Hence it is curious to observe, that those animals, who have more frequently exerted their muscles of respiration violently, as in talking, barking, or grunting, as children, dogs, hogs, scream much more, when they are in pain, than those other animals, who use little or no language in their common modes of life; as horses, sheep, and cows.

The next most frequent or most powerful efforts, which infants are first tempted to produce, are those with the muscles in biting hard substances; indeed the exertion of these muscles is very powerful in common mastication, as appears from the pain we receive, if a bit of bone is unexpectedly found amongst our softer food; and further appears from their acting to so great mechanical disadvantage, particularly when we bite with the incisores, or canine teeth; which are first formed, and thence are first used to violent exertion.

Hence when a person is in great pain, the cause of which he cannot remove, he sets his teeth firmly together, or bites some substance between them with great vehemence, as another mode of violent exertion to produce a temporary relief. Thus we have a proverb where no help can be had in pain, "to grin and abide;" and the tortures of h.e.l.l are said to be attended with "gnashing of teeth."

Hence in violent spasmodic pains I have seen people bite not only their tongues, but their arms or fingers, or those of the attendants, or any object which was near them; and also strike, pinch, or tear, others or themselves, particularly the part of their own body, which is painful at the time. Soldiers, who die of painful wounds in battle, are said in Homer to bite the ground. Thus also in the bellon, or colica saturnina, the patients are said to bite their own flesh, and dogs in this disease to bite up the ground they lie upon. It is probable that the great endeavours to bite in mad dogs, and the violence of other mad animals, is owing to the same cause.

4. If the efforts of our voluntary motions are exerted with still greater energy for the relief of some disagreeable sensation, convulsions are produced; as the various kinds of epilepsy, and in some hysteric paroxysms.

In all these diseases a pain, or disagreeable sensation is produced, frequently by worms, or acidity in the bowels, or by a diseased nerve in the side, or head, or by the pain of a diseased liver.

In some const.i.tutions a more intolerable degree of pain is produced in some part at a distance from the cause by sensitive a.s.sociation, as before explained; these pains in such const.i.tutions arise to so great a degree, that I verily believe no artificial tortures could equal some, which I have witnessed; and am confident life would not have long been preserved, unless they had been soon diminished or removed by the universal convulsion of the voluntary motions, or by temporary madness.

In some of the unfortunate patients I have observed, the pain has risen to an inexpressible degree, as above described, before the convulsions have supervened; and which were preceded by screaming, and grinning; in others, as in the common epilepsy, the convulsion has immediately succeeded the commencement of the disagreeable sensations; and as a stupor frequently succeeds the convulsions, they only seemed to remember that a pain at the stomach preceded the fit, or some other uneasy feel; or more frequently retained no memory at all of the immediate cause of the paroxysm. But even in this kind of epilepsy, where the patient does not recollect any preceding pain, the paroxysms generally are preceded by a quivering motion of the under jaw, with a biting of the tongue; the teeth afterwards become pressed together with vehemence, and the eyes are then convulsed, before the commencement of the universal convulsion; which are all efforts to relieve pain.

The reason why these convulsive motions are alternately exerted and remitted was mentioned above, and in Sect. XII. 1. 3. when the exertions are such as give a temporary relief to the pain, which excites them, they cease for a time, till the pain is again perceived; and then new exertions are produced for its relief. We see daily examples of this in the loud reiterated laughter of some people; the pleasureable sensation, which excites this laughter, arises for a time so high as to change its name and become painful: the convulsive motions of the respiratory muscles relieve the pain for a time; we are, however, unwilling to lose the pleasure, and presently put a stop to this exertion, and immediately the pleasure recurs, and again as instantly rises into pain. All of us have felt the pain of immoderate laughter; children have been tickled into convulsions of the whole body; and others have died in the act of laughing; probably from a paralysis succeeding the long continued actions of the muscles of respiration.

Hence we learn the reason, why children, who are so easily excited to laugh by the tickling of other people's fingers, cannot tickle themselves into laughter. The exertion of their hands in the endeavour to tickle themselves prevents the necessity of any exertion of the respiratory muscles to relieve the excess of pleasurable affection. See Sect. XVII. 3. 5.

