AN ENQUIRY, &c.

IN compliance with the requeſt which you urged in ſo obliging a manner, I am now to preſent you with a few re⯑marks on the nature, cauſes, and method of cure, of Nervous Diſorders. Under this denomination, in its full extent, are included ſeveral diſeaſes of the moſt dan⯑gerous kind; as the apoplexy, epilepſy, and convulſions, beſide the hyſteric paſ⯑ſion and hypochondriacal diſeaſe. The enquiry, however, ſhall be reſtricted to thoſe complaints more particularly deno⯑minated nervous, and which ſeem to de⯑pend [2]upon extreme ſenſibility of conſti⯑tution. But the nerves being the baſis of our ſubject, it may be proper to pre⯑miſe a few words on thoſe delicate parts of the human frame, univerſally admit⯑ted to be the medium of intercourſe to the body and ſoul.

The nerves are minute ramifications, reſembling chords; proceeding either from the brain or the ſpinal marrow, and diſ⯑tributed to the various parts of the body, for the purpoſes of ſenſation and motion. With regard to their ſtructure anatomiſts are divided; ſome holding them exqui⯑ſitely fine tubes; others, filaments with⯑out any cavity. The former hypotheſis, countenanced alike by experiment and analogy, is conſequently far the more probable. Thoſe who maintain the tubu⯑lar formation, conclude that the nerves are furniſhed with a fluid ſecreted in the brain, and known by the name of animal ſpirits.

Nervous complaints are ſo various and eccentric, that a volume would hardly ſuffice to a complete deſcription of them. The moſt common ſymptoms are, weak⯑neſs, flatulence, palpitations, watchful⯑neſs, ſleepineſs after eating, timidity, flaſhes of heat and cold, numbneſs, ri⯑gors of different parts, vertigo, pains, eſpecially of the head, back, and loins, hiccup, difficulty of reſpiration and de⯑glutition, anxiety, dry cough, limpid urine, &c.

An opinion prevails that nervous diſ⯑orders are more frequent in this country at preſent, than in any former period. This is commonly imputed to the drink⯑ing of tea, now ſo general among people of all ranks. Whether this celebrated exotic really proves ſo injurious as has been imagined, may ſtill be matter of diſpute. That in many conſtitutions it excites nervous ſymptoms, ſuch as tre⯑mors, palpitations, and watchfulneſs, we [4]are certain from experience; but we alſo know that in others it is regularly taken, not only without any ſenſible bad effects, but even with advantage. It relieves a headake, diſpels drowſineſs, and is often obſerved to promote digeſtion.

Should we examine the whole econo⯑my of perſons moſt addicted to tea-drink⯑ing, at leaſt of thoſe who are imagined to be chiefly affected by it, perhaps we might diſcover other probable cauſes of weakneſs. The numerous modes of in⯑dulgence practiſed in times of refinement and luxury, ought all to be allowed their reſpective ſhare in producing this effect. The farther we depart from ſimplicity and temperance in diet, and the more we ſacrifice the wholeſome exerciſes to the inactivity attending domeſtic amuſe⯑ments, the greater will be the influence of every phyſical error in diminiſhing the vigor of the conſtitution.

When we conſider that thoſe cauſes have more or leſs operated, at ſome pe⯑riod or other, in every country where re⯑finement has any time exiſted; and when we take into the account the numerous cauſes of weakneſs which have ariſen from accident or diſeaſe, there might ſeem reaſon for concluding, that in the ſpace of ſome thouſand years, the conſtitution of man has undergone an extraordinary change. But ſuch an opinion, however plauſible, is much to be queſtioned. On a ſubject of this nature we can draw no argument from experience. The vigor of one age has declined, before that of another has arrived at maturity; and no ſtandard is tranſmitted, by which we may determine the comparative ſtrength of ge⯑nerations. Perhaps it will be ſaid, that this point has long been ſettled by the poets.

Virgil, with a noble boldneſs, multiplies the number into twelve. Of the ſtone which Turnus lifted, to throw at Aeneas, he ſays,

Had the human race degenerated, ſince the Auguſtan age, in the ſame progreſ⯑ſion, to what a degree of weakneſs muſt mankind have by this time dwindled!

