In this brief sketch, we shall not enter into any de tail respecting the means of curing insanity. One of our first objects must be to inquire into the exciting cause, and if'possible to remove it ; we are next to ex amine the condition of the system generally, and of the circulation in particular, whether there he any devia tion from the healthy state, which we may have it in our power to relieve. Beyond this we have perhaps no general principles on which to proceed. The diges Live organs are always to be carefully attended to, and in females we arc minutely to watch the state of the uterine functions. The employment of the various means of depletion is to be regulated entirely by cir cumstanccs, and the same remark may be made as to the use of stimulants or sedatives; but, for the most part, the cure cannot be accomplished by the mere use of me endue, independent of general management or moral dis cipline. Every thing concurs to prove, that violence and harshness arc as useless as they are inhuman; that con straint is only so far proper, as to prevent the patient from injuring himself, or those around him ; that we must regard the insane as entitled to all the privileges of humanity; and that, when the reasoning powers arc not too far perverted, they may, in a majority of cases, be restored, by treating the patient with a due mixture of gentleness and firmness, and by occupying him with such pursuits as may engage his ideas with out harassing them. The cure of Amentia is more hope less than that of Mania; it more frequently depends upon an obvious structural affection of the brain, and is more frequently either connate, or the effect of some ir remediable injury. The treatment is the same for both the species, indeed there is no exact limit between them; so that, in the same patient, they often make their appearance at different periods of the complaint, or glide insensibly into each other. It may be observed, that the prognosis is more unfavourable when the af fection is hereditary, or when it comes on without any obvious cause; while, on the contrary, the cases which consist of what is termed over-excitement, or violent delirium, are more easily relieved than such as seem to depend upon mere weakness, proceeding from a diminution rather than excess of nervous energy. With respect to the operation of particular remedies in insanity, we may remark, that bleeding is not to be em ployed, except there be some indication of its use from the state of the circulation. It does not appear to have any specific effect over the disease; and nothing can be more disgraceful to the profession, than the indiscrimi nate manner in which it was practised, until very lately, even in our first public establishments. The same ob servation may be made respecting all the other evacua tions, which are only to be had recourse to when there is something in the state of the functions which seems particularly to call for their employment. Opium, camphor, digitalis, have each had their advocates, as well as the warm bath, the application of cold under various forms, and different kinds of mechanical exer cises; but it may be doubted whether any very decided benefit ought to be expected from them, or at least more than what can be supposed to depend upon their effect in promoting the state of the general health. Many of the alleged cures of insanity have, no doubt, been ac complished through the medium of the imagination, where the complaint was only partial, so as to leave the patient in a situation to be conscious of what was pass ing around him ; and, in some of the protracted cases, it must be attributed merely to the spontaneous effects of the system, inducing a salutary change in the functions, independently, or perhaps even in opposition to the means that were employed for the cute. See 'NSA.. N1TT.
l'aratrepses.
WE now come to our fourth class of diseases, those which we have named I'aratrepscs, including the mor bid affections that are concerned in the function of nu trition, of which the most important are the stomach, the intestinal canal, the liver, and the absorbent sys tem. The first of the four orders into which we divide this class, consists of diseases of the stomach and its appendages, of which we begin by an account of Dys pepsia. Dyspepsia, or Indigestion, as it is popularly termed, is a complaint that is infinitely diversified in its symptoms, and depends upon a great variety of causes, some connected with the structure and composition of the parts, and others with their functions, independent of any visible alteration. It is a complaint which does not run through any regular course, or observe any uniform progress, but consists in a number of morbid actions, which succeed or accompany each other, as it appears, merely from incidental circumstances. Among the most common symptoms of Dyspepsia, we may enu merate the following : loss of appetite, or sometimes the contrary state of an acute feeling of hunger, while the stomach is incapable of digesting the food that has been received into it, nausea, vomiting, pain of the sto mach, costiveness, or the opposite state of diarrhma, morbid condition of the fmcal discharges, flatulence, heartburn, eructation, head-ach, and a furred appear ance of the tongue; a circumstance which affords the practitioner one of the most certain indications of the state of the patient, and enables him to form his prog nosis. The disease is not attended with fever, nor is
the pulse necessarily affected, until it be so from the weakness which is induced when it is of long standing, and when the powers of the body begin to fail front the deficiency of nourishment. It is observed, that the mental faculties are much connected with, or influenced by, the condition of the stomach ; so that the same in dividual, who possesses the most active and cheerful disposition while the digestive organs are free from op pression, after a full meal becomes languid, melancho lic, and desponding. The exciting causes of Dyspep sia are as various as the aspects which the disease as sumes. Every other disease, which in any way influ ences the state of the general health, may induce Dys pepsia ; all violent mental emotions, especially those of a depressing kind; sedentary habits, or exercise carried to the length of exhaustion; and, what is the most fre quent cause, and the one which produces the most ur gent and distressing symptoms, a luxurious diet, or merely too great repletion; and especially the exces sive use of fermented or spiritous liquors. The ha bitual employment of opium or tobacco seems to act very unfavourably upon the digestive organs; and, in short, whatever may be supposed either to diminish the vital powers, or to produce their irregular action, fee. quently manifests its injurious effects through the me.