Chrysippus is recorded to have died laughing, when an a.s.s was invited to sup with him. The same is related of one of the popes, who, when he was ill, saw a tame monkey at his bedside put on the holy thiara. Hall. Phys.

T. III. p. 306.

There are instances of epilepsy being produced by laughing recorded by Van Swieten, T. III. 402 and 308. And it is well known, that many people have died instantaneously from the painful excess of joy, which probably might have been prevented by the exertions of laughter.

Every combination of ideas, which we attend to, occasions pain or pleasure; those which occasion pleasure, furnish either social or selfish pleasure, either malicious or friendly, or lascivious, or sublime pleasure; that is, they give us pleasure mixed with other emotions, or they give us unmixed pleasure, without occasioning any other emotions or exertions at the same time. This unmixed pleasure, if it be great, becomes painful, like all other animal motions from stimuli of every kind; and if no other exertions are occasioned at the same time, we use the exertion of laughter to relieve this pain. Hence laughter is occasioned by such wit as excites simple pleasure without any other emotion, such as pity, love, reverence. For sublime ideas are mixed with admiration, beautiful ones with love, new ones with surprise; and these exertions of our ideas prevent the action of laughter from being necessary to relieve the painful pleasure above described. Whence laughable wit consists of frivolous ideas, without connections of any consequence, such as puns on words, or on phrases, incongruous junctions of ideas; on which account laughter is so frequent in children.

Unmixed pleasure less than that, which causes laughter, causes sleep, as in singing children to sleep, or in slight intoxication from wine or food. See Sect. XVIII. 12.

5. If the pains, or disagreeable sensations, above described do not obtain a temporary relief from these convulsive exertions of the muscles, those convulsive exertions continue without remission, and one kind of catalepsy is produced. Thus when a nerve or tendon produces great pain by its being inflamed or wounded, the patient sets his teeth firmly together, and grins violently, to diminish the pain; and if the pain is not relieved by this exertion, no relaxation of the maxillary muscles takes place, as in the convulsions above described, but the jaws remain firmly fixed together.

This locked jaw is the most frequent instance of cataleptic spasm, because we are more inclined to exert the muscles subservient to mastication from their early obedience to violent efforts of volition.

But in the case related in Sect. XIX. on Reverie, the cataleptic lady had pain in her upper teeth; and pressing one of her hands vehemently against her cheek-bone to diminish this pain, it remained in that att.i.tude for about half an hour twice a day, till the painful paroxysm was over.

I have this very day seen a young lady in this disease, (with which she has frequently been afflicted,) she began to-day with violent pain shooting from one side of the forehead to the occiput, and after various struggles lay on the bed with her fingers and wrists bent and stiff for about two hours; in other respects she seemed in a syncope with a natural pulse. She then had intervals of pain and of spasm, and took three grains of opium every hour till she had taken nine grains, before the pains and spasm ceased.

There is, however, another species of fixed spasm, which differs from the former, as the pain exists in the contracted muscle, and would seem rather to be the consequence than the cause of the contraction, as in the cramp in the calf of the leg, and in many other parts of the body.

In these spasms it should seem, that the muscle itself is first thrown into contraction by some disagreeable sensation, as of cold; and that then the violent pain is produced by the great contraction of the muscular fibres extending its own tendons, which are said to be sensible to extension only; and is further explained in Sect. XVIII. 15.

