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arm or the jugulars; and fometimes alfo by cupping with scarifications in the occiput; particularly in cafe of a headach, or of fuch a degree of weakness as forbids the farther ufe of the lancet.

Vomiting is beft excited with ipecacuanha wine in the more weakly; but in the more robust with the tincture of white hellebore, or antimonial wine.

The propereft cathartics are black hellebore, or infufion of fena with tincture of jalap, or aloes; in fine, if the fuppreffion of the monthly evacuations in women, or of the hæmorrhoids in men, requires difcharges in blood by thefe natural ways. And thefe evacuations, both by vomit and ftool, are to be often repeated, in alternate order. Nor does it seem improper to add, that this difeafe demands powerful medicines; because in it the nerves are not easily stimulated.

But evacuation by the urinary organs is of greater moment than is commonly thought, especially when madness is accompanied with a fever. For it is of little benefit to melancholics, who for the most part make too much urine. And the most appofite diuretics in this cafe are the lixivial falts of vegetables, and the diuretic falt fo called any of which, or both forts, may be given by turns, in pretty large dofes.

Blistering plafters applied to the head will poffibly be thought to deferve a place among the remedies of this disease; but I have often found them to do more harm than good by their over-great irritation. It will be better, in imitation of the ancients, to fhave the head; and then to rub it often with vinegar, in which rofe-flowers or ground-ivy leaves have been infufed and alfo to make a drain, by paffing a feton

:

in the nape of the neck; which is to be rubbed with a proper digestive ointment, and moved a little every day, in order to give free iffue to the purulent matHowever, when the disease is of long standing,

ter.

blifters are fometimes ferviceable.

While the noxious humours are expelled by these means, the disease is likewise to be attacked by thofe medicines which effect a change in the body. The diet ought to be flender, chiefly gruel made of oatmeal or barley, and meats of eafy digeftion. For the body must be nourished, that the patient may have ftrength enough to bear the neceffary evacuations.

Authors, both ancient and modern, recommend a great number of medicines; fome of which are fuitable to maniacal, others to melancholic patients: but both forts agree in the property of correcting the bile; which is acrid at firft, then becomes vifcid, and black as pitch. Moreover, the very blood in this diforder is thick, fizy, and black whence, upon diffection, the brain appears dry, and almost friable, and the vessels diftended with black, fluggish blood. Now, it will be of use to obferve, that most of the medicines proper to be given in this disease, are in fome degree endued with the property of opening and fcouring the glands, and increasing perfpiration. Of this kind are the strongfmelling gums, especially afa foetida, myrrh, Ruffian caftor, and camphire: which laft is afferted, by fome authors of experience, to have likewise an anodyne quality, and to procure fleep with greater certainty and fafety even than opium. And in melancholic cafes, chalybeates are also very proper. In fine, a frequent ufe of the cold bath is very serviceable, efpecially in maniacal cafes. For nothing, as Celfus

VOL. III.

H

fays,

fays, is of fuch benefit to the head, as cold water *,

It now remains to lay down fome rules for thê management of mad-folks, than which nothing conduces more to their cure: and different methods are to be employed with the maniacal and melancholic. The unrulinefs of thofe is to be curbed; and the defpondency of these to be diffipated, by giving theti hopes, and raising their fpirits. And yet with regard to thofe who are outrageous, it is not neceffary to employ ftripes or other rough treatment, to bring them into order; binding alone being fufficient for that purpose: because, as 1 have already faid, they âre all cowards; and when they are once fenfible of being thoroughly conquered, they eafily fubmit for the future, and dare not offer violence to themfelves or others.

It is a more difficult matter to manage thofe whofe madness is accompanied with exceffive fadnefs or joy; to whofe different humours the phyfician ought to accommodate himself. Wherefore the ill-timed fits of laughter of fome are to be ftopped by chiding and threatening; and the gloomy thoughts of others are to be diffipated: to which concerts of mufic, and fuch diverfions as they formerly took delight in, are very conducive. And how mufic affects and relieves both the body and the mind, I have formerly publifhed my thoughts +.

But it ought to be a ftanding rule, to inculcate notions directly contrary to thofe with which they were long poffeffed, in order to inure the mind by *Lib. i. cap. 6. + Mechanical account of poifons, effay iii. See alfo what Aretaus fays on this head, 'de curat. acutor. lib. i.

degrees

degrees to a new way of thinking. For as in the cafe of a body broken with fickness or fatigues, reft and intermiffion of labour are proper to be ordered; fo it is requifite, by all practicable means, to draw off the mind from those vain fancies which it has imbibed. And this we shall compafs, if we turn it upon objects which excite different motions in it. Thus in imaginary fears of long duration, it is fometimes. beneficial to affright the patient with real dangers. But these real terrours muft in their own nature be quite unlike their false or imaginary ones, in order to caufe a different agitation in the mind. For the mind cannot be abfolutely at reft, though it may be free from care and anxiety: and a change of ideas may be deemed a recreation and relaxation from ftudies juft as the mufcles of the limbs, when tired with any one fort of labour, are refreshed by putting them on different actions.

Bodily exercife is never to be neglected. Walking, riding, playing at ball, bowls, and other fuch fports; fwimming, and travelling by land and fea, are of great ufe: for by thefe the conftitution of body is ftrengthened, and the mind refumes its rational faculties by the conftant exchange of objects.

To what has been hitherto faid, I fhall fubjoin one animadverfion more: That anodynes to procure fleep are very feldom proper in this disease. But yet in fome cafes, as in great terrours of mind, or when the patient, through folicitude and fadnefs, is much fatigued with constant watching, it may not be amifs to make trial of them; but we are not to perfift long in their ufe: for it often happens, even when they procure fleep, that when the patient a

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wakes, his head is filled with more terrifying ideas than before.

I close this chapter with obferving, that there is no disease, in which the danger of a relapfe is greater : wherefore every thing that has been hitherto propofed for the cure, whether relating to medicines, diet, or manner of living, ought to be repeated for a confiderable time at due intervals, even after the patient has recovered.

M

CHA P. IV.

Of the QUINSY.

Of

Edical authors have carefully treated of feveral forts of quinfies; but there are three forts the most acute and fatal of all, the nature of which they have not explained with fufficient accuracy. thefe the first may be called the watery quinfy, the fecond a gangrene of the tonfils, and the third a ftrangulation of the fauces.

In

In the first fort the glands of the mouth, palate, and neighbouring parts are diftended and fwoln. the fecond, an inflammation without a perfect fuppuration feizes the tonfils; which fwell and grow hard ; a gangrene foon enfues, which, if not very speedily relieved, is fatal. In the third, all the nerves are convulfed, and the patient drops down dead suddenly. Of this third fort I have feen one inftance, in which though a large quantity of blood was drawn twice in fix hours time, yet that evacuation was of no avail. Upon diffection there was not even the leaft appearance of fwelling or inflammation in the

glands

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