If the problem were determinable by facts, it would be ſo by inſtances of lon⯑gevity; but even thoſe are far from being deciſive. There is reaſon to doubt whe⯑ther longevity be a certain criterion of uncommon vigor. Perhaps it may be aſcribed rather to ſoundneſs of conſtitu⯑tion than to ſuperior ſtrength. Admitting the poetic authorities in favor of the primitive ages; admitting the extraordi⯑nary muſcular force of a Hector, a Tur⯑nus, or a Hercules; ſtill the vigor of thoſe heroes can reflect no general luſtre on the times in which they lived; nay their fame implies a great inferiority of the contemporary inhabitants of the world.

But to diſpute with former ages the palm of conſtitutional vigor, is not the object of enquiry. The ſpeculation could only be ſo far uſeful as it might enable us to aſcertain what circumſtances in the modern way of living appear the moſt ſubverſive of corporeal ſtrength. The [8]diſtinctions characteriſtic of faſhionable life are idleneſs and intemperance; the never-failing concomitants of high re⯑finement. Celſus obſerves that thoſe two vices had firſt ſpoiled the conſtitution of the Greeks, and afterwards of his coun⯑trymen the Romans, when they had be⯑come maſters of the luxury, as well as the territories, of that polite people. In ſimilar circumſtances, the ſame cauſes have ſimilarly operated; and their united in⯑fluence may, independently of any parti⯑cular ſpecies of modern luxury, continue to produce the ſame effects.

It is univerſally admitted, that the pre⯑diſpoſing cauſe of nervous diſorders is too great irritability of conſtitution, which may be either hereditary, or acquired in various ways; for inſtance, by a ſeden⯑tary life, too great application to ſtudy, intemperance of any kind, tedious diſ⯑eaſes, profuſe evacuations, or the depreſſ⯑ing paſſions.

Nervous diſtempers are alike incidental to both ſexes; with only this difference, that in the female, from the natural de⯑licacy of conſtitution, and the manner of life, they are, in general, more frequent and violent than in the other. Being pe⯑culiar to neither ſex, they are not reſtrict⯑ed to any period of life; but uſually moſt prevalent during the middle ſtages of it.

Though a weakneſs of the nervous ſyſtem be often hereditary, it ſeldom re⯑ceives any augmentation in the earlier part of life; the playfulneſs of children, and their exemption from cares, at leaſt from ſuch as are productive of habitual anxiety, counteracting the progreſs of the diſpoſition. The ſame cauſes may con⯑tinue to operate after the commencement of adult age, unleſs menſtrual irregulari⯑ties in one ſex, or pernicious exceſſes in the other, call forth the latent ſeeds of conſtitutional debility.

At whatever period the diſorder firſt appears, its progreſs in different perſons is liable to great variation. In ſome it remains a ſtationary complaint, with in⯑termiſſions, however, but without exacer⯑bations, for ſeveral years; while in others it fluctuates through all the gradations, from the fainteſt ſymptom of ſpaſmodic affection, to its conſummation in the epi⯑lepſy, apoplexy, or hyſteric paſſion.

When but one cauſe ſtimulates nervous affection, the health may not be greatly impaired for a time: but when two or more operate in conjunction; for in⯑ſtance, when to a ſedentary life is joined the influence of grief or anxiety; and when watchfulneſs, the natural concomi⯑tant of each, is rendered more obſtinate by the combination of all; the ſtrength muſt faſt decline, and the diſeaſe advance with proportionable rapidity.

An eminent author has obſerved, that there is ſcarce a diſeaſe which the ner⯑vous ailment will not counterfeit: he might have added, that there is hardly any which it may not realize. The debilitat⯑ed ſtate of the concoctive powers, and the general conſequent relaxation, are par⯑ticularly favorable to the production of chronic diſorders; while the irritability of the nervous ſyſtem no leſs diſpoſes to thoſe of the acute kind.

