Observations on Madness and Melancholy Part 10

but, within the last seven years, the tinctura jalapij has been subst.i.tuted for the tinctura sennae. It is so far an improvement, that it operates more speedily, and produces less griping.

This medicine seldom fails of procuring four or five stools, and frequently a greater number.

In confirmation of what I have advanced, respecting the irritable state of the intestines in mad people, it may be mentioned, that the ordinary complaints, with which they are affected, are diarrhoea and dysentery: these have heretofore been very violent and obstinate.

Perhaps it may be attributed to superior care that the occurrence of these complaints has, of late years, been comparatively rare, contrasted with the numbers who were formerly attacked with such diseases; and, when they do happen, an improved method of treatment has rendered these intestinal affections no longer formidable or fatal.

In those very violent diarrhoeas, which ordinarily terminate in dysentery, from five to ten grains of the pilula hydrargyri have been given according to the s.e.x, const.i.tution, and nature of the complaint, once or twice a day, and with general success.

It may be necessary to add, that it is proper, during the course of this mercurial remedy, which shortly arrests the disease, to keep the bowels in an open state, by some of the milder purgatives employed every third or fourth day.

Diarrhoea very often proves a natural cure of insanity; at least, there is sufficient reason to suppose, that such evacuation has very much contributed to it. The number of cases, which might be adduced in confirmation of this remark, is considerable; and the speedy convalescence, after such evacuation, is still more remarkable.

In many cases of insanity there prevails a great degree of insensibility, so that patients have scarcely appeared to feel the pa.s.sing of setons, the drawing of blisters, or the punctures of cupping. On many occasions, I have known the urine retained for a considerable time, without complaint from the patient, although it is well ascertained, that there is no affection more painful and distressing than distension of the bladder.

Of this general insensibility the intestinal ca.n.a.l may be supposed to partake; but this is not commonly the case; and, if it should frequently prevail, would be widely different from a particular and exclusive torpor of the primae viae.

But, sometimes, there arises a state of disease in maniacs, where the stomach and intestines are particularly inert. The patient refuses to take food, and is obstinately constipated: the tongue is foul, and the skin is tinged with a yellowish hue: the eyes a.s.sume a glossy l.u.s.tre, and exhibit a peculiar wildness. In this state, I have given two drachms of the pulvis jalapij for a dose, and which, on some occasions, has procured but one stool, so that it has been necessary several times to repeat the same quant.i.ty. After the bowels have been sufficiently evacuated, the appet.i.te commonly returns, and the patient takes food as usual.

Much mischief may be produced, if it be attempted to force food into the stomach in such a case, which the ignorance of keepers may attempt, supposing it to originate in the obstinacy of the patient. In order to continue the bowels in a relaxed state, after they have been sufficiently emptied of their contents, the following formula has been employed with advantage:

[Precsription] Infusi sennae, [ounce] vijss Kali Tartarizati, [ounce] ss Antimonij Tartarizati, gr 1ss Tincturae jalapij, [dram] ij

From two to three table spoonsful may be given once or twice a day, as occasion may require.

There are some circ.u.mstances unconnected with disease of mind, which might dispose insane persons to costiveness. I now speak of such as are confined, and who come more directly under our observation. When they are mischievously disposed they require a greater degree of restraint, and are consequently deprived of that air and exercise which so much contribute to regularity of bowels. It is well known that those who have been in the habits of free living, and who come suddenly to a more temperate diet, are very much disposed to costiveness. But to adduce the fairest proof of what has been advanced, I can truly state, that incurable patients, who have for many years been confined in the Hospital, are subject to no inconveniences from constipation. Many patients are averse to food, and where little is taken in, the egesta must be inconsiderable.

To return from this digression: it is concluded, from very ample experience, that cathartic medicines are of the greatest service, and ought to be considered as an indispensable remedy in cases of insanity.

The good sense and experience of every pract.i.tioner must direct him as to the dose, and frequency with which these means are to be employed, and of the occasions where they would be prejudicial.

_Vomiting._

However strongly this practice may have been recommended, and how much soever it may at present prevail, I am sorry that it is not in my power to speak of it favourably. In many instances, and in some where blood-letting had been previously employed, paralytic affections have within a few hours supervened on the exhibition of an emetic, more especially where the patient has been of a full habit, and has had the appearance of an increased determination to the head.

It has been for many years the practice of Bethlem Hospital to administer to the curable patients four or five emetics in the spring of the year; but, on consulting my book of cases, I have not found that such patients have been particularly benefited by the use of this remedy. From one grain and half to two grains of tartarized antimony has been the usual dose, which has hardly ever failed of procuring full vomiting. In the few instances where the plan of exhibiting this medicine in nauseating doses was pursued for a considerable time, it by no means answered the expectations which had been raised in its favour by very high authority.

