties of his mind were weak and timid.Taciturnity and meditation took place

i8 A REMARKABLE

of horror and depreffion, tears andlamentations, which recurred and re-mitted in proportion as his ruminatingparoxyfms were longer or (horter, hisnights were paffed in watchfulnefs, andhis days in fadnefs, with lucid intervalsof momentary duration, until March13th,when the folitary ftate of his mind

changed, on a fudden, into diflradionaudacity and violence,; the diliriumappearing to have taken a turn dire&lyoppofite to its former genus, fo thatfrom the defponding, he was now be-come the raving maniac, and the fitua-tion ofhimfelf and friends was renderedtruly deplorable indeed. At this crifisof calamity a hlijier to the head was

again propofed,and the former objeftionsgiving way to the emergency of the cafe.

CASE OF MADNESS. *9was applied, when the next day he was

infinitely worfe, and more refllefs andunmanagable than he beenbefore. The caufticity of the blifleroccafioned the mod violent excitement,and thereby counterbalanced everybenefit which might have arifen fromits difcharge, and indeed in a verylong and extenfive pradice I never re-member to have feen more than two

inflances of the good effects of vejicationto the head, one of which was in a phre-nitic complaint where torpidity andlangour had been brought on by profufeevacuations, and the other in a maniacalajfedion,

of fome handing, when thepowers of nature had been debilitatedby inanition. In the indifcriminate ufesof epifpa/iics to the head, for the cure of

20 A REMARKABLE

cerebral diforders, particularly wherean overfulnefs is already obvious, muchmi (chief may be apprehended fromtheir ardent and powerfully dimulatinginfluence. March 15th, the patient be-came fo very raving and redlefs, thathaving no drait waidcoat, nor tiling anyligatures to his arms and legs, it was as

much as three people could keep himfrom getting out ofbed,in which franticand turbulent date he continued untilMarch ijih, when another emetic wasadminidered, but with the fame ineffe-cacy as before. March 21ft. The vio-lence of the diforder feemed abated, andon that and the following day he wasnot fo loud and raving as he had beenfor many days before but often mutteredto himfelf, and appeared dupid, abfent.

CASE OF MADNESS. 21

and mufing. March 23 d, he continuedmore (till and quiet, but very low andmelancholic, at any time fcarcelyfpoke loud enough to be heard, andremained in this depreffed (late untilMarch 2 6, when he feemed to recovermore ol his ufual (pints, and was at

times tolerably confident and rational.Mo.rch 27 th, his former fymptoms re-curring, my advice and attendance was

thought necefiary, and when with themod feeling anxiety and fymphatheticconcern, the whole of the foregoingaccount was recollecled, and given mein detail, as far as her memory couldadift her, by the adli6led mother of thepatient, whom I found removed to a

remote part of the houfe, and lodged ina darkened room, with an adidant on

A REMARKABLE22

each Tide the bed, for the purpofe ofcoercion when necelfary, and notwith-flanding the length of his confinement,the violence of his disorder, and themany rclapfes to which he had beenfubjecf, he had not that morbid or ema-ciated appearence which might havebeen expe6ted. Approaching to thebedlide, I did not at firft feem to attra6lhis attention, but after fpeaking to himhe turned round, and in a low defpond-ing manner, faid, “ He fhould never6f be any better, but that I might do as I“ pleafed with him, that his father was

not able to provide for him, and that“ he had never been able to learn fo“quick as other boys; 5 ' to which Imade him the moil confolatory anfwersI could fugged, and foothed him as

CASE OF MADNESS. 23much as poffible; at the lame timeaiTuring him of the great probabilitywhich I entertained of doing him good,and of getting him quite well, providedmy rules and directions were punctual-ly followed; by this means appearingto have gained his good opinion, hefmiled, and Teemed pleafed ; and to domy little patient jullice, when in hisfenfes, and capable of fo doing, hechearfully drove to fecond my endea-vours to a (lift him, by an implicitobedience to my advice and inflruc-tions. Perceiving that he frequentlymade fudden efforts to jump out of thebed, and that the attendants in endea-vouring to reflrain him, irritated himthe more, I recommended the ufe ofa flrait waiflcoat, which I had brought