When a weakneſs of the nerves is he⯑reditary, the origin of their diſeaſes is loſt in the general debility of the ſyſtem: but if it has been acquired by errors in what are called the non-naturals, the be⯑ginning of thoſe complaints may, for the moſt part, be traced to a weakneſs of the ſtomach and bowels; whence if thoſe diſ⯑eaſes do not actually derive their earlieſt exiſtence, at leaſt the ſigns of their inva⯑ſion are there moſt perceptible. They commonly begin with an oppreſſion, [12]and ſenſe of fullneſs in the ſtomach after eating: the ſleep is much interrupted with dreams: frequently the perſon feels a ſlight pain in the ſtomach or belly. Thoſe ſymptoms are at times accompanied with a ſinging in the ears, and with fits of gid⯑dineſs, particularly in ſtooping.

That a diſeaſe which depends upon ir⯑ritability, and is ſupported by a ſympathy in the nervous ſyſtem, derives its origin from the ſtomach and bowels, is an opi⯑nion ſtrongly confirmed by the texture and offices of thoſe parts. Furniſhed with numerous branches of nerves, they are ex⯑tremely ſuſceptible of irritation; to which they are alſo particularly expoſed from the weight or reſiſtance of the food, its occa⯑ſional acrimony, and the ſtimulating na⯑ture of the gaſtric fluids, rendered yet more acrimonious by vitiated digeſtion.

At the beginning of the diſorder, be⯑fore the patient has either been cautioned [13]by the phyſician, or inſtructed by experi⯑ence, to abſtain from a hearty ſupper, it is not uncommon for this indulgence to be ſucceeded, in the night, by a great op⯑preſſion about the heart and ſtomach. This ſtate is frequently accompanied with a convulſive motion of the tongue and jaws; during which the former lolls out, and is expoſed to the gnaſhing of the teeth.

When a great weakneſs of the ſtomach and bowels has been introduced, many are the occaſional cauſes of irritation from which nervous ſymptoms may enſue. In general, whatever, by quantity or qua⯑lity, relaxes the ſolids, or by acrimony ſtimulates into ſpaſms; whatever dimi⯑niſhes the energy, or excites to irregu⯑lar motion, of the animal ſpirits, tends either immediately or remotely to the pro⯑duction of nervous diſorders.

The occaſional cauſes may be divided into the following claſſes: 1. Wind, phlegm, worms, or acrid matter, in the firſt paſſages. 2. Acrid matter in the blood. 3. The diminution or ſuppreſſion of ſome accuſtomed diſcharge. 4. Inani⯑tion, whether occaſioned by abſtinence or evacuation. 5. Violent paſſions. 6. Ob⯑ſtructions in the abdominal viſcera. 7. The effluvia of ſome odorous ſubſtances.

Though thoſe cauſes may operate ſing⯑ly towards the production of nervous ſymptoms, it is not uncommon for two or more of them to act at the ſame time, and when this happens, the diſorder which they excite in the animal economy, as has been already obſerved, is propor⯑tionably violent.

Of all the cauſes of nervous complaints, none is more pernicious than profuſe ſe⯑minal evacuation. It has been alledged that this diſcharge always accompanies a [15]chronic weakneſs: the remark is per⯑haps not ſufficiently confirmed by autho⯑rities. When ſuch a caſe occurs, there is reaſon to ſuſpect that the ſeminal weakneſs had preceded the nervous diſ⯑order. On the appearance of the latter, however, the former is liable to be in⯑creaſed.

In attempting the removal of the nerv⯑ous complaint, the greateſt attention is neceſſary to inveſtigate the preciſe origin, whether ſingular or plural, whence it de⯑rives its ſupport: for without ſuch know⯑ledge, in vain ſhall we endeavor to pre⯑vent the effects of irritation. With every advantage on our ſide, we ſhall often have occaſion to regret the obſtinacy of the diſ⯑eaſe. Indeed, that nervous diſorders ſhould prove difficult of cure, will not appear ſurpriſing, when we conſider how much they are diſtinguiſhed by a variety of oppoſite indications and circumſtances, [16]of a poſitive and negative, of a phyſical and moral kind. Amidſt the neceſſity of nouriſhment, is every impediment to di⯑geſtion. The impurity of the blood we find aggravated by great irregularity of the diſcharges. Sleep, however indiſpenſ⯑able for recruiting the exhauſted ſtrength, in many caſes comes not ſpontaneouſly; nor can it be procured by medicine, with⯑out increaſing relaxation. Exerciſe, ab⯑ſolutely neceſſary, is often prevented by a liſtleſſneſs, utterly averſe to motion. In morbid irritability, which requires the moſt ſoothing treatment, the patient is peculiarly liable to perturbations of body and mind. Notwithſtanding incidental or habitual lowneſs of ſpirits, which ſeems to indicate the expedience of ſome exhilarating liquor, even the moderate uſe of cordials may be neither effectual nor ſafe. Anxiety, natural to the com⯑plaint, and increaſed by every conſidera⯑tion, muſt yet be ſupported with patience. [17]And laſtly, though ſo complicated a diſ⯑temper might ſeem to demand the moſt active remedies, it is often obſerved to be aggravated even by thoſe of the gent⯑leſt kind.

