Observations on Maniacal Disorder

Reverend William Pargeter, Stanley Jackson

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781136089329
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

First Published in 1989. Current interest in the history of psychiatry is growing rapidly both among the psychiatric profession and social historians. This new series is designed to bring back into print many classic documents from earlier centuries. Each reprint has been chosen for the series because of its social and intellectual significance, and includes a substantial introduction written by an eminent scholar in the history of psychiatry. This volume contains 'Observations on Maniacal Disorders', by William Pargeter (1760-1810), and reflects change in therapeutic philosophy.

OBSERVATIONS

ON

Maniacal Disorders.

THE summit of luxury to which the present age has attained, must naturally tend to interrupt the regularity of the animal economy, and to enfeeble the generations of men. But the improvements which the practice of medicine and the enquiry into the structure of the human frame have received of late years, afford a strong presumption, that disease has arrived at the height of its dominion, and that mankind may at length regain the energy and longevity of their ancestors. It must, however, be acknowledged, that the hideous malady which so amazingly prevails at this day, should seem to denote, that we have made no very considerable advances towards the recovery of cur ancient vigour: and it must excite a reflection as humiliating to the pride of science, as painful to the feelings of philanthropy, that in the course of almost three thousand years no medicines have been discovered on which any reliance can be placed.

It would be almost too shocking to portray the real features of this terrible complaint; yet, in order to a conception of it, they ought in some measure to be contemplated. Let us then figure to ourselves the situation of a fellow creature destitute of the guidance of that governing principle, reason—which chiefly distinguishes us from the inferior animals around us, and gives us a striking superiority over the beasts that perish. View man deprived of that noble endowment, and fee in how melancholy a posture he appears. He retains indeed the outward figure of the human species, but like the ruins of a once magnificent edifice, it only serves to remind us of his former dignity, and fills us with gloomy reflections for the loss of it, Within, all is confused and deranged, every look and expression testifies internal anarchy and disorder. The wretched victim now triumphs in imaginary pleasures, and is now tortured with ideal woes—his distempered fancy transforms his best friends into the bitterest enemies, and he views them with implacable aversion or with disdain—he swells with pomp, or shrinks with terror, sometimes breathing menaces against his opposers, and sometimes trembling with apprehensions of their displeasure. He now relapses into fullen insensibility —the delirium, again returns, and he raves with all the vehemence of exasperated fury—far from attending to his own preservation, he is incapable of using the least effort for his safety —reduced to the mental weakness of a child, he is indebted to the friendly care and precaution of others for his very existence. Without this necessary interposition, the wretched sufferer would but too frequently execute deliberate vengeance on himself, and thus end his miseries and his life together. What then can be more melancholy—what misfortune more afflictive, than to labour under the pressure of this dreadful malady?

The frequency of this disease renders it truly alarming—it should therefore be one of the first objects of the physician’s meditation and research; and though it has been treated of by many authors of note, it must be acknowledged that their compositions betray much confusion and contradiction—and it may be suspected, that in practice, by too generally attending to appearances, and overlooking the causes, physicians have, with a pardonable but hafty zeal to do every thing, sometimes done much harm.

The Nosologists of the present era are far from being consistent in their arrangement of the several genera of this disease. Professor Cullen in his Nosology of Mania, has with the greatest propriety altered the arrangement of the two genera Mania et Melancholia, which Linœus and others have adopted, and comprehends his idea of the complaint in two words— Insanta Universalis. — Synop. Nos. Method, G. LXVII.

The doctrine of Mania includes in some degree that of Melancholia, consequently they cannot be generically different. Melancholia often arises to so high a degree as nearly to be confounded with Mania. The learned Dodonœus observes well, by faying “Madness and Melancholy are so nearly allied, that oftentimes Madness turns to Melancholy, and frequently the beginning of Melancholy assumes the appearance of Madness.” The distinction is so difficult, that if I was to attempt it, you would probably apply to me the words of Parmeno in the Eunuch:

Incerta hæc si tu postules

Ratione certa facere, nihilo plus agas,

Quam si des operam, ut cum ratione insanies.

TER. EUN. ACT I. SC. I.