A REMARKABLE24with ms for that purpose, and whichwas ufed before I left the houfe, andcontinued occalionally to the end ofthe cure. From the firfb beginning ofhis diforder, his appetite had been muchdepraved: upon examination I per-ceived a final! degree of tenfion aboutthe epigajhic region ; but not attendedwith any pain, nor had there been thelead degree of inflammation in theflomach or bowels; his breath had at

times been fetid, but not extremely fo,and was now rather often live ; the urinehad been fometimes high coloured, andat others pale and limpid; but hadnever been obferved to depofit anykind of fediment, and in general hadbeen made in fmaller quantities than

was natural. His deglutition had been

CASE OF MADNESS, 25obferved to be more difficult, whenunder the paroxyfm of dejection, and

in his moft delirious hate, with a flight7 u

degree of deafnefs, moifiure of the eyes,

dimnefs of fight, and an involuntarydifcharge of tears, he talked much more

incQnfifient than when I firfl faw him,and complained of fpectres and fright-ful dreams: often when at the belt, Iwas informed, he appeared drowfy andready to fall a fleep, he had frequenteru6tationry,and his feet were remarkedto have been alternately hot, dry, andcold, his eyes fufficiently indicated theperturbed hate of his mind, their pupilswere greatly diltended, and the lids tu-

mid and red,with a fordid rheum adhe-ring to the edges, his face was florid, butneither bloated nor fwelled,heexpreffed

2 6 A REMARKABLE

fome childiOilyridiculous fears,appearedvery forgetful, with a fmall degree offlupor, and upon afking him where hewas moil in pain, after two or threetimes waving his hand, as if in doubt,be at laft pointed to his forehead, heappeared to have an equal degree ofheat over the whole body,nor was therethe leaft augmentation thereof in hishead and temples, he was naturallyinclined to coOivenefs, and the floolshe had had through the courfe of hisdiforder, (when not procured by medi-cine,) where generally high coloured,and at the didance of two or threedays; he had not the lealt degree offever, and the fun&ions of his mindwere apparently injured and deranged,he frequently changed his pofition in

CASE OF MADNESS. 27bed with an extraordinary degree ofvelocity and ftrength, and was fo littledebilitated, that he appeared to have a

greater ihare of mufcular flrength,than ina healthy (late,is common to boys ol hisage. Ipbferved that he feemed ratherpleafed in every opportunity to givehis attendants frelh occalion to watchand guard him, his refpiration was notin the lead opprefied, and he had no

ficknefs at his llomach, his deep hadbeen much interrupted,and feldomlongcontinued, his fweats had been partial,and never once either profufe or gene-ral, chiefly in the night, and leldomcontinued more than a few minutesat a time; probably from the difturbedIfate of his mind, and the re (lie lineIs of

his body confequent thereon. In the

28 A REMARKABLE

paroxyfms he had been fometimesheard to grind and gnafh his teeth;had never appeared thirfty, nor at anytime had he drank with eagernefs andvoracity ; his voice was much lowerthan its natural pitch, and feemed in-capable of continued diflinft articula-tion. Thepulfe was low, at about fixty,and fcarcely perceptable, but though fblow and weak, I confidered it as

a fallacious guide, and that its pre-fent hate was a certain indication eitherof fome obftru6lion in the heart orlungs, or fome degree of oppreffion inthe cerebellum. I was therefore fullyfatisfied with the expediency of takingaway fome blood as the befl prelimi-nary hep to the cure. Venefe6lion was

accordingly performed, and about fix

29CASE OF MADNESS.

ounces of blood taken from the arm j

immediately after which the vibrationsof the artery were manifedly moredidinfl and fomewhat accelerated ; the,

blood, when cold, was covered with a

a very thin cake of gluten, adhered to

the bafon, was very bilious, and theferum was of a yellowifli color. Soonafter the operation, the child fpokcrationally for fome time, feemed muchlefs drowfy; was more inclined to deep,than he was before, but in about anhour relap fed into his former date. Idire&ed a feton to be made betweenthefcapulx in the dire&ion of the fpine;that his feet fiiould be frequently im-merfed in a warm pediluvium of faitand water, and with a view to induceperfpiration, that he fhould often re-

