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because to all its virtues, iron added the remarkable property of transmitting itself directly, without intermediary or transformation. What it communicated was not its substance but its strength; paradoxically, though itself so resistant, it immediately dissolved in the organism, depositing there only its qualities, without rust or waste. It is evident here that an imagery of wonder-working iron governs discursive thought and prevails over observation itself. If experiments were made, it was not to reveal a positive sequence of effects, but to emphasize this immediate communication of qualities. Wright fed a dog Mars salts; he observed that an hour later the chyle, if mixed with tincture of nut gall, did not display that purple color it invariably assumed if the iron had been absorbed. This must have been because the iron, without mixing with the digestion, without passing into the blood, without penetrating the organism substantially, fortified the membranes and fibers directly. More than an observed effect, the consolidation of the spirits and the nerves appears rather as an operative metaphor which implies a transfer of strength without any discursive dynamics. Strength is supplied by contact, exclusive of any exchange or substance, any communication of movements.
2. Purification. Clogging of the viscera, ebullition of false ideas, fermentation of vapors, violence, corruption of liquids and spirits—madness elicits an entire series of therapeutics, each of which can be attached to the identical operation of purification.
The ideal was a sort of total purification: the simplest but also the most impossible of cures. It would consist of substituting for the melancholic's overcharged, thick blood, encumbered with bitter humors, a light, clear blood whose new movement would dissipate the delirium. In 1662 Moritz Hoffman suggested blood transfusion as a remedy for melancholia. Some years later, the idea had attained suffi-
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cient currency for the Philosophical Society of London to plan a series of experiments upon the subjects confined in Bedlam; Alien, the doctor entrusted with the enterprise, refused. But Jean-Baptiste Denis tried it upon one of his patients stricken with amorous melancholia; he drew off ten ounces of blood, which he replaced with a slightly smaller quantity taken from the femoral artery of a calf;
the following day he began again, but this time the operation involved only a few ounces. The patient became calm;
the following day his mind cleared; he was soon entirely cured; "all the professors of the Academy of Surgeons attested it." The technique, however, was quickly abandoned, despite a few later attempts.
The preferred medications were those that forestalled corruption. We know "as a result of more than three thousand years of experience that Myrrh and Aloes preserve corpses."2 Are not these deteriorations of bodies of the same nature as those that accompany the diseases of the humors? Then nothing would be more recommendable against the vapors than products like myrrh or aloes, and especially the famous elixir of Paracelsus. But more must be attempted than to forestall corruptions; they must be destroyed. Whence the therapeutics that attack deterioration itself, and seek either to deflect the corrupt substances or to dissolve the corrupting ones: techniques of deflection and techniques of detersion.
To the first belong all the strictly physical methods that seek to create wounds or sores on the surface of the body, both centers of infection that relieve the organism, and centers of evacuation into the outside world. Thus Fallowes explains the beneficial mechanism of his oleum cephalicum; in madness, "black vapors clog the very fine vessels through which the animal spirits must pass"; the blood is thus deprived of direction; it encumbers the veins of the brain where it stagnates, unless it is agitated by a confused
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movement "that distracts the ideas." Oleum cephalicum has the advantage of provoking "little pustules on the head";
they are anointed with oil to keep them from drying out and so that "the black vapors lodged in the brain" may continue to escape. But burning and cauterizing the body at any point produces the same effect. It was even supposed that diseases of the skin such as scabies, eczema, or smallpox could put an end to a fit of madness; the corruption then left the viscera and the brain, to spread on the surface of the body, where it was released externally. By the end of the century, it became customary to inoculate scabies in the most resistant cases of mania. In his Instructions of 1785, addressed to the directors of hospitals, Francois Doublet recommends that if bleedings, purges, baths, and showers do not cure mania, the use of "cauters, setons, superficial abscesses, inoculation of scabies" will.
But the principal task is to dissolve the fermentations which, having formed in the body, give rise to madness. To accomplish this, the chief agent is bitters. Bitterness has all the harsh virtues of sea water; it purifies by wearing away, it works its corrosion on everything useless, unhealthy, and impure that the disease may have deposited in the body and the soul. Bitter and active, coffee is useful for "fat persons whose thickened humors circulate with difficulty"; it dries without burning—for it is the property of such substances to dissipate superfluous humidity without dangerous heat;
there is in coffee, as it were, fire without flame, a purifying power that does not calcine; coffee reduces impurities:
"those who take it feel by long experience that it restores the stomach, consumes its superfluous humidity, dissipates wind, dissolves the phlegm of the bowels, where it performs a mild abstersion, and what is most considerable, prevents the fumes from rising to the head and consequently reduces the aches and pains customarily suffered
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there; finally, it affords strength, vigor, and cleanliness to the animal spirits, without leaving any great impression of heat, even upon the most inured persons who are accustomed to use it."3 Bitter, but tonic also, is the quinine Whytt freely prescribes to persons "whose nervous system is very delicate"; it is efficacious against "weakness, discouragement, and depression"; two years of a cure consisting only of a tincture of quinine, "occasionally discontinued for a month at most," were sufficient to cure a woman suffering from a nervous complaint. For delicate persons, quinine must be associated with "a bitterness pleasant to the taste"; but if the organism is able to withstand stronger attacks, vitriol, mixed with quinine, cannot be too strongly recommended. Twenty or thirty drops of elixir of vitriol are sovereign.
