The London practice of physick, or, The whole practical part of Physick contained in the works of Dr. Willis faithfully made English, and printed together for the publick good.

CHAP. XI. Instructions and Prescripts for curing Madness, or the Mania.

AFter Melancholy, it remains for us to treat of Mdness, which is so far ally'd to the other, that these affect often change turns, and each passes into the other; for A melancholy disposition growing worse brings a Fury, adn a Fury coming to abate, often ends in a melancholy disposition.

Since Madness, raised withot a Fever, and with ••••••ighty annoy∣ance of the animal Function, is wont to be continual and long-lasting, its next and immediate subject must be the animal Spirits; which be∣ing affected not per consensum, nor by another thing forcibly moving them, but per se, and habitually, fall from their proper and genuine Dissposition, viz. salino-spirituous, into a salino-sulphureous nature, resem∣bling Aqua Stygia, as we have hinted before: and consequently they exert none but disorderly Actions, and continue so acting amiss for a long time: to this their Fault haply the Brain, the Blood, or other parts contribute something, but the Spirits themselves are first, and chiefly in the fault.

Concerning Maniacal Persons we must observe, that thefe three things are in a manner common to them all, viz. First, that their Fancies or Imaginations are perpetually occupied with the raging of impetuous Thoughts, so that mumbling to themselves, or crying out and yelling, they talk aloud various things both Day and Night. Secondly, that their Motions, or Conceptions are either incongruous, or are repre∣sented under a false or erroneous Species to them. Thirdly, that with their raving a Boldness and Fury are most commonly joyned, contra∣ry to what it is in melancholy Persons, who are always astected with a Fear and Sadness.

The Depravation or maniacal Disposition of the animal Spirits, to∣gether with the Juice irrigating the Brain, is wont to arise after vari∣ous manners, and for divers causes; but for the most part that affect (as we have observed in Melancholy) begins either from the Spirits themselves, or from the Blood.

1. A madness beginning from the Spirits, sometimes arises from a solemn evident cause, as from a violent Passion, sometimes also it pro∣ceeds from a Procatarxis laid in the Brain, as when it happens upon Melancholy or a Frensy; Let us confer a little the Cases, Reasons, and the various wayes of the coming to pass of both.

1. As to the former, when a vehement Passion turns any one from his right mind, that so happens to be done either because the Ani∣mal Spirits are too much cast down, and driven into confusion, or because they are raised above measure, and endeavour to expand themselves beyond their Sphere.

1. The Spirits are wont to be cast down by a violent and terrible Passion; so it many times happens, that some upon areal or imagina∣ry seeing of a Ghost, presently being struch with a pannick terour, fall into a perpetual madness. Moreover, some, by reason of some great disgrace, or reproach, others by reason of the hope of an excessive Love being frustrated on a sudden and unexpectedly, and others by reason of Vows rashly broken, and their Conscience being violated, first being mightily disturbed in Mind, become shortly after mad: the reason whereof is, that the animal spirits being driven out of their ranks and usual Passages, and put in a Confusion, frame new and bye wayes for themselves, which entring, they presently form delirous Phantasms: mean while the sline Partcles of the nervous Juice fall from their volatility, the spirituous being depress'd, and coming to flow, take to them the sulphureous Corpuscles sent from the Blood into the Brain, being then weak and open; whence this Liquour presently becomes most sharp like Aqua fortis, and the animal Spirits exorbitant, and very much troubled.

Secondly, the animal Spirits, sometimes, whilst they are raised too much, almost after the like manner, bring both to themselves, and the nervous Juice, a Disposition to Madness; hence Ambition, Pride and Emulation have made some run and; the reason whereof is, that whilst the coproreal Soul, swelling through the Opinion and Pride of its own excellency, raises and endeavours to expand it self every way as far as may be beyond the limits of the Body, the animal Spirits tu∣multuarily call'd into the Brian, are not able to be contain'd within their wonted Treacts, but being there refracted, and diversly reflected by reason of their too great exertion, are forc'd into new and wholly devious Tracts; wherefore, both themselves being disturbed from the course of their proper Emanation, and the nervous Liquour, soon ac∣quire a sharp and irritating disposition, and consequently a madness ensues.

So far of Madness raised by reason of a solemn evident cause alone: but this disease also arises often by reason of a Procatarxis praeexisting in the Brain, and chiefly by reason of a preceding Melancholy or Phrensy: in that the animal Spirits being exalted a little too much with the nervous Juice, and in this being a little too much depress'd, acquire the Disposition to madness.