A REMARKABLE

dine his head over the edge of an

earthen veflel, and receive the fumesof warm vinegar and water; that hefhould be retrained by the ufe of thewaiilcoat, as occalion Ihould require;and be talked to as little as polfible.Confidering the proximate caufe of hisdiforder to arife from a turgency anddetenfion in the cerebral veffels, 3recommended the diet to be cooling,plain and llender, with almoh a totalahjlinence from liquid food, that drinksof all forts fhould be fparingly ad-viitted; and in their head directedroafted apples, dried cherries, tama-

rinds, or currant jelly, &.c. All objefts,which engaged his attention, or excitedthe leaffc emotion, were to be removed,with a view to keep his mind calm

CASE OF MADNESS, 31and placid; fo that all mental irri-tation being taken off, the aptitudeof frantic paroxyfm might be leffened.He was ordered to abftain from allflatulent, vifcid, and grofs food, to

have more air, and even exercife,when it could be admitted. As emeticshad been fo repeatedly tried withouteffed, and were thought hazardous, asthey force too great a quantity of bloodto the head, I objeded to their ufe,and prefenbed a faline purgative mix-ture, with the infufion and tindure offena, to be taken until evacuationsfhould be procured. Laxatives werecontinued occafionally to prevent cof-tivenefs, and having in many inflancesexperienced the efficacy and goodeffeds of camphor in fimilar diforders.

32 A REMARKABLE

as may be Teen in my late publicationof SELECT CASES OF INSA-NIT Y, I prefcribed as follows.

R. Camphorce sij5: V: R: siijGum: Arabic & Sacc : Alb: a sij

Mifce fimul denique adde gradatimaquce pluvialis 5 viij cujus capiat cock. ijvcl iij ad libitum: for which formI was in great meafure indebted to Dr,

Rowley , who in his excellent Treatifeon Female Nervous Difeafes , Madnejs,

&c, very judicioufly recommends itas a much better preparation of cam-phor than the julepum c camphora;

becaufe in the former the dofe ofcamphor may be afeertained, whereasin the latter the hnefl particles, by theufe of boiling water, evaporate and fly

CASE OF MADNESS. 33off, fo as to render the remedy of doubt-ful utility, or perhaps, in a great mea-fure inefficacious. On the day aftermy vilit, March 28th, I was informedthe patient had palled a tolerable eafynight and had derived the expe&ed re-lief from the purgative medicine.March zgth, he had fome ficknefs at

the ftomach, which was attributed to

the camphor, on which account the julepwas dire£led to be given in lefs quan-tities, and not fo often, March 30th,the report was Hill more favourable,he was more rational, and talked withrecollection and propriety, but wasfubjeft to remitting pains in his head,

March 3.lJt, he became very low, in-deed, and was in every refpe£l in aHate fimilar to that at the commence-

34 A REMARKABLE

ment of his complaint. April ijl, bewas tolerably rational; but complainedof bis head, with deprellion of fpirits,and cried very much, faid ef nobodyt( loved him, and that he (hould not beib happy in a future flate.’’ April 2 dmhaving paffed a very indifferent night,he was attacked with cold fhiveringsand yawning, cried very much, andintreated his mother to come, which{lie did; but his diftrefs and anxietycontinued the fame as before. Thefeton began to difeharge plentifully, inthe afternoon, his head was eaiier, heappeared better, and the depreffionswere of much fhorter duiation thanthey had been. April 3d, he had a to-

lerable good night, and was flill more

rational and quiet than the day before;

CASE OF MADNESS. 35upon the whole, there appeared a pro-bable chance of fuccefs by a continua-tion of the plan firft laid down, April4thy after a tolerable night, early in themorning the depreflion returned, hisfeet being damp and cold, the pcdiln-vium was ufed; he had no occaflonfor opening medicines, having hadfecal evacuations regularly once, andfometimes twice, on the three precedingdays; the urine had continued its pro-per courfe, April sth, the urine was

very high coloured, v/ithout fcdiment,or fever, the belly regular, pulfe fe-venty. The di(charge from the (eton

was little, but from the iffue muchincreafed; in the night he was ratherreftlefs, with flight wanderings of thtmind, but more rational in the day-