Quite naturally, soaps and soap products inevitably enjoy privileged effects in this purificatory enterprise. "Soap dissolves almost anything that is concrete."4 Tissot believes that soap can be consumed directly, and that it will calm many nervous ailments; but more often it is sufficient to consume, first thing in the morning, by themselves or with bread, "soapy fruits"—that is, cherries, strawberries, currants, figs, oranges, grapes, ripe pears, and "other fruits of this nature." But there are cases where the difficulty is so serious, the obstruction so irreducible, that no soap can conquer it. Soluble tartar is then recommended. Muzzell was the first to have the idea of prescribing tartar for "madness and melancholia," and published several triumphant observations on the subject. Whytt confirms them, and shows at the same time that tartar functions as a detersive, since it is especially efficacious against obstructive illnesses:
"Insofar as I have observed it, soluble tartar is more useful in maniac or melancholic affections produced by harmful humors amassed in the primary canals, than for those pro-
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duced by a flaw in the brain." Among the dissolvants, Raulin also cites honey, chimney soot, Oriental saffron, wood lice, powdered lobster claw, and bezoar.
Halfway between these internal methods of dissolution and the external techniques of deflection, we find a series of practices of which the most frequent are applications of vinegar. As an acid, vinegar dissolves obstructions, destroys foreign bodies as they are fermenting. But in external application, it can serve as a revulsive, and draw harmful humors and liquids to the surface. It is curious but quite characteristic of the therapeutic thinking of this period that
no contradiction was admitted between these two modes of action. Given what it is by nature— detersive and revulsive—vinegar would act in any situation according to this double determination, even though one of these two modes of action can no longer be analyzed in a rational and discursive fashion. It functions, then, directly, without intermediary, through the simple contact of two natural elements. Hence it is recommended to rub the head, shaved if possible, with vinegar. The Gazette de medecine cites the case of an empiric who managed to cure "a quantity of madmen by a very swift and very simple means. Here is his secret. After he has purged them above and below, he has them soak their head and hands in vinegar, and leaves them in this situation until they fall asleep, or rather until they wake up, and most of them are cured upon waking. He also applies to the patient's shaved head chopped leaves of Dipsacus, or fuller's weed."
3. Immersion. Here two themes intersect: the theme of ablution, with all that relates it to the rites of purity and rebirth; and the much more physiological theme of impregnation or immersion, which modifies the essential qualities of liquids and solids. Despite their different origin, and the gap between their levels of conceptual elaboration, they form, up to the end of the eighteenth century, a unity
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coherent enough so that their opposition is not experienced as such. The idea of nature, with its ambiguities, serves as their element of cohesion. Water, the simple and primitive liquid, belongs to all that is purest in nature; all the dubious modifications man has been able to add to nature's essential kindness cannot change the beneficence of water; when civilization, life in society, the imaginary desires aroused by novel reading and theatergoing provoke nervous ailments, the return to water's limpidity assumes the meaning of a ritual of purification; in that transparent coolness, one is reborn to one's first innocence. But at the same time, the water naturally inherent in the composition of all bodies restores each to its own equilibrium; water serves as a universal physiological regulator. All these themes were expressed by Tissot, a disciple of Rousseau, whose imagination was as moral as it was medical: "Nature has prescribed water as the unique beverage of all nations; she gave it the power to dissolve all sons of nourishment; it is agreeable to the palate; choose therefore a good cold water, fresh and light; it fortifies and cleans the bowels; the Greeks and Romans regarded it as a universal remedy."
The practice of immersion reaches far back into the history of madness; the baths taken at Epidaurus alone would bear witness to this; and cold applications of all kinds must have been current throughout antiquity, since Soranus of Ephesus, if we are to believe Caelius Aurelianus, already protested against their abuse. In the Middle Ages, the traditional treatment of a maniac was to plunge him several times into water "until he had lost his strength and forgotten his fury." Franciscus Sylvius recommends immersions in cases of melancholia or frenzy. And the story, accepted in the eighteenth century, of Van Helmont's sudden discovery of the usefulness of hydrotherapy, was actually a reinterpretation. According to Menuret, this invention, supposedly dating from the middle of the seventeenth cen-
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tury, was the fortunate result of chance: a heavily chained madman was being transported on an open wagon; he managed, however, to free himself from his chains and jumped into a lake, tried to swim, fainted; when he was rescued, everyone thought he was dead, but he quickly recovered his spirits, which were abruptly restored to their natural order, and he "lived a long time without experiencing any further attack of madness." This anecdote supposedly enlightened Van Helmont, who began to plunge the insane indiscriminately into the sea or into fresh water; "the only care that must be taken, is to plunge the sufferers into the water suddenly and unawares, and to keep them there for a long time. One need have no fear for their lives."