It may well be imagined, that a diſ⯑eaſe which for the moſt part originates from an irritability of the alimentary ca⯑nal, or is always accompanied with it, requires particular attention to diet. In no other chronic diſorder is a dietetic re⯑ſtriction equally indiſpenſable: for the perſon who would either ſtop the com⯑plaint, or obtain a recovery, muſt be not only temperate, but circumſpect, in all convivial gratifications. The infinite di⯑verſity of temperaments renders it im⯑poſſible to deliver rules accommodated to every individual; but in general, the re⯑gimen of thoſe who are ſubject to ner⯑vous complaints may be compriſed under the following directions. — The food ought to be eaſy of digeſtion, and chief⯑ly [18]of the animal kind: vegetables, on account of the flatulence they occaſion, being commonly hurtful. Paſtry-work, and butter-ſauces, are prejudicial; as are likewiſe fat meats. Even bread ſhould be eaten ſparingly, and never on the day that i [...] is baked: for, if new, it occaſions a great fermentation in the ſtomach. Wine, for the moſt part, cauſes diſtur⯑bance, if not in the ſtomach, at leaſt in the bowels of the valetudinary. The ſame may be obſerved of malt-li⯑quors: but to ſome conſtitutions porter, in the quantity of half a pint, or not ex⯑ceeding a pint, is often found ſalutary. For the majority, however, of the nerv⯑ous, water, either alone, or mixt with a ſmall portion of brandy, which is lighter on the ſtomach than rum, is the beſt adapted drink. Whatever kind is uſed, dilution ſhould always be moderate. Sup⯑per ought either to be omitted, or taken in a very ſparing quantity, and at an ear⯑ly hour.

This attention is the more neceſſary, as errors committed in diet never fail to affect the nightly reſt; a conſideration of the greateſt importance. For, though di⯑geſtion may have hitherto proceeded with⯑out much uneaſineſs, yet when its pro⯑greſs is retarded by a recumbent poſture, which alſo greatly impedes the diſcharge of flatulence from the ſtomach; when the aliments, by retention in the bowels, have acquired a more conſiderable degree of acrimony; and when the body, by the relaxing warmth of the bed, is rendered more ſuſceptible of irritation, ſleep, if not entirely prevented, which is ſometimes the caſe, is at leaſt ſo much interrupted as hardly to afford any refreſhment.

Previous to an account of the cure of nervous diſorders, it cannot be improper to make a few remarks on the method by which it has hitherto been uſually con⯑ducted. We know too little of the phy⯑ſiology of the nerves, to be intimately ac⯑quainted [20]with the nature and modifica⯑tions of their diſeaſes. Our theory is conjectural; and our practice, if not founded on principles too vague, is fre⯑quently indiſcriminate. Among the oc⯑caſional cauſes mentioned above, only a few may be ſafely oppoſed by an imme⯑diate recourſe to aſtringent and ſtrength⯑ening remedies: yet too often has this method been purſued under different cir⯑cumſtances of the complaint. Of this prepoſterous practice not the only ill con⯑ſequence is the fruitleſs adminiſtraction of corroborants: for the proceſs of cure be⯑ing commenced where it ought to have ended, the requiſite preparation is neglect⯑ed, and a foundation laid for the eſtabliſh⯑ment of the diſeaſe.

When nervous diſorders ariſe from in⯑anition, or from the ſuppreſſion of ſome accuſtomed diſcharge, their origin may be aſcertained from either of thoſe cauſes. If they proceed from the latter, the eva⯑cuation [21]ought to be recalled; if from the former, haſty repletion muſt be avoided. Without this caution the digeſtive powers will be oppreſſed, and a load of impure humours will be generated; which, by farther weakening the body, contaminat⯑ing the blood, and hazarding obſtructions in the bowels, will not only increaſe the original, but may give riſe to two other principal cauſes of the complaint.