S6 A REMARKABLE

time. The regimen continued to bepun&ually obferved, and the patientwas carried out in the open air up-wards of an hour. April 6th, he com-plained of his belly, and was obfervedto rub and pick his nofe, with fomedegree of lownefs, a hidden lofs ofvoice, and palenefs of countenance; hecomplained of naufea at his ftomach,his breath was unufually fetid, in thenight, he was very watchful, and in-coherent in his expreffions, and hadtroublefome dreams,with evident marksof indigeftion. April yth, he was muchthe fame all day, the night was rehlefsand uneafy, the fetor of the breathcontinuing, with pricking fenfationsof the abdomen and a frequent irri-tation to ftool, induced an idea of worms

CASE OF MADNESS. 37'being the caufe; but as the excrementshad never appeared white or flimy, andnone had ever been voided by ftool;that they really did exifl was a matterof doubt; however, from the foregoingevidence, I thought it advifeable to

try the mercurius faccharatus of theEbinburgh Difpenfatory; both as a

good evacuant, and a fafe vermifuge ;

this medicine after being taken twice,occasioned two dejeclions within thefpace of a few hours; but no worms,nor any thing of a verminous nature

appearing in the flools, and the fymp-toms which had given rife to this fup-pofition flill continuing, the more effec«tually to diflodge them, if they didexifl; I preferibed one grain of the

38 A REMARKABLE

gum gut. gamb. with half a grain of calo-mel, and an additional proportion of

faccharum, made into the form of apowder, to be exhibited at proper pe-riods, behdes which, I direded fomegarlic to be cut fmall, and betweenwhiles to be given in milk, but neitherof thefe remedies producing the lead;

appearance of worms, and the patientbeing apparently not fo well in manyrefpeds as before, he difcontinued hisformer regimen and medicines. Aprilli tlu They were had recourfe to

again, the purgative medicine beingdirededtobe intermitted as ufual—wehad now a partial fuppreflion of urine,which was foon removed by mild diu-retics.—It was an obfervation madeby thofe about him, that he was

CASE OF MADNESS, 39always more in his fenfes, and that hishead was always cleared when therewas a plenty of urine,and that this hadbeen the cafe from the commencement

of his diforder; it was therefore a fymp-tom which more particularly requiredan alleviation, and was removed withoutmuch difficulty by fmall dofes of thefpiritus nitri dulcis in parjley-root tea,and to the prevention of which thewarm pediluvium, which was con-

flantly continued, did in great meafurecontribute. April 12th, he appearedmuch better in every refpecl, his mindwas fettled and quiet, and he was takeninto the air, and except fome flatulen-cies in the ftomach, pafled the day in amuch more rational manner than at anytime before; but in the evening was

40 A REMARKABLE

agairl very low, fighed much, and was

incongruous in his fpeech and beha-viour,dbut not turbulently fo, he fleptbut little all that night, and the next

morning appeared drowfy and low-fpirited, which was in great meafureattributed to taking cold in his airing

O O

the day before. April 13th. After ha-ving had a tolerable good night he gotup and dreffed, walked about the roomand was very rational; the feton whichbefore had been very fore and painful,difcharged more and became eafier;having had no flool for two days, thepurgative medicine was given and re-

peated at proper diftances, but not ha-ving its ufual effect in the evening, anemollient clyfter was adminiftered,which produced llools of a fetid and

CASE OF MADNESS. 4*loofe kind, and he had this night a

more general and long continued per-fpiration than at any time before duringhis illnefs; but was at intervals watch-ful and reftlefs. April he wasvery fenhble, and at his own requellagain taken out into the air for fomeconfiderable time, continued tolerablyrational all day; but in the eveningwas again deprelfed and low, wander-ed in his converfation from one fubjeclto another, and complained of pain andweight in his head. The warm pedilu-vium was made ufe of for half an hourbefore, and at bed-time, the camphora-ted julep was given, his fleep was fre-

quently interrupted with terrifyingdreams, he had no 11001, and in themorning awoke very forrowful and

