stimulating cataplasmata on the soles of the feet, or to the legs, till the impatience of pain is expressed, is more efficacious.

But it is still preferable to excite vesication, where it is indicated in mania, by the application of a plaster composed of tartarised antimony and the common wax plaster. It soon occasions considerable heat, and a crop of pustules, from which a discharge may be kept up or checked at will. This application might judiciously supersede cantharides in mania; since it produces all their good, and none of their bad effects.

8. Setons and Issues.

Setons and issues inserted on the occiput, nape of the neck, &c. have been prescribed as derivants, to diminish cerebral irritation. I have rarely met with a case where I was quite satisfied that convalescence was the result of either of these applications. Recovery doubtless sometimes follows the introduction of them; but I have had reason for suspecting that other remedies have had an equal or greater share in the event. In two or three cases, however, in which the malady had continued some months, and there was still evident cerebral commotion, with throbbing in the head, I have certainly found these symptoms gradually decline after a discharge in this way had been established.

I think it probable, that where they have been reported to have effected a cure, the malady has originated in metastasis, by the retrocession of some cutaneous eruption or transfer of a morbid action of a remote part to the brain, or from the suppression of some long-continued or periodical discharge from the hæmorrhoidal vessels, gleet, or leucorrhoea. Drains of these kinds in such cases are decidedly useful.

Whenever any of these causes may be suspected of

having influenced the mental disorder, a seton or issue should be introduced as near the head as is convenient.

Long-established setons and issues hastily dried up, have caused many cerebral affections, and insanity among them.

9. Artificial Eruptions.

Derivation may also be accomplished by producing a crop of pustules.

The effect of the retrocession of cutaneous eruptions in causing cerebral diseases, and the cessation of those diseases on their re-appearance, is well known.

When any eruption suddenly recedes, most frequently the transfer of the morbid action is to the brain, and then inflammatory or maniacal delirium supervenes. Analogy in this case would point out the propriety of bringing back the original eruption to the skin, or producing one that was imitative of it. Again, the doctrine of counterirritation, which often prompts the application of blisters, setons, issues, the moxa, &c. might well suggest the adoption of any remedy which would produce on the skin a crop of pustules in any way resembling spontaneous eruptions or natural exanthemata.

Of all the means with which we are acquainted for this purpose, tartarised antimony is the best; for by rubbing it into the skin, a local irritation succeeds, and pustules are raised which contain, and discharge most copiously, well-formed pus.

Friction of an unguent with this preparation on the shaven scalp, or neck, or between the shoulders, or on the inside of the fore-arms, till distinct pustules are produced, has been highly recommended to cure insanity. When gastric affections have preceded the mental derangement, a crop of pustules raised by this means on the epigastric region has, it is said, removed the mental affection.

Papulæ of some magnitude are consequent on this

operation, containing at first a serous fluid, which soon becomes maturated, with considerable inflammation and itching. The success of this treatment in the cure of insanity had been variously reported before the celebrated Dr. Jenner so forcibly recommended it.* Of eighteen cases in which he used the tartarised antimonial ointment, five were of insanity, and three of hypochondriasis nearly approaching to it. According to his report, the effects were almost miraculous, since two or three recovered their intellects in a few days; and he mentions no case where it was tried that it did not succeed in curing these disorders.+

Where a prompt effect is required, he advises the quantity of the tartarised antimony to be increased. It is to be rubbed into the inside of the arms night and morning, and to be continued for several weeks.

Encouraged by this brilliant success of a remedy, although I had frequently tried it before unsuccessfully, and perhaps in a more active form, (for I combined about five grains of carbonate of ammonia with the ointment, omitting the two last ingredients,) yet I resumed the use of it, thinking I might have failed from not observing all the regulations he prescribes for the infriction. I now therefore strictly conformed to them.

As Dr. Jenner conceived that this application not only vesicates, but produces diseased action on the skin itself, by deeply deranging its structure beneath the surface, and that its effect was probably owing to this deep-seated derangement, I continued the frictions till this effect was

*Letter to C. H. Parry, M.D., on the Influence of Artificial Eruptions, &c. By Edward Jenner, Esq. M.D. &c. &c. 1822.

This is Dr. Jenner's formula : —

R Antimon. Tartar. (subtil. pulv.) 3ij.

Ung. Cetacei, 3ix.

Sacchari albi, 3j.

Hydr. Sulph. Rub. gr. v.

M. fiat unguentum.

produced on the cutis. Still, I did not meet with the success which his account taught me to expect.

Where insanity has been connected with much gastric pain or irritation, and when retrocessent eruptions have been the cause, I have seen the symptoms ameliorated by this application, but I never saw the mental disorder recede so rapidly as he has described.

I have frequently had the ointment rubbed on the shaven scalp, where I wished to stimulate and have been afraid of cantharides. In one case, where the tartarised antimony was applied in a different way, I was disposed to think it was at least an auxiliary in the cure of the case a gentleman who, though young, had lived intemperately and been troubled with dyspepsia, was attacked by furious mania. It subsided in violence in a few days. He had been very largely depleted by bloodletting, &c. before I saw him. I found him in a very weakened state, inclining to fatuity. His pulse was very small and his appetite bad. Plenty of nourishment was allowed, and tonics, and a little wine. In a few days there was an appearance of mortification of his extremities. Cinchona, opium, and wine, were administered. A warm plaster, with tartarised antimony intermixed, was applied over the shaven scalp. He complained in a day or two of great itching of the head; but the plaster was not removed. He got well very soon, and without the extremities sloughing. But whether the general treatment or the plaster to the head had the merit of the cure, I will not determine.

When counter-irritation is desired, I frequently have recourse to this remedy; for it has none of the objections to be urged against vesication by cantharides, in cases of insanity, and yields all the good to be derived from them.

I own, however, that there are few cases in which I should venture to rub in this active preparation for weeks

together, as recommended by Dr. Jenner, for it sometimes. occasions very deep sloughs, which are not lightly to be treated in some cases of insanity.

10. Bathing.

The good effect of the bath in the treatment of insanity has been fully appreciated in all ages. But the mode of applying this sovereign agent, and the degree of temperature of the bath, have equally been matter of discussion; some recommending it to be hot, others tepid or cold. Celsus advised beginning with hot, then tepid, and lastly to pour cold water over the head and whole body for some time, and then to dry it and anoint. And he expressly says, that it is very beneficial for one who has a weak head to hold it where a strong stream of water may fall upon it. Hence we trace the douche to be of great antiquity.

Cælius Aurelianus ordered warm fomentations, applied with sponges to the eyelids, because he supposed it relaxed their hardness, and was of service to the brain by penetrating to the membranes through the eyes. Injecting warm infusions through the ears he recommended with the same view. Although we may not be quite satisfied, from this specimen, with the physiological or anatomical knowledge of Cælius, yet we must recollect that he treats very ably of the cure of insanity, and that he doubtless had experienced good effects from the topical application of warm fomentations.

Immersion in a bath at 90° Fahr. is considered generally as the most useful. The time to continue in it must be regulated by the constitution. Commonly, half an hour is the extent, keeping up carefully the temperature of the bath. But when the patient is spare, highly nervous, and irritable, he may be kept so immersed for many hours. If there be any disposition to determination

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