2. The Disposition to madness no less frequently has its roots in the mass of Blood, and at length is produc'd into act, to wit, when the Blood being mightily depraved, and nitrosulphureous, either perverts

the nervous Liquour together with the animal Spirits, or furnishes such as are evil, which kind of taint of the Blood is eiter hereditary or acquir'd.

First, its a common observation, that men born of Parents that are sometimes wont to be mad, will be obnoxious to the same disease: and tho often they have lived prudently and soberly above thirty or forty years, yet afterward without any occasion or evident cause will fall mad. The reason whereof is, that the Blood at that time being fal∣len from its due crasis by degrees to be nitrosulphureous, furnishes the Brain with animal Spirits, and a nervous Juice of a most sharp Nature. We heave formerly shewn that the Elementary Particles in our Body persist during Life, separately from those that are scondary, supplyed by Nutrition, and that they have times of their Crudity, Maturity, and Decay: wherefore we judge also, that the morbid Seminia come to a ripeness also according to the periods of ages: Moreover, we ob∣serve, that often these mobid Fruits being ripend, continue a good while, or during Life, and that sometimes they wither away again as it were of their own accord, and then that afterward, after some tract of time, new Fruits spring forth again from the miasm left behind, and rises by degrees to their height; wherefore an hereditary Madness sometimes is continual, sometimes interrmittent, and its Fits sometimes are wont to return after shorter intervals, sometimes after longer.

2. As the Procatarxis of the Mania, sticking in the Blood, is often innate or originally in it, so the same sometimes is engendred by degrees, either by an ill form of dyet, or by a suppression of solemn Evacuati∣ons, by reason of a precedent Feaver, or for other causes, and at length being brought to a maturity, breaks forth into a madness. It's usual in a great dearth for certain poor People who are forc'd to love only on disagreeing Food, or such as is of an ill digestion, at first to become sad, with a staring and wan aspect, and in a short time after to turn mad: the Flux of the Hemorrhoids or Menses being restrained, or malignant Ulcers supprest, dispose towards this Disease. Moreover, those who originally or acquiredly are of an eager Temperament, an extravagant Behaviour, and an earnest Countenance, because of being nigh to a nitrosulphureous Disposition of the Blood, are in danger of falling mad upon some strong evident cause.

3. Venemous Ferments insinuated into the Blood and nervous Juice, as especially from the biting of Animals that are mad, or by the taking of some venemous things, are wont to cause Madness. Concerning the reason of the former, we have elsewhere proposed our Conjectures. Of late a noble Lady, and worthy of Credit, related to me of her own Knowledge, that a certain Gentleman after having eaten at Dinner the tender Leaves of Wolf-bane in a Sallet with other Herbs, found him∣self ill in the Evening, and complaining of a great agitation and rest∣lessness of his Blood and Spirits, entreated his Friends that a Chirur∣geon

might be called to open a Vein, and said that otherwise he should presently run mad: which indeed happned as he said, for, before he could be let blood, falling mad, he dyed within the space of twenty four hours; which deadly affect hapned so on a sudden, in as much as the Poyson did not only pervert both the Blood and animal Spirits as to their Crasis, but by its malign Ferment presently subverted them utterly.

The reason why mad Persons are bold and very confident, so that they flye no dangers, and set upon the most difficult of things, is, that the animal Spirits being very exorbitant, and vehemently moved, both fortifie the Imagination, that no Object seems greater or more terrible to it than usual, and actuate the Praecordia with Vigour, so that they strongly and swiftly convery the Blood, and briskly drive it into the outmost bounds of the Body. In this affect the Soul strives to outgoe, and to springit self as it were beyond the circumference of the Body, and so making an effort every way, it bears it self undaunted against any incursions of exteriour things.

2. The Reason why mad Persons are strong to a miracle, is, that Par∣ticles as it were nitrosulphureous, or otherwise very sharp, or as it were Stygian, ar contained in their Blood and nervous Juice, whence the animal Spirits excell in a stupendous and incredible elastick, or ex∣plosive force, far above the natural.

3. It is to be observed, that mad Persons are hardly ever wearied, for tho by raging and striving they strongly exercise their Limbs for many dayes and Nights, and in the mean while live without eating and sleeping, they scarce at all faulter, nor desist from their strugling through a failure of Strength; which doubless so happens, for as much as the animal Spirits, tho very movable and elastick, yet are not volatile and easily dissipable, but by reason of the saline Particles de∣press'd from their volatility into a flowing state, and being combin'd with the sulphureous ones, become firm and fixt, and therefore hold out veryling in their Activity.