6. Many instances have been given in this work, where after violent motions excited by irritation, the organ has become quiescent to less, and even to the great irritation, which induced it into violent motion; as after looking long at the sun or any bright colour, they cease to be seen; and after removing from bright day-light into a gloomy room, the eye cannot at first perceive the objects, which stimulate it less. Similar to this is the syncope, which succeeds after the violent exertions of our voluntary motions, as after epileptic fits, for the power of volition acts in this case as the stimulus in the other. This syncope is a temporary palsy, or apoplexy, which ceases after a time, the muscles recovering their power of being excited into action by the efforts of volition; as the eye in the circ.u.mstance above mentioned recovers in a little time its power of seeing objects in a gloomy room; which were invisible immediately after coming out of a stronger light. This is owing to an acc.u.mulation of sensorial power during the inaction of those fibres, which were before accustomed to perpetual exertions, as explained in Sect. XII. 7. 1. A slighter degree of this disease is experienced by every one after great fatigue, when the muscles gain such inability to further action, that we are obliged to rest them for a while, or to summon a greater power of volition to continue their motions.

In all the syncopes, which I have seen induced after convulsive fits, the pulse has continued natural, though the organs of sense, as well as the locomotive muscles, have ceased to perform their functions; for it is necessary for the perception of objects, that the external organs of sense should be properly excited by the voluntary power, as the eye-lids must be open, and perhaps the muscles of the eye put into action to distend, and thence give greater pellucidity to the cornea, which in syncope, as in death, appears flat and less transparent.

The tympanum of the ear also seems to require a voluntary exertion of its muscles, to gain its due tension, and it is probable the other external organs of sense require a similar voluntary exertion to adapt them to the distinct perception of objects. Hence in syncope as in sleep, as the power of volition is suspended, no external objects are perceived. See Sect.

XVIII. 5. During the time which the patient lies in a fainting fit, the spirit of animation becomes acc.u.mulated; and hence the muscles in a while become irritable by their usual stimulation, and the fainting fit ceases.

See Sect. XII. 7. 1.

7. If the exertion of the voluntary motions has been still more energetic, the quiescence, which succeeds, is so complete, that they cannot again be excited into action by the efforts of the will. In this manner the palsy, and apoplexy (which is an universal palsy) are frequently produced after convulsions, or other violent exertions; of this I shall add a few instances.

Platernus mentions some, who have died apoplectic from violent exertions in dancing; and Dr. Mead, in his Essay on Poisons, records a patient in the hydrophobia, who at one effort broke the cords which bound him, and at the same instant expired. And it is probable, that those, who have expired from immoderate laughter, have died from this paralysis consequent to violent exertion. Mrs. Scott of Stafford was walking in her garden in perfect health with her neighbour Mrs. ----; the latter accidentally fell into a muddy rivulet, and tried in vain to disengage herself by the a.s.sistance of Mrs. Scott's hand. Mrs. Scott exerted her utmost power for many minutes, first to a.s.sist her friend, and next to prevent herself from being pulled into the mora.s.s, as her distressed companion would not disengage her hand.

After other a.s.sistance was procured by their united screams, Mrs. Scott walked to a chair about twenty yards from the brook, and was seized with an apoplectic stroke: which continued many days, and terminated in a total loss of her right arm, and her speech; neither of which she ever after perfectly recovered.

It is said, that many people in Holland have died after skating too long or too violently on their frozen ca.n.a.ls; it is probable the death of these, and of others, who have died suddenly in swimming, has been owing to this great quiescence or paralysis; which has succeeded very violent exertions, added to the concomitant cold, which has had greater effect after the sufferers had been heated and exhausted by previous exercise.

I remember a young man of the name of Nairne at Cambridge, who walking on the edge of a barge fell into the river. His cousin and fellow-student of the same name, knowing the other could not swim, plunged into the water after him, caught him by his clothes, and approaching the bank by a vehement exertion propelled him safe to the land, but that instant, seized, as was supposed, by the cramp, or paralysis, sunk to rise no more. The reason why the cramp of the muscles, which compose the calf of the leg, is so liable to affect swimmers, is, because these muscles have very weak antagonists, and are in walking generally elongated again after their contraction by the weight of the body on the ball of the toe, which is very much greater than the resistance of the water in swimming. See Section XVIII. 15.

It does not follow that every apoplectic or paralytic attack is immediately preceded by vehement exertion; the quiescence, which succeeds exertion, and which is not so great as to be termed paralysis, frequently recurs afterwards at certain periods; and by other causes of quiescence, occurring with those periods, as was explained in treating of the paroxysms of intermitting fevers; the quiescence at length, becomes so great as to be incapable of again being removed by the efforts of volition, and complete paralysis is formed. See Section x.x.xII. 3. 2.

