of blood, refrigerating the head while in the bath is not only a safe but beneficial practice.

According to Poggius the Florentine, in his time the insane were placed in baths to the knees, waist, or higher, as the state of the disease required. Pomme treated maniacal patients by employing the warm bath for eight hours every day, and applying cloths constantly wet with cold water to the head during the whole time. He even kept them in the bath for twenty-four hours.*

Pinel more generally introduced Pomme's plan; but he ordered that the cold water should descend on the head in a column (douche), varying in height according to the effect he wished to produce; sometimes limiting it to a mere sprinkling (douche en arrosoir) on the cranium. The intention was, to derive the circulation towards the surface, and diminish, by refrigeration, the energy of the brain.+

This practice (the douche) was carried to too great an excess in the French hospitals, for it was used almost indiscriminately. Much more circumspection is now adopted with this powerful remedy.

The effects which Esquirol describes the douche to occasion on those on whom it is tried only for a few minutes, and the precautions he previously advises, sufficiently testify that it is a hazardous remedy, and liable to be abused. I can easily conceive, however, that in judicious hands it may also, like the circulating and rotatory machines, prove very efficacious. As of gyration, so of the douche, much is said in favour of it as a means of repression, of calming violence, breaking dangerous associations of ideas, and conquering obedience.‡

The cold bath has had, perhaps, more advocates than the warm in the treatment of insanity. Two modes were

* Orteschi, Giornal Med. tom. ii.

+ Traité, p. 329.

Dict. des Scien. Méd. tom. xvi. p. 233.

principally followed: first, simple immersion, by plunging voluntarily and openly; and, second, by surprise.

Whenever a tonic plan becomes requisite, there can be no doubt that cold bathing in the ordinary way, by plunging, is efficacious. The mode adopted at the Senavra Hospital at Milan, of placing timid patients first in the bath, and then letting in the water by degrees through holes in the bottom of it, changes entirely the effect to be desired. Collapse, instead of the re-action which should follow, and which is the essence of this remedy, must be the consequence.

Van Helmont regarded the bath of surprise as the best means of curing insanity; and Baglivi, Boerhaave, &c. adopted this opinion. The latter, however, seems to have had a further view in it; for he recommends the patient to be kept completely submersed, and not taken out of the water till animation had almost ceased. His motive, therefore, was clearly to try the effect of asphyxia, or suspension of vital as well as of all intellectual operations, so far as safety would permit. In the case I have related (p. 452), where the submersion was complete, and animation entirely suspended, the delirium which had preceded continued on the restoration of the vital functions, and ceased only upon the abstraction of some blood from the head by scarifying, and the use of means to procure composure and sleep.

What may be the specific effects of the bath of surprise, I have no personal experience. It is reported in some instances, which I can credit, to have produced instant recovery of the senses. Sudden immersion, it is well known, will make a drunken person sober; and in certain deliria, such as delirium tremens and others resembling inebriation, it may restore the mind. But mania and drunkenness are so nearly allied to apoplexy, that this experiment in either state must be attended with considerable danger.

Most probably, this mode of bathing acts as terror does on the sensorium. It might cause as well as cure insanity; for the blood is driven back from the capillary vessels with such sudden and intense force on the heart and large vessels, as sometimes to suspend their action altogether; or the re-action may be so great as to occasion death.

A just apprehension of this violent remedy appears now to predominate, and therefore it is little used in those lunatic establishments where heretofore it was often resorted to. In some foreign hospitals it has been interdicted by the government.

The effect of general bathing, whether warm or cold, is imitative of the process of fever, which, as I have shewn, will suspend the maniacal action, sometimes as long only as that lasts, and sometimes accomplish the perfect restoration of the intellectual faculties. Fever gives an impetus to the circulation, and distributes the blood through the encephalon with an activity that imparts new energies to the brain.

Warm bathing immediately produces accelerated circulation; cold bathing mediately, by re-action. Hence, both are perturbators, and eventually may equalise the circulation, which, perhaps, in every case of insanity is, in one way or the other, disturbed. Consequently, provided the necessary precaution of evacuation be adopted in the plethoric, or those with a manifest determination of blood to the head, either warm or cold bathing may prove equally beneficial. In using the warm bath, the conjoint application of cold to the head may prevent the ill effects of determination, even when evacuation had not been premised; but the safer practice in such cases is, to prepare for its use by local bleeding and proper alvine dejections.

Ferriar advises the warm bath for mania, and the cold for melancholia. Half an hour immersed in the former, he says, will make a man who required six to put him

into the bath, so passive, that one may take him out.* Generally, however, the reverse of this obtains; and I confess I have found more good in melancholia from the warm than the cold bath; though in certain constitutions the cold is useful. It will very soon be discovered whether the warm produces quiet in the furious, and reaction and vigour in the melancholic; and if these expectations are disappointed, the temperature for each should be reversed.

The circulation in melancholia is often torpid; and hence, probably, the functions of the prima viæ, liver, and skin, with which organs the latter so especially sympathise, are generally disturbed. Keeping up an artificial heat propels the circulation, relaxes the skin, promotes perspiration and all the natural functions, and induces refreshing sleep.

Cold bathing attains the same object when it produces re-action or a universal glow on the surface. If it have this salutary effect, it acts as a tonic; and is peculiarly adapted to that physical and mental state of debility which succeeds the active stage of insanity, and is then an inestimable remedy.

For delicate and timid persons, and for those to whom a plunging bath is inaccessible, the shower-bath, which may be either tepid or cold, is an admirable and convenient application. Those who can obtain neither, will find simple affusion of water over the head and body a good expedient. The same precautions apply to bathing in cases of insanity as in all other diseases.

Bathing in sea-water, which by many has been thought almost a specific in insanity, has no superior advantages by itself.

11. Purging.

Purging and vomiting, like bleeding, have formed, even in modern days, a part of that absurd system of

* Med. Reflect. vol. i.

routine treatment of insanity which cannot be too much reprobated, but which has been happily superseded by more enlightened views of the treatment of this malady. Each remedy, too, has had its advocates, vaunting its effects as infallible. Experience and more accurate observation prove all these accounts to be fallacies. Both, however, in cases of insanity, have their respective merits.

In tracing the exhibition of purgatives in maniacal affections, we arrive at the first rudiments of the healing art. The prescribing of hellebore for the cure of insanity, is the first instance of purging in the treatment of a human disease. It forms, therefore, a remarkable era in the history of medicine. It is not the least of the wonders attaching to this wonder-working herb, that for upwards of two thousand years, faith in its virtues was maintained.

Possibly, the celebrity hellebore enjoyed was derived from its being the only substance known, when it was discovered, as possessing purgative qualities; hence it was regarded as a specific. At the same time it should be remarked, that no remedy was so suitable to the existing pathology of diseases, which were then all explained agreeably to the humoral theory. We consequently find that Hippocrates, though with many cautions as to its use, and all his disciples who believe in the sportive influence of black and yellow bile, pituita, and sundry peccant humours, in originating melancholia, mania, and the varieties of insanity, prescribed it. So universal was its repute, that to ask-do you want hellebore? was synonymous with saying-you are mad!

Even hellebore, however, has experienced the instability of popular reputation; for, in the middle ages, Trallianus* tells us that it had grown into disuse, and was

* De Melancholia.