4. Almost for the same reason, many Persons, how much soever they suffer or are afflicted, are not hurt: but endure Cold, Heat, Watchings, Fastings, Stripes and Wounds, without any sensible dam∣mage, because the Spirits being strong and fixt, do not faulter nor flye away. Moreover, the Blood having got a nitrosulphureous dys∣crasy, is incapable of any other change, wherefore, tho insensible trans∣piration be stopt, and other solemn evacuations are supprest, or sup∣plyes of te nutritive Juice are deny'd, neither a Catarrh, nor Feaver, nor an Atrophia, or Cacochymia lightly ensue upon Madness, for in this affect, tho the Particles of the Blood are grown very turgid, yet by reason of the store of Salt, they do not take to a feverish Flame.

As to the prognostick of Madness, since the affected are never ob∣noxious to a Fever, nor to oter Diseases besides, nor are easily hurt by outward Accidents, it is not a mortal Disease of it self: but is very

of Cure, because a great alteration is to be made in the Blood and Spirits, and the Diseased are refractory to any method of Cure, being Enemies both to the Physicians, and themselves.

If the Madness be inveterate or hereditary, or be caus'd by the bite of a mad Dog, it admits of a perfect Cure with difficulty, or not at all; that which is rais'd through some occasion, whether it be from an evident cause alone, or comes upon a Fever, also on which the Itch, Small Pox, Hemorrhoids, or Varix's happen, is more easily Cured.

Those that are obnoxious to this Disease at times, are very much in danger about the Summer Solstice, or in the Dog days; also in great changes of the Air, as when long colds or heats are changed into op∣posite constitutions of the Heavens.

Since there are two kinds of Madness, to with, a continual and intermittent one; the method of Curing also ought to be two∣fold.

1. The Therapeutick method to be used in a continual Mania, sug∣gests to us the three primary Indications so vulgarly known: viz. the first Curatory, which, regarding the Disease if self, endeavours to cor∣rect or appease the furies and exorbitancies of the Aniaml Spirits: The second preservatory, which, levelling at the causes of the Disease, undertakes to remove or amend the sharp and nitrosulphureous Dyserasies of the Blood and the Nervous juice, and the Stygian dispo∣sition, as it were, of the Spirit. The third Vital, which directs such a way of Dyet and resumptive nourishment, that both the nutritive and vital functions may be able to be carried on and maintain'd as is barely necessary in this Disease.

The first Indication, viz. Curatory, requires Discipline, viz. threats, bindings, or stripes, as well as Physick; and therefore the mad Person, being put into a House fit for that purpose, let him be so ma∣naged both by the Physician, and prudent attendants, that he be kept in a manner always in his due behaviour, and in meet gestures and motions, either by advice, chiding, or by punishments now and then inflicted on him; and indeed there is nothing more efficacious or necessary for curing mad Persons, than that they always dread and stand in awe of certain Tortures, as it were; for by this means the Corporeal Soul, being somewhat deprest and restrained, is forced to remit of its haughtiness and exorbitancy; and therefore afterward grows mild by degrees, and is reduced to order. Wherefore mad men are sometimes sooner and more certainly cured by punish∣ments and tortures, in a pent up room, than by Physick, or Me∣dicines.

But withal, such a course of Physick also ought to be us'd, which may restrain and bring down the haughtiness of the Corporeal Soul: Wherefore in this Disease Blooding, Vomitories and Catharticks, how

strong soever they are, and given at rovers and boldly, very often do good. Which indeed manisestly apperars, because Empyricks, only with this kind of Physick, together with governanace, and a severe discipline, often successfully cure Mad-men. Tho this rough way of handling, does not so well agree with all mad persons, but chiefly with such as are raving mad, oters being more remissly mad, are often cured by fair usage and gentle Medicines.

But in most mad persons, it is both the common voice and general practice to bleed plentifully about the beginning of the Disease; and in∣deed it will be good now and then to repeat it as far as the strength will bear, and sometimes to perform the operation in the Arm, some∣times in the Jugular Vein, Forehead, or Foot; and sometimes to open the Hemorrhoid Vessels by Leeches: For these evacuations being sea∣sonably made, both the exorbitancies of the Spirits, and te haugh∣tiness of the Soul are excellently supprest; and likewise the Dyscrasies of the Blood are corrected, in regard that a new and more mild springs up in the place of that which was taken away, being sharp and corrosive.

That Vomits also do great good in curing mad persons, it is past even into a Proverb, so that all Hellebore, nay, all Anticyra is assign'd to them: After what manner Emeticks often do good in Cephalick Dis∣eases, we have shewn before: Quacks in this case giving a large dose of Stibium, tho it be rashly and dangerously, yet have often success. In truth, Chymical things best agree here, both because they move more powerfull, and because the Disased may be deceived more easily by them.