Many of the paralytic patients, whom I have seen, have evidently had diseased livers from the too frequent potation of spirituous liquors; some of them have had the gutta rosea on their faces and b.r.e.a.s.t.s; which has in some degree receded either spontaneously, or by the use of external remedies, and the paralytic stroke has succeeded; and as in several persons, who have drank much vinous spirits, I have observed epileptic fits to commence at about forty or fifty years of age, without any hereditary taint, from the stimulus, as I believed, of a diseased liver; I was induced to ascribe many paralytic cases to the same source; which were not evidently the effect of age, or of unacquired debility. And the account given before of dropsies, which very frequently are owing to a paralysis of the absorbent system, and are generally attendant on free drinkers of spirituous liquors, confirmed me in this opinion.

The disagreeable irritation of a diseased liver produces exertions and consequent quiescence; these by the accidental concurrence of other causes of quiescence, as cold, solar or lunar periods, inanition, the want of their usual portion of spirit of wine, at length produces paralysis.

This is further confirmed by observing, that the muscles, we most frequently, or most powerfully exert, are most liable to palsy; as those of the voice and of articulation, and of those paralytics which I have seen, a much greater proportion have lost the use of their right arm; which is so much more generally exerted than the left.

I cannot dismiss this subject without observing, that after a paralytic stroke, if the vital powers are not much injured, that the patient has all the movements of the affected limb to learn over again, just as in early infancy; the limb is first moved by the irritation of its muscles, as in stretching, (of which a case was related in Section VII. 1. 3.) or by the electric concussion; afterwards it becomes obedient to sensation, as in violent danger or fear; and lastly, the muscles become again a.s.sociated with volition, and gradually acquire their usual habits of acting together.

Another phaenomenon in palsies is, that when the limbs of one side are disabled, those of the other are in perpetual motion. This can only be explained from conceiving that the power of motion, whatever it is, or wherever it resides, and which is capable of being exhausted by fatigue, and acc.u.mulated in rest, is now less expended, whilst one half of the body is capable of receiving its usual proportion of it, and is hence derived with greater ease or in greater abundance into the limbs, which remain unaffected.

II. 1. The excess or defect of voluntary exertion produces similar effects upon the sensual motions, or ideas of the mind, as those already mentioned upon the muscular fibres. Thus when any violent pain, arising from the defect of some peculiar stimulus, exists either in the muscular or sensual systems of fibres, and which cannot be removed by acquiring the defective stimulus; as in some const.i.tutions convulsions of the muscles are produced to procure a temporary relief, so in other const.i.tutions vehement voluntary exertions of the ideas of the mind are produced for the same purpose; for during this exertion, like that of the muscles, the pain either vanishes or is diminished: this violent exertion const.i.tutes madness; and in many cases I have seen the madness take place, and the convulsions cease, and reciprocally the madness cease, and the convulsions supervene. See Section III. 5. 8.

2. Madness is distinguishable from delirium, as in the latter the patient knows not the place where he resides, nor the persons of his friends or attendants, nor is conscious of any external objects, except when spoken to with a louder voice, or stimulated with unusual force, and even then he soon relapses into a state of inattention to every thing about him. Whilst in the former he is perfectly sensible to every thing external, but has the voluntary powers of his mind intensely exerted on some particular object of his desire or aversion, he harbours in his thoughts a suspicion of all mankind, lest they should counteract his designs; and while he keeps his intentions, and the motives of his actions profoundly secret; he is perpetually studying the means of acquiring the object of his wish, or of preventing or revenging the injuries he suspects.

