524 PRACTICE OF PHYSIC. 



it is ,never desirable to confine them to a horizontal situation ; 

 and whenever it can be admitted, they should be more or less 

 in an erect posture. Although there may be no symptoms of 

 any preternatural fulness or increased impetus of blood in the 

 vessels of the brain, a horizontal posture always increases the 

 fulness and tension of these vessels, and may thereby increase 

 the excitement of the brain. 



MDLXIII. The restraint mentioned requires confinement 

 within doors, and it should be in a place which presents as few 

 objects of sight and hearing as possible ; and, particularly, it 

 should be removed from the objects that the patient was former- 

 ly acquainted with, as these would more readily call up ideas 

 and their various associations. It is for this reason, that the 

 confinement of madmen should hardly ever be in their usual 

 habitation ; or, if they are, that their apartment should be 

 stripped of all its former furniture. It is also for the most part 

 proper, that maniacs should be without the company of any of 

 their former acquaintance ; the appearance of whom commonly 

 excites emotions that increase the disease. Strangers may at 

 first be offensive ; but in a little time they come to be objects 

 either of indifference or of fear, and they should not be frequent- 

 ly changed. 



MDLXIV. Fear being a passion that diminishes excite- 

 ment, may therefore be opposed to the excess of it ; and par- 

 ticularly to the angry and irascible excitement of maniacs. 

 These being more susceptible of fear than might be expected, 

 it appears to me to have been commonly useful. In most cases 

 it has appeared to be necessary to employ a very constant im- 

 pression of fear ; and therefore to inspire them with the awe 

 and dread of some particular persons, especially of those who 

 are to be constantly near them. This awe and dread is, there- 

 fore, by one means or other, to be acquired ; in the first place, 

 by their being the authors of all the restraints that may be oc- 

 casionally proper ; but sometimes it may be necessary to acquire 

 it even by stripes and blows. The former, although having the 

 appearance of more severity, are much safer than strokes or 

 blows about the head. Neither of them, however, should be 

 employed further than seems very necessary, and should be 

 trusted only to those whose discretion can be depended upon. 