Practical writers have generally distinguished Mania by the fury, impetuosity, and angry temper attending it—but such a complaint may take place without any impetuosity. The term furibunda, which Linœus has admitted into his character of Mania, should be left out, because I have often seen Maniacs, who at different times were furious and peaceful, without any remission of the essential characteristic symptoms of the disorder Insania Universalis—but in lower degrees of Melancholia, the error of the intellectual power is confined principally, often entirely to one subject.

The Professor takes notice of two states of the brain; the one he terms excitement—the other collapse. Collapse may be defined a morbid diminution of the tone of the brain, and of the motion of the nervous fluid. The term excitement must be obvious to every one. I am inclined to be of opinion, that collapse or undue excitement, takes place, more or less, in every species of Mania. It is manifestly perceptible, from the consideration of the states of sound sleep and dreaming, that different parts of the brain, or different faculties of the intellect, can be in different degrees of excitement at the same time. The delirium occurring at falling asleep, or at first waking out of sleep, shews, that the perfect exercise of our intellectual faculties requires some equality in the excitement of every part of the brain; and the delirium in the instances above mentioned, seems to depend on an unequal excitement of the different parts. To apply these propositions to our present purpose, we may observe, that sometimes a collapse of one part of the brain interrupts the communication of the due excitement of the whole, and thus induces delirium. Any excess, especially a partial excess of excitement will have the same effect; for the regular order and succession of ideal, with which judgement is immediately connected, depends upon a certain degree or measure in the force and velocity with which these ideas take place, and therefore it is, that every cause of hurry throws us into confusion, which is a momentary and slight degree of Mania. Every sudden emotion is liable to have this effect, and some emotions produce it more permanently. Thus we shew that an uncommonly encreased excitement of the brain, is a principal circumstance in Mania—a position which I think is confirmed by the increased impetus of the blood, a common cause of too great excitement of the brain inducing delirium in phrenitis, and fever; for the delirium occuring in these cases, can only be explained upon this principle. To put it beyond all doubt, we may observe, that in most instances of Mania, in every instance of the Mania furibunda, a violently encreased excitement is manifest from the increase of strength and vigour which takes place; of which have been seen many wonderful instances, even in females, before weak and delicate. Another proof of this position is, that Maniacs resist: all those sedative powers which in natural health are so remarkable for inducing sleep. They sustain watching for an almost incredible length of time. Another proof may be deduced from their insensibility to the power of cold ; they feel no bad effects from its impressions; they resist indeed impressions of every kind: this perhaps may be no proof of an excited state of the brain. They resist also, for the most part, the power of opium, and those anodynes which render the nervous power immovable by ordinary impresions. It has been alledged, that every tone of the mind has a state of the body corresponding with it; if it is the case, I think the fury of Maniacs is a mark of a strongly excited state of the mind, and therefore of the brain: the same takes place in the paroxysms of anger, which is furor brevis. The Mania furibunda depends more manifestly upon a greater excitement, probably affecting every part of the brain. In the Mania tranquilla, probably a great degree of collapse affects one part of the brain, while other parts are unusually excited, or even the common degrees of excitement remains in these : for an inequality of the excitement of the brain will disturb the exercise of the intellectual functions, as much as a violent increase of it—but the phenomena attending this state will not be so evident as dreadful.

We are acquainted with many of the proximate causes of Mania, but whether they operate directly by inducing collapse, or by bringing on an increased excitement, is not determined. The principal of these are, various topical affections of the brain—watry effusions—obscure schirri—preternatural ossifications—and numerous causes of increased impetus of the blood in the head. Many cases of Mania are short and transitory, and admit of very sudden changes —these certainly are not dependant on any organic affection—others continue through life; it is equally improbable, that any organic affection is here present: many are cured, and frequently relapse; this gives us some suspicion of a peculiar affection of the brain; but we are not clear concerning the nature of this state. There must indeed be in every case of Mania, in all probability, some peculiar corporeal morbid state, with which that peculiar state of the mind is connected; and it is more than probable, that the corporeal part affected is the brain.

It may therefore be proper, before we proceed to the consideration of the remote causes of Mania, to investigate the state of the brain, which at that time takes place. The sum of all the observations made before Boerhaave’s time, by dissections, are given in his Aphorism, 1121, “And we must take notice, that by anatomical inspection it has been made evident, that the brain of those is dry, hard, friable, and yellow in its cortex ; but the vessels turgid...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Introduction
• Original Half Title Page
• Original Title Page
• Preface
• Errata
• Observations on Maniacal Disorders