Take sulphur of Antimony from eight grains to ten, Cream of Tartar half a scruple, mix them, by grinding them together, make a Powder, let it be given in a spoonful of Panada, or if it must be given craftily, and the Per∣son not knowing of it, let it be put in a crust of white Bread, to be taken in Broath or Milk: let this vomitory be frequently repeated, viz. once within four dayes.

Take Mercurius Vitae six or seven grains, make a Powder, let it be given after the same manner. The Emetick Tartar of Mynsicht, Hercules, Bovii, and other various preparations of Mercury, may begiven after the sme man∣ner. Aurum Vitae, or the Solar, and also the Lunar precipitate are ac∣counted by Chymists specifick Remedies against against Madness, and indeed Mercurial Medicines, in as much as they work by Vomit, and Seige, and often also by Sweat, Ʋrine, or Salivation, prove egregiously benefici∣al: a copious Spitting, and of long continuance has perfectly cru'd some mad persons.

Strong Pruges (where the strength and constitution will bear them) in as much as they depress the exorbitances of the Blood and spirits, and much evacuate the emunctories for receiving the recrements of the Rlood and Nervous juice, often give relief also in this Disease.

For this use, preparations of black Hellebore, as especially its extract, and the Wine of the infusion of its Fibres, or the pap of an Apple boyled with the Roots of it sticking in it, are very much commended.

Take extract of black Hellebore, Calamelanos, of each a scruple; make; a Bolus.

Take Calamelanos a scruple, Diagridium from twelve grains to fifteen, make a Powder.

Take Confectio Hamec, or the Electuary of the Juice of Roses from half an ounce to six drams, let it be given in Broth.

Take Gereons Decoction of Senna, or the Decoction of Epithymum (with two drams of the roots of Black Hellebore) six ounces, make a draught.

The Pulvis Diasennae two drams, let it be taken in Whey.

In the mean while that these things are done, let the preservatory Indication take care of the Cause of the Disease. Wherefore with these frequent Purges and Bloodings let alterig Remedies be interlac'd, for tempering the Blood and nervous Juice, and for reducing them to their due Crases; if haply the diseased, being obsequious and tracta∣ble, do not refuse to take such things methodically.

Take crystal Mineral, or Nitre excellently purified two ounces, Pearl powdred two drams, Sugar-Candy two drams and a half, Camphire half a Scruple, let them all be ground into a subtle Powder; let two drams of this be put in a Glass-bottle holding a quart, with Fountain-water, or small or mild Beer for ordinary Drink, wich may be given at pleasure.

Let boyling Whey be poured to the Flowers of Violets or Nymphea, after an infusion for two hours let it be drank off plentifully: Spaw-waters also drank regularly and in a plentiful manner, are proper for mad Per∣sons.

Take fresh and tender tops of Borrage and Bugloss of each four handfuls, three mash'd Apples, Sal Prunella two drams, Sugar half an ounce, being bruised together, pour to them three pounds of Rountain-water, express it strongly, let half a pound be taken thrice a day or oftner.

Take Conserve of the Flowers of Borrage and Violets of each three drams,. Confection of Hyacinth, Alchermes of each two drams, Coral prepared a dram and a half, Pearl powdred a dram, Salt of Coral a dram, Syrup of red Poppyes what suffices, make an Electuary, wherefore let two drams be taken twice or thrice a day drinking after it of the following Liquour four ounces.

Take Water of Nymphea, Borrage, Bugloss, black Cherryes, of each four ounces, of red Poppyes six ounces, red Rose-water two ounces, Camphire tyed in a Nodulus and hung in a Glass half a dram, Syrup of Coral an ounce and a half, mix them, make a Julep.

Take the yellow Flowers of a Willow what suffises, distill them with com¦mon Organs, repeat the distillation, pouring the Water on fresh Flowers by three Cohobations, let it be given to four ounces twice or thrice a day, sweet∣ning it with Syrup of Nymphaea.

Take leaves of the Willow, Meadow-sweet, Burnet, Borrage, Baum, of each six handfuls, Flowers of Nymphaea, tops of St. Johns Wort of each four handfuls, Camphire powdred three drams, all being slic'd together pour to them of fresh Milk eight pounds, distill it with common Organs.

Let Sheeps Brains be distilled with milk, and let the Water be given to three or four ounces, thrice a day.

Moreover, let specifick Remedies be applyed to use, of which kind the Decoction of Pimpernell with a purple Flower is famous, also the tops of St. Johns Wort, and other Decoctions, Opiats, and powders against Madness, well known by all famous Empiricks.

