Memoirs of Erasmus Darwin, M.D. 307 



the organs of sense as well as evacuate the stomach, may 

 contribute to answer both indications of cure. 



Where maniacs are outrageous, there can be no doubt 

 but coercion is necessary ; which may be done by means of a 

 strait waistcoat ; which disarms tnem without hurting them ; 

 and by tying a handkerchief round their ankles to prevent 

 their escape. In others there can be no doubt, but that 

 confinement retards rather than promotes their cure ; which 

 is forwarded by change of ideas in consequence of change of 

 place and of objects, as by travelling or sailing. 



The circumstances which render confinement necessary, 

 are: first, if the lunatic is liable to injure others, which must 

 be judged of by the outrage he has already committed. 2dly, 

 If he is likely to injure himself ; this also must be judged 

 of by the despondency of his mind, if such exists. 3dly, If 

 he cannot take care of his affair?. Where none of these 

 circumstances exist, there should be no confinement. For 

 though the mistaken idea continues to exist, yet if no ac- 

 tions are produced in consequence of it, the patient cannot 

 he called insane, he can only be termed delirious. If every 

 one, who possesses mistaken ideas, or who puts false esti- 

 mates on things, was liable to confinement, I know not 

 who of my readers might not tremble at the sight of a mad- 

 house ! 



The most convenient distribution of insanities will be into 

 general, as mania mutabilis, studium inane, and vigilia ; 

 and into partial insanities. These last again may be subdi- 

 vided into desires and aversions, many of which are suc- 

 ceeded by pleasurable or painful ideas, by fury or dejection, 

 according to the degree or violence of their exertions. Hence 

 the analogy between the insanities of the mind, and the 

 convulsions of the muscles described in the preceding genus, 

 is curiously exact. The convulsions without stupor, are 

 either just sufficient to obliterate the pain which occasions 

 them ; or are succeeded by greater pain, as in the convulsio 

 dolorifica. So the exertions in the mania mutabilis are either 

 just sufficient to allay the pain which occasions them, and 

 the patient dwells comparatively in a quiet state ; or those 

 exertions excite painful ideas, which are succeeded by fu- 

 ll 2 xious 