The truth of the story is of little importance; one thing is certain, which it conveys in the form of an anecdote: from the end of the seventeenth century, the water cure takes or regains its place as a major therapeutics of madness. When Doublet published his Instructions shortly before the Revolution, he prescribed, for the four major pathological forms he recognized (frenzy, mania, melancholia, imbecility), the regular use of baths, adding the use of cold showers for the first two. And at this period, Cheyne had already long since recommended that "all those who need to fortify their temperament" install baths in their house, and use them every two, three, or four days; or "if they have not the means, to bathe in some manner either in a lake or in running water, whenever they have occasion."
The advantages of water are evident, to a medicine dominated by the concern to equilibrate liquids and solids. For if water has powers of impregnation, which place it first among the humectants, it has, insofar as it can receive supplementary qualities like cold and heat, the virtues of constriction, of cooling or of heating, and it can even have those effects of consolidation attributed to substances like iron. In fact, the interplay of qualities is very labile, in the
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fluid substance of water; just as it penetrates easily into the web of all the tissues, it may be easily impregnated by all the qualitative influences to which it is subjected. Paradoxically, its universal use in the eighteenth century was not the result of a general recognition of its effect and mode of action, but of the ease with which the most contradictory forms and modalities could be attributed to its action. It is the locus of all possible therapeutic themes, forming an inexhaustible reservoir of operative metaphors. In this fluid element occurs the universal exchange of qualities.
Of course, cold water cools. Otherwise would it be used in frenzy and mania—diseases of heat, in which the spirits boil, solids stretch, liquids seethe to the point of evaporation, leaving the brains of these sufferers "dry and fragile," as anatomy can daily testify? Reasonably enough, Barthelemy-Camille Boissieu cites cold water among the essential means of cooling cures; as a bath, it comes first among the "antiphlogistics" which tear from the body the excessive igneous particles found there; as a drink, it is a "procrastinative dilution" which diminishes the resistance of fluids to the actions of solids, and thus indirectly lowers the general heat of the body.
But it can just as well be said that cold water heats and hot water cools. It is precisely this thesis which Darut defends. Gold baths attack the blood that is at the periphery of the body and "drive it more vigorously toward the heart." But the heart being the seat of natural heat, there the blood is heated, especially because "the heart, which struggles alone against the other parts, makes new efforts to drive out the blood and to overcome the resistance of the capillaries. Whence a great intensity of circulation, the division of the blood, the fluidity of the humors, the destruction of the encumbrances, the augmentation of the forces of natural heat, of the appetite of the digestive forces, of the activity of the body and the mind." The paradox of the
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hot bath is symmetrical: it draws the blood to the periphery, as well as the humors, perspiration, and all liquids, useful or harmful. Thus the vital centers are relieved; the heart now must function slowly; and the organism is thereby cooled. Is not this fact confirmed by "those syncopes, those lipothymias, that weakness, that lack of vigor" which accompany the too constant use of hot baths?
Further still: so rich is water's polyvalence, so great its aptitude for submitting to the qualities it bears, that it even manages to lose its efficacity as a liquid, and to act as a desiccant. Water can conjure away humidity.' It revives the old principle "like to like," but in another sense, and by the intermediary of an entire visible mechanism. For some, it is cold water that dries, heat on the contrary preserving water's humidity. Heat, in fact, dilates the pores of the organism, distends its membranes, and permits humidity to impregnate them by a secondary effect. Heat clears the way for liquids. It is precisely for this reason that all the hot drinks the seventeenth century used and abused risk becoming harmful: relaxation, general humidity, softness of the entire organism—this is wha
t threatens those who consume too many such infusions. And since these are the distinctive traits of the female body, as opposed to virile dryness and solidity, the abuse of hot drinks risks leading to a general feminization of the human race: "Most men are censured, not without reason, for having degenerated in contracting the softness, the habits, and the inclinations of women; there is lacking only a resemblance in bodily constitution. Excessive use of humectants immediately accelerates the metamorphosis and makes the two sexes almost as alike in the physical as in the moral realm. Woe to the human race, if this prejudice extends its reign to the common people; there will be no more plowmen, artisans, soldiers, for they will soon be robbed of the strength and vigor necessary to their profession."6 In cold water, it is
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the cold that vanquishes all the powers of humidity, for by tightening the tissues, it closes them to all possibility of impregnation: "Do we not see how much the vessels, the tissues of our flesh tighten when we wash in cold water or when we are numbed with cold?"6 Cold baths thus have the paradoxical property of consolidating the organism, of guaranteeing it against the softness of humidity, of "giving tone to the parts," as Hoffmann said, "and augmenting the systaltic power of the heart and the vessels."
Madness and Civilzation ( A History of Madness) Page 18