42 A REMARKABLE

low, and continued in that datethrough the greateft part of the day.April 15th, he was much the fame, inthe forenoon he took twice of thecamphorated julep, and in the after-noon once of the laxative medicine,which had no effeft; he had little or

no appetite, appeared much out oftemper, and at times talked wild andinconlillently; in the evening a clyllerwas given, which foon after returnedwithout doing any fervice. The nightwas palled in watchfulnefs, and muchinterrupted by frightful dreams. Aptil16th, he appeared much clearer in hisintelle6ls, but complained of pain inhis head, with a tenlion of the abdomenand difficult refpiration; the oleum ri-cini was therefore prefcnbed inllead of

CASE OF MADNESS. 43the former purgative, the fecond dofeof which procured a flool foon after itwas taken; but he was not able to pafsany water, nor had he made a drop forthe laffc four and twenty hours. TheJpiritus nitri dulcis was therefore againdirected to be taken in a cupful of

parjley-root tea,till he made water

freely—he continued calm all the day,but not very rational, and had rather a

better night than before. April ijth,he was very low, fpoke but little, andat times was rather abfurd in his actionsand behaviour; continued fo all theday, and pahed but a very indifferentnight. April 18th, he had a free paf-fage, and had no occafion for either thedrops or oil. April \yth3 he was verycompofed and confiftent; the feet were

44 A REMARKABLE

continued to be immerfed in the warm

pediluvium, and continued moifl: andwarm ; he perfpired during hisfleep, which was longer and but littleinterrupted; and made water freely; itwas of a reddifh colour, and depofitedalight fediment, April igt/i and 20th,he continued in a comfortable ftate,had good nights, and his appetite re-turned, April 21ft, he was very low,and complained of his head, and havinghad no ftool for three days, a fpoonfulof the oil was given him, which an-fwered the purpofe foon after it wastaken; his head was relieved, he con-tinued cool and rational all the day,and had a very good night. April 22d,At his own particular requeft he was

placed in a little carriage for feveral

CASE OF MADNESS. 45hours, drawn about in the air, and wasindulged in every little amufement thatcould be thought of; but with the pre-caution, that the mental faculty fhouldnot be permitted to dwell too long at a

time on any object whatever; he nowbegan to fpeak and play about in hisufual manner, and with more vivacity,it was obferved, than before his difor-der took place. He wifhed to ride onhorfeback, but for the prefent it was

thought improper, and he patientlyacquiefced in that opinion. As theAngularity of his cafe excited much cu-

riolity, many perfons had a defire tofee him, but none were admitted fo to

do, but thofe he had been previouflyacquainted with—if by chance he faw

46 A REMARKABLE

any Grangers, it was remarked that thefight of them did not hurry and agitatehis mind fo much as it had done in theformer part of his complaint. He con-tinued in a quiet and rational hate un-

der the fame regulation of diet andmedicine as before enjoined, until May10, when after an indifferent night,very early in the morning he was re-attacked withhis former unaccountablelownefs of fpirits and melancholic ideas,his mind became alternately agitatedwith fear and forrow, fufpicion andfolicitude, and continued fo all theday, having had no regular ftools forthe laft two days; fome of the oil was

given, the firft dofe of which had noeffect; the fecond anfwered the pur-pofe, but from this as well as fome

CASE OF MADNESS, 47fleep which he go!: in the firll part ofthe night, he derived but little benefit.The pediluvium and camphorated julepwere continued regularly, and May12th he appeared much more tranquil,but complained of pain in the lowerbowels, which was removed bv a fli-

j

mulating clyfter, after two doles of theoil had been tried in vain. May 13th9

he was affe&ed with a pain in his head,and his eyes being flightly inflamed,and the lids rather fwelled and red,by my direction a furgeon was fent forto bleed him. who at firll objected tothe operation, on account of the low-nefs in his pulfe* but at the requeflof the mother, through refpe6l to