dium of the stomach. Another class of causes which impair the digestion, are those that consist in some structural disease of the various chylopoetic viscera, as chronic inflammation, contraction, or scirrhus of the stomach itself, which usually occurs about the pylorus; affections of the spleen and pancreas; and whatever im pedes the due secretion of the bile, or its discharge into the alimentary canal.
The indications of cure to be observed in Dyspepsia are sufficiently obvious, but the accomplishment of them is often very difficult ; and perhaps, in a majority of cases, we are rather to practise with a view to ob viate particular symptoms, than in prosecution of any general principles. Our first object must be to ascer tain, if possible, whether there he any structural dis ease of the stomach or the digestive organs, a circum stance which must materially influence our treatment, and still more our prognosis; for while we may hope to relieve the most obstinate dyspeptic symptoms, as long as the structure of the part is unimpaired, so our prospect of success must always be very small on the contrary supposition. In this latter case, the disease is to be regarded as entirely symptomatic, and, until the primary affection be removed, not only would most of the remedies that arc proper for Dyspepsia be useless, but probably even injurious. When we have reason to suppose that the affection of the stomach is altogether independent of the structural disease, our first object is to inquire into the habits and modes of life of the pa tient, and especially into the nature of the diet ; and, for the most part. we shall find that, by a proper regu lation of these points, the most urgent symptoms may he relieved even more effectually than by the exhibi tion of the most powerful medicines. Yet painful and distressing as the complaint is, so much so as to destroy all the comforts of life, and even to render existence it self a burden, so inveterate are the habits of self-indul gence, and so unable is the patient to resist the calls of a pampered appetite, craving for its accustomed grati fications, that we too frequently find all our admoni tions to be in vain, and our advice to be totally ne glected. With respect to other remedies, the numbers that have been employed, and the various forms in which they have been administered, to accommodate the taste or the caprice of the patient, are almost infinite ; but we may arrange them under the three heads of evacuants, stomachics, and tonics. It generally hap pens that the intestines are either torpid or in an un natural state, and there is perhaps no instance of Dys pepsia, of all the numbers that fall under our care, in which we shall not find it highly beneficial to com mence with active purgatives. They will be frequent ly found to supersede the whole tribe of carminatives, antispasmodics and antacids, which have been so li berally prescribed in this complaint, and will lay the best foundation for the subsequent use of stomachics and tonics. It would not be consistent with the na ture of this treatise to enter into any account of the particular medicines, or combinations of them, which may be adapted to the various symptoms or conditions ol the disease, but we generally think it desirable to em ploy them in a simple form and in small doses, and rather to rely upon a change in the external circum stances, which may be conceived likely to promote the general health, than upon the administration of any particular article of the matcria medica. Country air and exercise, temperance in diet, avoiding the oppres sive cares of business ; and, we may add, as what is scarcely less necessary, the unreasonable pursuits of pleasure, are the grand remedies for Dyspepsia ; and we conceive that no one who has given them a full trial, and has experienced the relief which is obtained from them, will be disposed to relapse into those luxurious habits, from which it is so difficult, in the first instance, to wean the patient.