Where the tartarized antimony, given with this intention, operated as a purgative, it generally produced beneficial effects.

Ten years have elapsed since the former edition of this work appeared; but this length of time, and subsequent observation, have not enabled me to place any greater confidence in the operation of emetics, as a cure for insanity.

An author[36] who has lately published a work, ent.i.tled "_Practical Observations on Insanity_," is however a determined fautor of emetics in maniacal cases. In his skilful hands they have worked marvellous cures; nor have any prejudicial effects ever resulted from their employment.

Perhaps no one has enjoyed a fairer opportunity of witnessing the effects of remedies for insane persons than myself; and when emetics are employed in Bethlem Hospital they have the best chance of effecting all the relief they are competent to afford, as they are given by themselves, without the intervention of other medicines; and this course of emetics usually continues six weeks. Had Dr. c.o.x confined himself to the relation of his own victories in combating madness with vomits, it would have been sufficient; but he endeavours to raise the levee en ma.s.se of medical opinion to co-operate with his sentiments. He says, page 78, "Yet _every_ physician, who has devoted his attention to this branch of the profession, _must_ differ from him when he treats of vomiting." It was never my intention to deny, in a disordered state of the stomach, that the madman would be equally benefited with one in his senses by the operation of a vomit: but I have a.s.serted, that after the administration of many thousand emetics to persons who were insane, but otherwise in good health, that I never saw any benefit derived from their use. It will also be granted, that some ascendancy may be gained over a furious maniac by forcing him to take a vomit, or any other medicine, but this is widely different from any positive advantage resulting from the act of vomiting. Sir John Colebatch, in his "_Dissertation concerning Misletoe_," says, _p._ 35, "But I have been for some years afraid of giving vomits, even of the gentlest sort, in convulsive distempers, from some terrible accidents, that have been likely to ensue, from moderate doses of Ipecacuanha itself."

In St. Luke's hospital, the largest public receptacle for insane persons, where the medical treatment is directed by a physician of the highest character and eminence, and whose experience is, at least, equal to that of any professional man in this country, vomits are by no means considered as the order of the day; they may be employed to remove symptoms concomitant with madness, but are not held as specifics for this disease.

In reading over the cases related by Dr. c.o.x, there is no one, where emetics have been solely employed as agents of cure; they have been always linked with other remedies; and it requires more sagacity than even the doctor can exact, to p.r.o.nounce, when different means of cure are combined, to which the palm should be adjudged. In the relation of my own experience concerning vomiting, as a remedy for insanity, I have had only in view the communication of facts, for I entertain neither partiality nor aversion to any remedies, beyond the fair claim which their operations possess. Had I modestly ventured to state, after the example of the Doctor, "that I had _devoted_ myself _exclusively_ and _a.s.siduously_ for a _series of years_, to the care of insane patients in an _establishment_, where persons of _both s.e.xes_ are received,"[37] it might be suspected, that the superstructure of my philosophy had been reared on the basis of private emolument.

_Camphor._

This remedy has been highly extolled, and doubtless with reason, by those who have recommended it: my own experience merely extends to ten cases; a number, from which no decisive inference of its utility ought to be drawn.

The dose was gradually increased, from five grains to two drachms, twice a day; and, in nine cases, the use of this remedy was continued for the s.p.a.ce of two months. Of the patients, to whom the camphor was given, only two recovered: one of these had no symptoms of convalescence for several months after the use of this remedy had been abandoned: the other, a melancholic patient, certainly mended during the time he was taking it; but he was never able to bear more than ten grains thrice a day. He complained that it made him feel as if he were intoxicated. Considering the insoluble nature of camphor, and the impracticability of compelling a lunatic to swallow a pill or bolus, it has been found convenient (when a large quant.i.ty was required) to give this medicine in the form of an emulsion, by dissolving the camphor in hot olive oil, and afterwards adding a sufficient quant.i.ty of warm water and aqua ammoniae purae.

_Cold Bathing._

This remedy having for the most part been employed, in conjunction with others, it becomes difficult to ascertain how far it may be exclusively beneficial in this disease. The instances where it has been separately used for the cure of insanity, are too few to enable me to draw any satisfactory conclusions. I may, however, safely relate, that in many instances, paralytic affections have in a few hours supervened on cold bathing, especially where the patient has been in a furious state, and of a plethoric habit. That this is not unlikely to happen may be supposed from the difficulty of compelling the patient to go head-foremost into the bath. In some cases vertigo, and in others a considerable degree of fever ensued after immersion. The shower-bath was employed some years ago in the hospital, and many cases were selected in order to give a fair trial to this remedy, but I am unable to say, that any considerable advantage was derived to the patients from its use. If I might be permitted to give an opinion on this subject, the princ.i.p.al benefit resulting from this remedy, has been in the latter stages of the disease, and when the system had been previously lowered by evacuations. As a remedy for insanity cold bathing has been disregarded by a celebrated pract.i.tioner. To a question from a select committee of the House of Commons to Doctor Willis, 9th March, 1807, the following answer was given.