If the weakneſs productive of nervous diſtreſs be owing to any ſudden and great evacuation, recourſe ſhould immediately be had to ſtrengthening remedies: but in all caſes, except the above, preparation is neceſſary; and the ſtomach being either primarily or ſecondarily affected, the treatment might do well to begin with a gentle vomit of ipecacuanha or camomile flowers. The next indication is a laxa⯑tive, to be repeated occaſionally through the courſe of the complaint, when the patient is ſubject to coſtiveneſs; a ſtate [22]that generally accompanies nervous diſ⯑orders, and always tends to increaſe them. In different caſes different laxatives are proper. When bilious humours cauſe ir⯑ritation, rhubarb may prove moſt ſuit⯑able; but if acid humours, as often, pre⯑dominate, a tea-ſpoonful or two of mag⯑neſia may be given, either alone, or mix⯑ed with a few grains of the former. All rough and violent purges are to be avoided, as they increaſe at once irritation and weakneſs.

After diſcharging from the ſtomach and bowels any acrid humours which may have occaſioned irritation, preſcription ſhould be adapted to the particular cauſe, or cauſes, ſuppoſed to produce or promote the diſeaſe. Thus, if there ſhould be rea⯑ſon to ſuſpect worms, anthelmintic me⯑dicines muſt be given. But when ob⯑ſtructions in the abdominal viſcera appear the cauſe of the diſorder, recourſe is to be had (after blooding, if the patient be [23]plethoric) to deobſtruent medicines; as the ſaponaceous, gum ammoniac, &c. with the uſe of warm fomentations. It is difficult, indeed, to aſcertain ſuch ob⯑ſtructions, unleſs, what ſeldom happens, the tumors be perceptible to the touch. But if the ſigns of weak digeſtion be at⯑tended with fixt pains in the belly, and a quick pulſe, without much heat or thirſt, the exiſtence of this cauſe may be pre⯑ſumed.

Of all the occaſional cauſes of nervous complaints, wind in the ſtomach or bowels is the moſt frequent, and that which uni⯑verſally excites the moſt troubleſome ſymptoms. For diſpelling it the uſual recourſe is carminatives: but, unleſs the wind be in the ſtomach, thoſe ſel⯑dom afford immediate relief; ſometimes they even aggravate the complaint. A more certain remedy is a tea-ſpoonful of the ſpiritus aethereus, diluted with two table-ſpoonfuls of water. For the ſame [24]end, nothing is more efficacious than opi⯑um, preſcribed with aſſa foetida; which proves equally ſucceſsful, whether the fla⯑tulence be in the ſtomach or inteſtines. In nervous diſorders, however, opiates are never to be given without great re⯑ſerve, as they impair the ſtrength, and increaſe the depreſſion of ſpirits, ſo com⯑mon in thoſe caſes. A glaſs of cold wa⯑ter, by contracting the muſcular coat of the ſtomach, will ſometimes immediately operate the diſcharge of flatulence. But ſhould this ſimple expedient prove inef⯑fectual, it muſt not again be attempted.

In oppreſſion from the above cauſe, ex⯑ternal applications may alſo be ſucceſsful. Much benefit has been received from rub⯑bing, at bed-time, upon the ſtomach and bel⯑ly, ſome of Bate's anodyne balſam, mixt with half its quantity of the expreſſed oil of mace, and a fourth part of the oil of mint. An antihyſteric plaſter may like⯑wiſe be employed with advantage.

It is adviſable for perſons troubled with flatulence to rub the belly a little, in a circular direction, in the morning, before getting up. For this purpoſe the hand were preferable to the fleſh-bruſh, did it not expoſe the joints of the fingers to ſwelling: a conſequence to which nerv⯑ous patients are peculiarly liable, and when it does take place, the pain is often inſtantaneouſly exaſperated, on taking the ſmalleſt quantity of wine, or any ſtrong liquor.

