superseded by the famous Armenian stone, which was much less dangerous; and according to Nonus, a Greek physician in the tenth century, the latter was still preferred. However, hellebore was never wholly exploded.

But brisk purging began to be dreaded. The Arabian physicians especially, feared the too great activity of this plant; for Avenzoar recommends the flowers of nymphæa to be mixed with it, in the same way as mastic is prescribed with aloes and scammony, and sweet almonds with coloquintida, viz. to correct their effects. Its reputation afterwards revived. Many fatal accidents, however, occurred from its use, notwithstanding the different expedients to guard against its virulence. Cophon, an Italian physician of the 12th century, had a very refined mode of preparing it: a chicken was to be fed with white hellebore, and after eight days was to be killed and made into broth, and this was to be taken as a gentle purge.

Morgagni lost a patient in melancholia who took half a drachm of the extract of black hellebore, and he ascribes his death to not having taken whey after it, as he always prescribed. It produced great purging and vomiting; and the stomach and intestines in this case were found inflamed, and the brain particularly soft and lax.*

Both species, the black and the white, were commonly administered. Black to cause dejections in melancholia ; and white vomiting, when the patient was too high and merry in mania. In these diverse intentions of the two species, we recognise the principles both of purging and vomiting in the treatment of insanity. In the paucity of medicinal remedies during the infancy of the curative art, a plant endowed with these double properties was invaluable the one species caused the evacuation of those morbid biliary secretions which generally mark

* Epist. xlix. art. 15.

melancholia; and the other occasioned either vomiting, or that nausea which subdues or regulates the fury of mania. It has been thought probable, from the different accounts given, that the genuine black hellebore of the ancients was lost, because that which is now found is a very innocent medicine. Ages ago, from the disappointment experienced in its effect, it was supposed that the hellebore of Anticyra, so vaunted by the ancients in the use of insanity, was a different plant. But from Morgagni's case, and others' experience, every idea of its innocuous powers must be abandoned. Besides, if the experiments and observations of Schabel, of Weissembourgh, on the properties of hellebore, be correct, it is clear that both species are virulent poisons, equally injurious to animal and vegetable life. Their influence, he conceives, is exercised on the human system through the medium of the circulation; their action being most marked when applied to organs well furnished with blood-vessels, and especially the mucous membranes. Nevertheless, this once universal remedy is still held in high estimation in many parts of the continent, particularly in Germany.

I have tried the powers of both the black and white species, in the form of extract. The operation has always been very uncertain, and I never found in their effects, either on the mental disorder or in the nature of the excretions, any thing particular, or differing from the action of other purgatives or emetics. I have, therefore, long since discarded hellebore.

Keeping the bowels in free action is indispensable in all cases of insanity, but absolute purging in the incipient and active stages is especially necessary. The secretions at these periods of the disease are almost always bad; more morbid perhaps in melancholia than in mania.

Ferriar, Med. Reflect. vol. ii. p. 104.

Montanus inveighs against half purges, which tire nature and molest the body to no purpose.* Thomas Willis seems to have been of the same opinion. His purging formula in melancholia was: calomel and extract of black hellebore, each a scruple, and extract of jalap, six grains. Either the human constitution was more vigorous, or these ingredients were not so potent as at present, for such a dose in these days would be dangerous.

I observe no stated days or periods for purging, but am governed by the circumstances of the case. And when the evacuations have become natural, I endeavour to keep them so by exercise, diet, and such means as are best calculated to preserve the functions of the body in health.

Drastic purgatives may be indicated in the first instance, not only to overcome the torpidity of the bowels common in incipient attacks, but also because there are often large quantities of morbid bile or scybala collected in the colon and large intestines, the evacuating of which will sometimes at once greatly diminish the cerebral irritation and delirium. And for this purpose very small doses (the sixth or fourth of a grain) of elaterium have proved very beneficial. Calomel, in conjunction with other cathartics, is very useful.

When the evacuations prove of this description, strong purges must be interposed; but the bowels in the interim should be kept regular by milder cathartics. If vomiting and purging are desired at the same time, I give a solution of Epsom salts, with one grain of emetic tartar to each ounce of the solution, and of this a table-spoonful or two every half hour, till both or one of the effects be produced. If great activity of the bowels be required, two grains of emetic tartar should be added to six ounces of the common

* Consil. 30.

senna mixture, and three or four table-spoonsful of it be repeated every two, three, or four hours, till it freely operates.

An impression prevails, that the bowels of all lunatics are difficult to move. This is a dangerous error that should be exploded, for they are often free to act, and sometimes are very irritable. Caution, therefore, at first ought to be observed. My practice has been to begin with moderate doses, and continue purging at intervals so long as the excretions bear an unhealthy appearance, and to remit it as they improve, always having regard to the constitution of the patient.

As men of studious and sedentary habits are often affected with melancholia and hypochondriasis, it should be remembered that they, especially, can never bear violent purging. Their intense application and abstraction generally brings on a cachectic habit. Hence, remedies which either strongly excite the nerves or produce large evacuations, induce in them debility- the one directly, the other indirectly.

Means of obviating Constipation.

Where the system is much exhausted, either by longcontinued violence, or for want of a proper quantum of nutrition, or disability of assimilation, all which conditions are frequently met with, drastic purges are out of the question. Glysters are then the only resource.

Very old and paralytic lunatics sometimes lose the power of evacuating the contents of the bowels, and an immense load accumulates in a hardened mass, forming, what is vulgarly called, a ball stool. This state is generally discovered by efforts to go to stool, and passing only a thin fæcal discharge, though with a great sense of forcing down of the rectum, and there is often an impediment to the passage of the urine from pressure of the ball on the

neck of the bladder. As soon as this case is suspected, an examination per anum should take place; and if it prove so, the means advised (see pp. 228-229) should be used.

Obstinate cases of constipation are most frequently seen in public lunatic asylums, among the lower orders, whose bowels, from habitual neglect, have become thus inactive. Such cases are much more rare in private practice.

I fear that the general impression of the difficulty in getting the bowels of insane people to act, must be imputed to that neglect of them which is consequent on a lunatic's indifference to the performing of all natural functions. This fact ought not to be forgotten. The bowels of some lunatics are disposed to act too much, and are not easy to restrain. We should therefore be careful, when the patient is a stranger and his history obscure, lest we rashly prescribe cathartics too drastic and powerful.

The determined resistance often met with to the taking of any medicines, or of submitting to any means of relieving the bowels, renders these cases very difficult to manage. It is of importance, then, to have recourse to such purgatives as from their bulk and insipidity can be best disguised. A dose of calomel mixed with a grain or two of tartar emetic to give it activity, is a convenient form. I have often succeeded, by putting this between two pieces of buttered bread, in getting it down. The croton oil may also be sometimes administered, rubbed down with a little sugar and mixed in a little beer. The elaterium, in point of bulk and certainty of effect, is an excellent medicine; but, unfortunately, it is so nauseous that it cannot be disguised except in a pill, and that is a form, if refused, very difficult to make them swallow. There is this objection, too, both to the croton oil and the elaterium, that intense nausea and vomiting sometimes follow. In one case, the former created so much