VESANIJE. 525 



There is one case in which they are superfluous ; that is, when 

 the maniacal rage is either not susceptible of fear, or incapable 

 of remembering the objects of it ; for in such instances, stripes 

 and blows would be wanton barbarity. In many cases of a mo- 

 derate disease, it is of advantage that the persons who are the 

 authors of restraints and punishment, should be upon other oc- 

 casions the bestowers of every indulgence and gratification that 

 is admissible ; never, however, neglecting to employ their awe 

 when their indulgence shall have led to any abuse. 



MDLXV. Although in mania no particular irritation nor 

 fulness of the system seems to be present, it is plain that the 

 avoiding all irritation and means of fulness is proper ; and, 

 therefore, that a diet neither stimulating nor nourishing is com- 

 monly to be employed. As it may even be useful to diminish 

 the fulness of the system, so both a low and a spare diet is likely 

 in most cases to be of service. 



MDLXVI. Upon the same principle, although no unusual 

 fulness of the body be present, it may be of advantage to dimin- 

 ish even its ordinary fulness by different evacuations. 



Blood-letting, in particular, might be supposed useful ; and 

 in all recent cases of mania it has been commonly practised, and 

 I think with advantage ; but when the disease has subsisted for 

 some time, I have seldom found blood-letting of service. In 

 those instances in which there is any frequency or fulness of 

 pulse, or any marks of an increased impetus of the blood in the 

 vessels of the head, blood-letting is a proper and even a neces- 

 sary remedy. Some practitioners, in such cases, have preferred 

 a particular manner of blood-letting, recommending arteriotomy, 

 scarifying the hind-head, or opening the jugular vein; and 

 where any fulness or inflammatory disposition in the vessels of 

 the brain is to be suspected, the opening of the vessels nearest 

 to them is likely to be of the greatest service. The opening, 

 however, of either the temporal artery or the jugular vein in 

 maniacal persons is very often inconvenient ; and it may gene- 

 rally be sufficient to open a vein in the arm, while the body is 

 kept in somewhat of an erect posture, and such a quantity 

 of blood drawn as nearly brings on a deliquium animi, which 

 is always a pretty certain mark of some diminution of the ful- 

 ness and tension of the vessels of the brain. 