In flatulent complaints of the ſto⯑mach and bowels, to rub the legs fre⯑quently with a fleſh-bruſh has been found of good effect; which ſeems to be produced by exciting agreeable oſcillations. This exerciſe, however, ought not to be continued above a few minutes at a time; otherwiſe it is apt to occaſion languor, and increaſe irritabi⯑lity.

A ſymptom not uncommon with nerv⯑ous perſons is a coldneſs of the extremi⯑ties, particularly the feet. To this they are chiefly expoſed in the winter, when they ſit by a bad fire, and fix their atten⯑tion on any object. In ſuch circumſtances ſhould they venture to bed, the conſe⯑quence is almoſt certain that they will continue awake, until by ſome means or other the uneaſy ſenſation be removed. The beſt expedient is to chafe the feet with warm bricks, or any application cal⯑culated to anſwer the ſame purpoſe.

For the nervous pain in the ſmall of the back, ſometimes ſo acute that the patient can hardly ſtand upright, it is adviſable to fold round the body a napkin, which has either been warmed at the fire, or, what is better, likewiſe impregnated with the ſteams of myrrh, benzoin, and frank⯑incenſe, burnt on a ſhovel. In many caſes, this application gives almoſt inſtant relief.

The immediate cauſe of nervous diſor⯑ders appearing to be either a deficiency, or irregular motion, of the animal ſpirits, the moſt efficacious might ſeem to be ſuch medicines as exert the ſpeedieſt influence on the nervous ſyſtem. For whatever warms the ſtomach, and excites in it an agreeable ſenſation, affords a temporary relief. This remark may be thought to ſuggeſt the diſcrete uſe of cordials; which, doubtleſs, in ſome caſes, may have their propriety. Several reaſons concur, how⯑ever, to preſcribe with great moderation, where not entirely to prohibit the recourſe to thoſe remedies, whether of the vinous or of the ſpirituous kind. The former, by the fermentation they undergo in the ſtomach and bowels, are apt, as before obſerved, to create diſturbance in nervous habits; and the latter, it is well known, have an injurious effect on the viſcera. But when wine does not diſagree with the patient, and when ſpirituous liquors are ſufficient⯑ly diluted, it would be hard, in caſes ſo [28]entitled to ſympathy, to prohibit any pru⯑dent gratification.

In this diſeaſe, the beſt cordials are thoſe that have no immediate tendency to exhilarate, in the manner of intoxicating liquors; but ſuch as rather allay than ex⯑cite an irregular motion of the ſpirits, and enliven only by removing the obſtacles to their placid and equable exertion. For medicines to accompliſh this important purpoſe, have the various departments of nature been ranſacked. Long and whim⯑ſical was the preſcription of animal ſub⯑ſtances, and many the fruitleſs reſearches among the mineral tribes; until modern practice learned to place its dependence on the ſimples of the vegetable kingdom, and principally on thoſe of the fetid claſs. Happy recourſe, were its efficacy equally eſtabliſhed, and itſelf directed by more determinate rules. With the common method of adminiſtering thoſe remedies, however, ſmall is the reaſon to be ſatiſ⯑fied. Frequent is the practice to give [29]them at ſtated times, without conſidering whether they be duly indicated. The conſequence of ſuch repetition is, that they gradually loſe their ſedative and anti⯑ſpaſmodic power; an inconvenience againſt which we cannot be too guarded, in the treatment of ſo tedious a diſeaſe; where palliative remedies, though uſed only when requiſite, by habit become neceſſary to the conſtitution. Cautiouſly are we, therefore, to reſerve them for the more urgent ſymptoms; for languors, faint⯑ings, oppreſſion from flatulence, &c.

Fetid medicines, taken at bed-time, by aſſuaging nervous agitations, favor a diſ⯑poſition to ſleep. But they will be taken to no purpoſe, and may even increaſe perturbation, if the patient retire prema⯑turely to bed, while the gaſtric, or abdo⯑minal region is diſtended with flatulence. On thoſe occaſions, it is of great advan⯑tage to promote the diſcharge of wind from the ſtomach, by gentle preſſure with [30]the hand; which method ſhould alſo be practiſed ſitting up in bed, if uneaſineſs, from the ſame cauſe, be felt in a recum⯑bent poſture.