As to the cure of Madness caused by the biting of venemous or mad Ani∣mals, since it is in a manner only Empirial, and vulgarly known, there is no need for us to discourse of it in this place, we having also pro∣pos'd our Conjectures concerning it elsewhere: Again, the Decoction or infusion of Apples either crude or boyled in fountain Water; the Liquour Tea, Emulsions, with many other things, forms of which we have given in the cure of Melancholy, are proper in this case.

Moreover, many other helps besides Blooding are wont to be afford∣ed from Cbirurgery for curing this Disease: Cupping-glasses, with a Scarification often do good; Vesicatories, Cauteries, both actual and potential, are commended by many. Some commend Arteriotomy, others trepanning, and others Salivation: But these kinds of admini∣strations, besides that they are of a doubtful effect, cannot easily, and searce with safety, come in practice, by reason of the intractable disposition of the Diseased. Wherefore it would be superfluous here to enquire into the reasons of the relief or Cure to be expected from those things. It is good sometimes, the Head being shav'd, to apply the warm Lungs of a Lamb or Sheep, and other fomentations to the Sinciput, and now and then to change them. But these Epithemes also, in regard they cannot be methodically applied and repeated to the Diseased, who admit them with reluctancy, often do more hury than good.

30. The Vital Indication directs how mad persons ought to be han∣dled, as to their Government, Diet and Sleep. In this Disease, other∣wise than in many others, there is no need of restoring: for neither ought the strength to be restor'd with Resumptives, nor the Spirits with Cordials; but on the contrary, a suppression, or as it were, a certain extlnction is to be us'd to both, being too exorbitant of themselves, resembling a flame, as it were, burning above measure: Therefore let the Dyet be thin and not delicate, the cloathing course, the lodg∣ing hard, the dealing with them severe and rigid. But Sleep, be∣cause it is very necessary, if it be wholly wanting, ought sometimes to be caus'd by giving Remedies; for which end, the Hypnotick Medi∣cines prescribed before for Melancholy, are proper also in this disease, those who have an inveterate habitual Madness are seldom put to a

Physical cure, but being committed to Hospitals for mad Persons, by the ordinary discipline of that Place, either return at length to themselves, or are kept there from doing hurt to themselves or others.

It is not needful to illustrate the nature of this Disease with Histories and Examples, and to set forth many Types of it; but rather address your selves to the Hospitals of mad People, where, not withour a great admiration, you may behold as it were a new and monstrous Genera∣tion of Men, viz. contrary to such as are rational, and as it were our Antipodes; who, if they could all be gathered together into one place, and all the Fools and senseless Persons be joyned with them, I know not whether they would not make an equal division of the whole Earth with the sober and prudent.

So far of the cure of a continual Madness. But the intermittent has perfectly lucid intervals, in which the diseased return to a sound Mind, or the Fury only ceases, the Delirium still remaining, so that the affected become gentle and tractable: yet continuing still to err as to their Imagination and Judgment, they speak and do a great many absurd or incongruous things, and afterward become mad again at times.

The remedy of both these affects, as to the curatory Indication, is the same as in a continual Madness, that it will not be needful to fet down here any other Method or Medicines: but as to what regards the Pro∣phylaxis, or preservatory Indicatin, to wit, whereby the way of cu∣ring to be used out of the Fits for preventing or lessenging them is order'd, in which the Fury only intermits, the Delirium remaining, the very same physical Method and Remedies, which we have prescribed for removing the Procatarxis of Melancholy are proper. pa In a madness which intermits perfectly, as to all smptoms; at the most fit seasons, to wit, Spring and Fall, solemn courses of Physick ought to be entred upon; and also there is always need of a care and governance of the Diseased; both that as to his diet, and way of Life, lie be kept always in an even and moderate Temper; and that as soon as the signs of an imminent Fit appear, blooding and purging being pre∣sently used, its access be kept off.

Therefore, at the approach of the Equinoxes, let Blood be drawn from the Arm, and then after seven, or eight dayes from the Hemorr∣hoid Veins by Leeches: Let Purges and Vomits by due intervals be gi∣ven twice or thrice: moreover on intermitting dayes, let altering Re∣medies be orderly taken at physical Hours: forms of these are deliver'd both in this Chapter and in the foregoing for the cure of Melancholy: let the diet be thin and of good digestion; as to Sleep, Motion, and other non-natural things, let all be maderate: If at any time aperson seems to be threatned with an access of Madness, constantly before the Summer solstice, let blooding with vomiting, and a thin diet be used.