ray advice, his opinion was overruled,and he took away about twelve

48 A REMARKABLE

ounces of blood ; he bled very flow, anddid not appear to mils the blood at all;until his arm was binding up, when heturned pale, his lips became white, andhe was all over in perfpiration, butfoon recovered without fainting. Thepulfe, after bleeding, was obferved tobe more manifeft to the touch, flronger,and rather more accelerated. Uponenquiry, I found the blood had a flighthuffy appearance, and by way of cu-

riofity upon being divided and put intofcales, the crajfamentum weighed fixounces and three quarters, and the ferumfive ounces and a halfi: an experimentmade to pleafe the fancy, and forthe fatisfahlion of the mother of thepatient. The feton had difehargedlittle, but the iiTue very much, which

CASE OF MADNESS, 49had been the cafe all along; after breed-ing he pafTed the night well, and was

tolerably well all the next day. May15th, he was rather low and inconhflentin his difcourfe, having had no (tool theufual quantity of oil was given and re-

peated, but without efFed. May 16th,he was not fo low as yefterday and moreconfident, but having made no water

all the former day and night, the fcar-city of it was relieved as ufual by thedrops and parfley-root tea . May 17th,he was very dull, talked but little, andfeeme d not much to attend to externalobjects. May \ B ih. Having pafTed avery good night, and having had a

natural flool in the morning, he ap-peared much better in every refped,and was very tradable, (till, and ra-

5° A EFMARKABLE

tional all day. May igtJi, he appearedquite comfortable and happy, and de-ftred to ride on horfeback, which bymy direction was agreed to. At thefame time I advifed, that he fhouldreceive every admiffible gratification.From this time, he continued rationalin his converfation, and confident inhis behaviour; but was frequently too

Tiigh-fpirited, and fometimes rathertroublefome to rule, and it was notwithout the interpofition of fome au-

thority, that he was prevailed on to

perfevere in any part of the regimenwhich had been before enjoined; forhaving recovered his liberty, and ex-

perienced the indulgent partiality na-turally refulting from the joy of theparent, whofe tendered; feelings had

CASE OF MADNESS. 5*been fo long exercifed on his account*and as he got better, the diet havingbeen allowed to be more liberal andnutritious, though fmall in quantityand gradually increafed, he began to

conlider every reftraint with more im-patience—although in general he con-formed to order tolerably well. Onaccount of hidden flight inflammationand itching in his right eye, it wasthought advifable to repeat the bleed-ing on the feventh of June, from whichtime every diftrefling and tumultuarymotion fubflded, and he has continuedwithout interruption in the full pleni-tude of his mental faculties, to the com-fort and grateful acknowledgment ofhis worthy and refpe&able family.The feton was dried up foon after the

52 A REMARKABLE

laft bleeding, but the ilfue in the armhas been kept open. It is very lingularthat ever lince his recovery he has beenmuch more chearful and fprightly,and not in the leafb fubjeft to thatlownefs and deje&ion of fpirits whichhad always before been conlidered as

naturally attached to his temper anddifpolition.

APPENDIX,

APPENDIX.

Jt may be thought that one Cafe,however linking, may not be fufficient-ly conclulive to determine the efficacyof any new plan of cure, but there arefeveral more that have come undermy obfervation; amongft thefe the two

following are worthy the confiderationof Medical Practitioners.

46 APPENDIX.

A man about Forty-eight years of age,naturally of a melancholic tempera-ment, without any apparent caufe, on a

fudden, became fullen, referved, andmorofe, fhewed a great propenfity to

fuicide, and his mind gradually funkinto the mod diflrefsful hate of dejec-tion and melancholy ; his memory wasvery defe&ive, the lucid intervals wereof fhort and momentary duration, hisappetite was depraved there was a con-ftipation of the bowels, he was fome-times very deaf, was fubje£l to emula-tions, with involuntary motion of theeyes; his countenance was pallid, andhis face bloated and fwelled, he hadoften the moh ridiculous fears andapprehenfions, and now and then com-plained of a pain as though a nail were