3. A late French philosopher, Mr. Helvetius, has deduced almost all our actions from this principle of their relieving us from the ennui or taedium vitae; and true it is, that our desires or aversions are the motives of all our voluntary actions; and human nature seems to excel other animals in the more facil use of this voluntary power, and on that account is more liable to insanity than other animals. But in mania this violent exertion of volition is expended on mistaken objects, and would not be relieved, though we were to gain or escape the objects, that excite it. Thus I have seen two instances of madmen, who conceived that they had the itch, and several have believed they had the venereal infection, without in reality having a symptom of either of them. They have been perpetually thinking upon this subject, and some of them were in vain salivated with design of convincing them to the contrary.

4. In the minds of mad people those volitions alone exist, which are unmixed with sensation; immoderate suspicion is generally the first symptom, and want of shame, and want of delicacy about cleanliness.

Suspicion is a voluntary exertion of the mind arising from the pain of fear, which it is exerted to relieve: shame is the name of a peculiar disagreeable sensation, see Fable of the Bees, and delicacy about cleanliness arises from another disagreeable sensation. And therefore are not found in the minds of maniacs, which are employed solely in voluntary exertions. Hence the most modest women in this disease walk naked amongst men without any kind of concern, use obscene discourse, and have no delicacy about their natural evacuations.

5. Nor are maniacal people more attentive to their natural appet.i.tes, or to the irritations which surround them, except as far as may respect their suspicions or designs; for the violent and perpetual exertions of their voluntary powers of mind prevents their perception of almost every other object, either of irritation or of sensation. Hence it is that they bear cold, hunger, and fatigue, with much greater pertinacity than in their sober hours, and are less injured by them in respect to their general health. Thus it is a.s.serted by historians, that Charles the Twelfth of Sweden slept on the snow, wrapped only in his cloak, at the siege of Frederickstad, and bore extremes of cold and hunger, and fatigue, under which numbers of his soldiers perished; because the king was insane with ambition, but the soldier had no such powerful stimulus to preserve his system from debility and death.

6. Besides the insanities arising from exertions in consequence of pain, there is also a pleasurable insanity, as well as a pleasurable delirium; as the insanity of personal vanity, and that of religious fanaticism. When agreeable ideas excite into motion the sensorial power of sensation, and this again causes other trains of agreeable ideas, a constant stream of pleasurable ideas succeeds, and produces pleasurable delirium. So when the sensorial power of volition excites agreeable ideas, and the pleasure thus produced excites more volition in its turn, a constant flow of agreeable voluntary ideas succeeds; which when thus exerted in the extreme const.i.tutes insanity.

Thus when our muscular actions are excited by our sensations of pleasure, it is termed play; when they are excited by our volition, it is termed work; and the former of these is attended with less fatigue, because the muscular actions in play produce in their turn more pleasurable sensation; which again has the property of producing more muscular action. An agreeable instance of this I saw this morning. A little boy, who was tired with walking, begged of his papa to carry him. "Here," says the reverend doctor, "ride upon my gold-headed cane;" and the pleased child, putting it between his legs, gallopped away with delight, and complained no more of his fatigue. Here the aid of another sensorial power, that of pleasurable sensation, superadded vigour to the exertion of exhausted volition. Which could otherwise only have been excited by additional pain, as by the lash of slavery. On this account where the whole sensorial power has been exerted on the contemplation of the promised joys of heaven, the saints of all persecuted religions have borne the tortures of martyrdom with otherwise unaccountable firmness.

7. There are some diseases, which obtain at least a temporary relief from the exertions of insanity; many instances of dropsies being thus for a time cured are recorded. An elderly woman labouring with ascites I twice saw relieved for some weeks by insanity, the dropsy ceased for several weeks, and recurred again alternating with the insanity. A man afflicted with difficult respiration on lying down, with very irregular pulse, and oedematous legs, whom I saw this day, has for above a week been much relieved in respect to all those symptoms by the accession of insanity, which is shewn by inordinate suspicion, and great anger.

In cases of common temporary anger the increased action of the arterial system is seen by the red skin, and increased pulse, with the immediate increase of muscular activity. A friend of mine, when he was painfully fatigued by riding on horseback, was accustomed to call up ideas into his mind, which used to excite his anger or indignation, and thus for a time at least relieved the pain of fatigue. By this temporary insanity, the effect of the voluntary power upon the whole of his system was increased; as in the cases of dropsy above mentioned, it would appear, that the increased action of the voluntary faculty of the sensorium affected the absorbent system, as well as the secerning one.

