By Benjamin Rush, M.D.,
Professor of the Institutes and Practice of Medicine, and of Clinical Practice in the University of Pennsylvania.
Fourth Edition. 1830. Date of Preface 1812.

MANIA in the first stage, if caused by study, requires separation from books. Low diet, and a few gentle doses of purging physic : if pulse tense, ten or twelve ounces of blood. In the high grade, catch the patient's eye and look him out of countenance. Be always dignified. Never laugh at or with them. Be truthful. Meet them with respect. Act kindly towards them in their presence. If these measures fail, coercion is necessary. Tranquillizing chair. Strait waistcoat. Pour cold water down their sleeves. The shower-bath for fifteen or twenty minutes. Threaten them with death. Chains seldom, and the whip never required. Twenty to forty ounces of blood, unless fainting occur previously ; even in absence of morbid pulse, if other symptoms be present, as wakefulness, &c. : to be more copious in phrenimania, less in the insanity from drunkenness. Cupping after the symptoms calling for bloodletting have disappeared ; hurtful before the action of the pulse has been reduced. Solitude. Darkness. The erect position. Low diet. Purging: cremor tartar, salts, senna, calomel and jalap been employed two last especially where mingled with bilious fever ; sometimes an artificial diarrhoea. Nitre same service as in other diseases of bloodvessels. Blisters to extremities after depletion. Cold externally, and head to be shaved. Opium in small doses: when from drunkenness, then combined with volatile salts, bitters, and small quantities of ardent spirits. Showerbath two or three times a day. Digitalis failed with him : so also camphor. Hellebore only useful by acting as a purge. Exercise so soon as excitement has abated: wakefulness at this stage must be combated by opium. If hysterical or convulsive symptoms present, castor and the oil of amber. Direct his mind from the ruling delusive subject: Dr. Ash was cured by studying mathematics. Combat one passion by another. Whilst in a furious state do not contradict. Never confine, after ceasing to injure themselves or others. Let them read ; copy manuscripts. Plaintive music. Grief, by mentioning the name of a person, to whom they are under some obligation. Convalescents to be kept from the 82 noise of the more insane. Too much cannot be said in favour of salivation.

In manicula : in which the pulse is typhoid, and there is peculiar sensibility to cold-Garlic and the different preparations of iron.

In manalgia ; in which there are apathy and inattention to everything -cordial food and drinks, as savoury as possible. Warm bath above natural temperature of body. Shower-bath. The two just mentioned, one directly after the other. An artificial diarrhoea. Caustic issue to back of neck. Mercury. Exercise. Cox's swing best. Labour. Invigorating music. Great pain. An errhine of sulphate of mercury or muriate of ammonia, mixed with flour. Pleasant odours. Loud sounds. Exciting stimulating emotions, as anger.

In dementia, when attended, as generally with great excitement: bleed. ing, low diet, purges, and all other such sedative remedies. When periodical, bark and other tonics during the intervals.

In hypochondriasis-blood-letting, if pulse full and tense or depressed. Purges: calomel, aloes, jalap. Emetics. Reduced diet. After the above, depletory measures : remedies should consist in stimulating aliment, drinks, and medicines. Madeira wine, sherry, or porter: knew a case cured by Madeira. Iron with ginger or black pepper and common bitters. Tar in pills. Garlic in substance or peppermint tea. Alkalies for sour stomach. Assafcptida and opium for exhilaration. Aromatic warm bath, succeeded by cold. Frictions. Exercise, especially on horseback. Pain. Salivation. Blisters and issues. Must not treat the disease lightly but seriously. If he thinks a living animal in him, one to be placed in his close-stool. An unwillingness to discharge the urine was cured, by Dr. Ferriar, by means of an emetic. Exciting powerful emotions. Employment. Amusement. Travelling. If they refuse food, it should be left in their room : Pinel mentions that withholding drink from a patient refusing to eat, induced him to do so, on its being given to him. Similar remedies avail in melancholia. Errors to be soothed, diverted or ridiculed according to their force. Reasoning has most effect, in cases in which the patient imagines something supernatural respecting himself.

In fatuity from fevers, stimulants as in manalgia, though milder. For derangement of memory, abstraction of exciting causes: Sir John Pringle's memory was restored by leaving off the use of snuff. Depletion if plethora, and pulse tense and oppressed : then blisters ; issues in arms ; errhines ; aromatics-cubebs, cloves, lavender, &c. ; cold bath ; exercise : also, mental remedies.