APPENDIX. 47driven into his head, with anuneafinefsin the right hypochondrium, whichupon examination appeared rather hardand fwelled ; he had taken feveral vo-

mits, and had ablifler to the head with-out receiving the lead advantage fromeither, he had never been in the leadredrained from duids, but on the con-

trary differed to indulge in the free ufeof thofe, to which he was mod partial;when he was placed under my care,the pulTe was in general about eighty,rather weak and fmall, but becameevidently dronger and greater, afterthe effulion of fix ounces of blood fromthe arm; evacuating cathartics were

preferibed occafionally, a feton was

opened between the fhoulders in thediredion of the fpine; and Ten grains of

48 APPENDIX.

camphor were adminiffered in a bolus,four times in a day. Abjlinence fromfluids was obferved with the greateftcare and circumfpedlion, their quantitiesbeing gradually abridged, and almofftotally left off for nearly five monthsfucceflively according to Dr, Rowleys

fyftem, at the end of which period thereremained not the leaff incongruity ofidea, his perception was clear, and hisjudgment as found as at any formerperiod of his life, he voluntarily conti-nued with me fome months after thecure, and has ever fince retained thefull enjoyment of his health and reafon.

A young lady about the age of

twxnty feven, naturally of a habit ob-noxious to inflammatory diforders,whofe

APPENDIX. 49mother had unfortunately been fubjedlto chronic madnefs, was fuddenly feizedwith a rigor iucceededby an acute in-flammatory fever, a quick full and tenfepulfe,great heat,thirft,and acute pains inthe head, back and loins, and flight deli-rium, with dimnefs of fight, to moderatethe febrile fymptoms venefeclion, cool-ing diaphoretics and diluting drinkswere prefcribed. On the ninth dayfrom the attack, loofe flools and turbidurine,confirmed thecrifis of the diforder,and the more violent fymptoms confe-quently fubfiding, the cortex took placeas a tonic, and flie v/as thought to be ina promifing flate of convalefcence, butan anxiety and folicitude of mind veryunufual to her before her illncfs, fuper-yening ferved as a confirmation to her

APPENDIX.

friends of her being in the full poffeflionof the morbid patrimony of her mother,her appetite was depraved, her pulfequick and hard, and her breath was

uncommonly hot and offenfive, fhetalked wild, and with aimed inceffantvociferation, got but little deep, withlefs perfpiration, expreifed falfe fears,and often defcnbed images which didnot exift, fhe often fhuddered withcold, and was afterwards hot and thirf-ty, after a continuation in this phreneticdate for feveral davs, (he was committ-

j 3

ed to my care. I found fhe had beendiffered to drink copioufly of dilutingliquorSjthe ferous veffe 1s were tinged withred blood, the eye lids puffed and tumid,

-the tunica albuginea was red and inflam,

ed, andthe pupils much diflcnded, there

APPENDIX*

was an uncommon floridity of the face,a great difcoloration of the tongue, anddifficulty of refpiration; at intervalsfhe became filent, referved, and melan-choly, at other times fo obflreperousand violent, as to render coercionabfolutely rfeceiTary, the pulfe washard and cordlike, and about an hundredand twenty flrokes in a minute, venc-

Jectio ad deliquum was advi fed, the bloodappeared to be in a very inflamed anddifordered date, neutral falts wereadminiflered occafionally, the warmpcdiluvium was directed every nightbefore fhe went to bed, camphor andnitre were given at dated intervals,and almoft a total abjlinence from fluids,was enjoined for neaerly two months,in which time venefe6liou was thrice

52 APPENDIX.

repeated ; when the mentalperturbationwhich was evidently dependent on

the fever, and a type thereof, togetherwith the primary caufe terminated fa-vourably,(he (laid with me fome monthsafter the cure, bad no relapfe, and hasremained perfedly clear in her intel-leds ever (ince.

THE END.

ERRATA,

Page 6, line 7, for Abfortion, read Abforptio*7, 10, indegijiible, indigejlible18, 10, Dilirium, ~ Delirium19, - 14, Langour, Languor21, —« 10, was <—< were

- 11, dele and2;, 12, eruSiationry, erudlat ionr29, 11,- was more, and•io, 16, after, &c. and

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