kEDICIiNE. 
sence of the pyrexy and head-ache, and from 
delirium by the state of the pulse, by the 
patient not knowing the place where he is, 
nor the persons of his friends or attendants, 
and from not being conscious of external 
objects, except when roused, and even then 
he'soon relapses into a state of inattention ; 
whereas in mania, he is frequently sensible, 
and is continually planning the means of 
preventing or revenging supposed injuries, 
and frequently the resentment is directed 
against his dearest friends. 
Treatment. According to Dr. Darwin, 
the circumstances which render confine- 
ment necessary are, the lunatic being liable 
to injure others, or himself, or not being 
able to take care of his own affairs ; and if 
none of these circumstances exist, there 
should be no confinement : for he remarks, 
though the mistaken idea continues to exist, 
yet if no actions be produced in conse- 
quence, the patient cannot be called in- 
sane, but only delirious : and he adds, that 
if every one who possesses mistaken ideas, 
or who puts false estimates on things, were 
liable to confinement, he does not know 
who of his readers might not tremble at the 
sight of a madhouse. It will, however, in 
the first instance, always be proper to gain 
a complete ascendency over the patient, 
either by gentle or coersive measures ; his 
anger and violent passions must be restrain- 
ed by the straight waistcoat ; he should be 
kept in silence and darkness, and as much 
as possible in an erect posture ; none of his 
intimate acquaintance or friends should be 
allowed to visit him. At the commence- 
ment of this disease, blood letting may be 
employed with advantage; the blood should 
be taken from a large orifice, in such quan- 
tity as to induce some tendency to deli- 
qniiim animi: when the temporal artery, 
or jugular vein, can be conveniently open- 
ed, it should be preferred. If the disease 
have been of considerable duration, bleed- 
ing will not be advisable; a solution of 
the gum ammoniacum with Glauber’s salts 
should be given daily, so as to keep the 
bowels pretty laxative; the head should be 
shaved, and cloths, moistened with the 
coldest water, pounded ice, or water artifi- 
cially rendered so, should be gently wrung, 
and applied constantly to the head ; they 
should be renewed as soon as they acquire 
any heat, until a sense of cold and ctiilliness 
be induced, when they are to be left off, 
and had recourse to again when necessary, 
or the affusion of cold water upon the head 
may be substituted; it should be poured 
VOE. IV, 
from a considerable height: it is recom- 
mended to put the patient into the warm 
bath up to his shoulders, and then to pour 
cold water upon the head, previously shaved ; 
vomits, consisting of from five to ten grains 
of tartar emetic, are recommended to be 
given every three or four days, for two 
or three weeks ; opium and camphor have 
been employed in large doses, and fre- 
quently witli advantage; the digitalis has 
been found particularly serviceable, jt should 
be exhibited in gradually repeated doses, 
and continued until a degree of sickness 
is induced, or till the frequency of the pulse 
suffers a considerable diminution, it must 
then be left off, and again renewed when 
its effects on the constitution begin to wear 
off; the gratiola has been recommended in 
doses of ten grains, two or three times a 
day; hard labour, and long-continued jour- 
neys have, in some instances, effected a 
cure ; it is proper to remark, that the pulse 
in mama, is sometimes full and strong; when 
this occurs, evacuations and diluents will be 
necessary ; at other times, the pulse is quick 
and weak, in this case a more nourishing 
diet, bark, chalybeates, and small doses of 
opium, w'ill be proper ; in general, the pa- 
tient should be allowed only a low and 
spare diet; blistering has not been found of 
service, except at the commencement of 
the disease ; the affusion of warm water on 
the surface of the body, that is, water of 
the temperature of the blood and upwards, 
IS often employed with soothing effects. 
The cold bath is strongly recommended in 
the height of the paroxysm, except the 
digestion is much impaired, or the vigour of 
the circulation is much debilitated; the 
patient should be thrown in headlong, and 
as he comes out he should be thrown in 
again, until he becomes calm and rational 
or very much debilitated. Though in mania 
the temperature of the body is little, or not 
at all, increased, maniacs retain the actual 
heat with great tenacity; and under the 
above restrictions the cold bath may often 
be applied with advantage, and always witli 
safety. After the disease is removed, it 
will be proper to administer bark, chaly- 
beates, the oxide, or sulphate of zinc, and 
the sulphuric acid. 
CLASS III. CACHEXIiE. 
DEPRAVED HABITS. 
A depraved habit of the whole or greatest 
part ot tlie body, without primary pyrexy 
or neurosis. The following are the orderi 
of this class ; 
(l! e 