8. In respect to relieving inflammatory pains, and removing fever, I have seen many instances, as mentioned in Sect. XII. 2. 4. One lady, whom I attended, had twice at some years interval a locked jaw, which relieved a pain on her sternum with peripneumony. Two other ladies I saw, who towards the end of violent peripneumony, in which they frequently lost blood, were at length cured by insanity supervening. In the former the increased voluntary exertion of the muscles of the jaw, in the latter that of the organs of sense, removed the disease; that is, the disagreeable sensation, which had produced the inflammation, now excited the voluntary power, and these new voluntary exertions employed or expended the superabundant sensorial power, which had previously been exerted on the arterial system, and caused inflammation.

Another case, which I think worth relating, was of a young man about twenty; he had laboured under an irritative fever with debility for three or four weeks, with very quick and very feeble pulse, and other usual symptoms of that species of typhus, but at this time complained much and frequently of pain of his legs and feet. When those who attended him were nearly in despair of his recovery, I observed with pleasure an insanity of mind supervene: which was totally different from delirium, as he knew his friends, calling them by their names, and the room in which he lay, but became violently suspicious of his attendants, and calumniated with vehement oaths his tender mother, who sat weeping by his bed. On this his pulse became slower and firmer, but the quickness did not for some time intirely cease, and he gradually recovered. In this case the introduction of an increased quant.i.ty of the power of volition gave vigour to those movements of the system, which are generally only actuated by the power of irritation, and of a.s.sociation.

Another case I recollect of a young man, about twenty-five, who had the scarlet-fever, with very quick pulse, and an universal eruption on his skin, and was not without reason esteemed to be in great danger of his life. After a few days an insanity supervened, which his friends mistook for delirium, and he gradually recovered, and the cuticle peeled off. From these and a few other cases I have always esteemed insanity to be a favourable sign in fevers, and have cautiously distinguished it from delirium.

III. Another mode of mental exertion to relieve pain, is by producing a train of ideas not only by the efforts of volition, as in insanity; but by those of sensation likewise, as in delirium and sleep. This mental effort is termed reverie, or somnambulation, and is described more at large in Sect. XIX. on that subject. But I shall here relate another case of that wonderful disease, which fell yesterday under my eye, and to which I have seen many a.n.a.logous alienations of mind, though not exactly similar in all circ.u.mstances. But as all of them either began or terminated with pain or convulsion, there can be no doubt but that they are of epileptic origin, and const.i.tute another mode of mental exertion to relieve some painful sensation.

1. Master A. about nine years old, had been seized at seven every morning for ten days with uncommon fits, and had had slight returns in the afternoon. They were supposed to originate from worms, and had been in vain attempted to be removed by vermifuge purges. As his fit was expected at seven yesterday morning, I saw him before that hour; he was asleep, seemed free from pain, and his pulse natural. About seven he began to complain of pain about his navel, or more to the left side, and in a few minutes had exertions of his arms and legs like swimming. He then for half an hour hunted a pack of hounds; as appeared by his hallooing, and calling the dogs by their names, and discoursing with the attendants of the chase, describing exactly a day of hunting, which (I was informed) he had witnessed a year before, going through all the most minute circ.u.mstances of it; calling to people, who were then present, and lamenting the absence of others, who were then also absent. After this scene he imitated, as he lay in bed, some of the plays of boys, as swimming and jumping. He then sung an English and then an Italian song; part of which with his eyes open, and part with them closed, but could not be awakened or excited by any violence, which it was proper to use.

After about an hour he came suddenly to himself with apparent surprise, and seemed quite ignorant of any part of what had pa.s.sed, and after being apparently well for half an hour, he suddenly fell into a great stupor, with slower pulse than natural, and a slow moaning respiration, in which he continued about another half hour, and then recovered.