In proſecuting the radical cure of ner⯑vous complaints, the moſt efficacious re⯑medies are ſteel, the Peruvian bark, and the cold-bath. In ſome caſes, the two firſt may with propriety be combined; in others, one of them only can be adminiſ⯑tered with advantage. When the pulſe is ſlow, either may be given; if frequent, unleſs this ſymptom be occaſioned by weakneſs, ſteel eſpecially is unadviſable. It ought, however, to be remarked, that in thoſe diſorders, the pulſe is ſubject to great irregularity; and therefore, that no poſitive indication ſhould be drawn from it, without the concurrence of other cir⯑cumſtances. Both ſteel and bark are im⯑proper while the patient is plethoric, or afflicted with fixt pains in the belly. Cha⯑lybeate waters are indicated in the ſame [31]circumſtances with ſteel medicines, and may be found alike beneficial.

By nothing is the body more effectual⯑ly ſtrengthened than by the cold-bath, which ſhould, therefore, never be neglect⯑ed, when no particular circumſtance for⯑bids. To bathe three or four times a⯑week, is ſufficient; and at the end of every three months the practice ought to be intermitted, for a week or ten days; a caution alſo to be adopted with regard to the ſtrengthening medicines.

The method of uſing the cold-bath in ſummer and autumn, and the internal cor⯑roborants in the winter and ſpring, is li⯑able to exception. For the former, by far the more efficacious, is by this means too long interrupted, and in the ſeaſons when, if the bath be of freſh water, its influence is ſenſibly greater. A more ad⯑viſable method is to uſe the bath, with the bark and chalybeates, in ſhorter alterna⯑tions; [32]bathing two or three weeks, and then taking the medicines half that time. Nay, there lies no objection againſt the uſe of the Peruvian bark every day the perſon does not bathe; obſerving to inter⯑mit the medicine occaſionally for a few days. A light tincture of the bark, join⯑ed to bitters, may be uſed in this manner with ſucceſs.

When acids do not diſagree with the ſto⯑mach, twenty or thirty drops of the elixir of vitriol may be taken once or twice a⯑day, in a ſmall diſh of camomile or roſe⯑mary tea.

Beſide thoſe remedies, and a ſtrict at⯑tention to diet, it is neceſſary that the pa⯑tient uſe daily exerciſe; than which no⯑thing is more conducive to promote di⯑geſtion, facilitate ſleep, and reſtore to the conſtitution the poſſible degree of ſtrength. Both the kind and duration of exerciſe muſt be ſuited to the ſtate of the patient. [33]The moſt beneficial is riding on horſe⯑back. Whatever be the exerciſe, the per⯑ſon ſhould carefully avoid fatigue, which not only retards the cure, but excites pal⯑pitations and ſpaſms of different parts, with variety of uneaſineſs. In thoſe cir⯑cumſtances, fetid medicines have peculiar power. Of uſe they may be alſo to allay the craving of the ſtomach, to which nervous perſons are frequently ſubject. But this ſymptom finds, perhaps, no bet⯑ter remedy than a cruſt of bread, or any thing ſolid.

A dry air, temperately cool rather than warm, is moſt favorable to the cure of nervous diſorders. If ever the Peruvian bark be preferable to cold-bathing, it is during a moiſt ſtate of the atmoſphere. At leaſt in ſuch ſeaſons it might be alternat⯑ed with the other. In moiſt weather, the fleſh-bruſh is alſo of particular ſervice; but it ſhould always be adminiſtered by an attendant. For a nervous perſon is ſoon [34]fatigued with the exerciſe: and as the moſt proper time for it is that of going to bed, the conſequence of ſuch fatigue might be continued watchfulneſs.

In the treatment of nervous diſorders, no care is more important than that of preſerving tranquillity. Vexation, grief, and deſpondence are peculiarly injurious; while on the other hand, chearfulneſs, and whatever promotes it, as agreeable com⯑pany and amuſement, eſſentially conduce to the cure; which may be alſo conſider⯑ably forwarded by the practice of early riſing.

When the diſorder may have reſiſted all the above remedies, from the uſe of a milk-diet has relief ſometimes been ef⯑fected. But this final reſource muſt either be continued during life, or quit⯑ted with great caution, and by ſlow de⯑grees.

If theſe remarks ſhould afford you any ſatisfaction, I ſhall be doubly gratified in having performed your commands.