_Question._ Are you of opinion that warm and cold baths are necessary for lunatic patients?

_Answer._ I think warm baths may be very useful, but it _can seldom happen_ that a cold bath will be required.[38]

_Blisters._

These have been in several cases applied to the head, and a very copious discharge maintained for many days, but without any manifest advantage.

The late Dr. John Monro, who had, perhaps, seen more cases of this disease than any other pract.i.tioner, and who, joined to his extensive experience, possessed the talent of accurate observation, mentions, that he "never saw the least good effect of blisters in madness, unless it was at the beginning, while there was some degree of fever, or when they have been applied to particular symptoms accompanying this complaint."[39] Dr. Mead also concurs in this opinion. "Blistering plasters applied to the head will possibly be thought to deserve a place among the remedies of this disease, but I have often found them do more harm than good by their over great irritation."--_Medical Precepts, page 94._ Although blisters appear to be of little service, when put on the head, yet I have, in many cases, seen much good result from applying them to the legs. In patients who have continued for some time in a very furious state, and where evacuations have been sufficiently employed, large blisters applied to the inside of the legs, have often, and within a short time, mitigated the violence of the disorder.

In a few cases setons have been employed, but no benefit has been derived from their use, although the discharge was continued above two months.

Respecting opium, it may be observed, that whenever it has been exhibited, during a violent paroxysm, it has hardly ever procured sleep: but, on the contrary, has rendered those who have taken it much more furious: and, where it has for a short time produced rest, the patient has, after its operation, awaked in a state of increased violence.

Many of the tribe of narcotic poisons have been recommended for the cure of madness; but, my own experience of those remedies is very limited, nor is it my intention to make further trials. Other, and perhaps whimsical modes of treating this disorder, have been mentioned: whirling,[40] or spinning a madman round, on a pivot, has been gravely proposed; and, music has been extolled, with a considerable glow of imagination, by the same gentleman.--That the medical student may be fully aware of the manifold agents which _practical physicians_ have suggested for the restoration of reason, I shall conclude my volume with the following extract.[41]

"The medical philosopher, in his study of human nature, must have observed, that _sympathetic correspondence of action_ between the mind and body, which is _uniformly_ present in health and disease, though _varying_ with circ.u.mstances. The different pa.s.sions, according to their nature, the degree or intensity of application, and the sensibility of the party, exhibit certain characteristic expressions of countenance, and produce obvious _changes_, actions, or motions, in the animal economy. MUSIC has been found to occasion _all_ these actions, changes, and movements, in some sensible systems; and where one pa.s.sion morbidly predominates, as frequently happens in mania, those species of simple or combined sounds, _capable of exciting an opposite pa.s.sion_, may be _very usefully_ employed. _If_ then such effects _can_ be produced by such a power, acting on a mind only endued with its healthy proportion of susceptibility, what may we _not_ expect where the sensibility is morbidly increased, and where the patient is alive to the most minute impressions? Cases frequently occur where such acuteness of sensibility, and _extreme_ delicacy of system exist, that most of the more common, _moral_, and medical means are contra-indicated; _here_ relief may be often administered through the medium of the _senses_; the _varied modulations, the lulling, soothing_ cords of even an Eolian harp have _appeased_ contending pa.s.sions, _allayed_ miserable feeling, and afforded ease and tranquillity to the bosom _tortured_ with real or fancied woe: and I can easily _imagine_, that _jarring discord_, _grating harsh rending_ sounds, applied to an ear _naturally_ musical, would uniformly excite great commotion. Under circ.u.mstances calculated to a.s.sist this action, by producing unpleasant impressions through the medium of the other senses, as when SCREECHES and YELLS are made in an apartment painted _black_ and _red_, or _glaring white_, every man must be painfully affected: the maniacal patient, _however torpid_, _must_ be roused: or, on the contrary, where an opposite state obtains, extreme sensibility and impatience of powerful impression, there _much may be expected_ from placing the patient in an _airy room_, surrounded with _flowers breathing odours_, the walls and furniture _coloured green_, and the air agitated by undulations of the softest harmony. _Much_ of this may appear FANCIFUL and RIDICULOUS, but the _enquiring_ pract.i.tioner _will_ find, on making the experiment, it deserves his _serious_ attention; and no mean is to be despised that is capable of arresting the attention, changing the trains of thought, interesting the affections, removing or diminis.h.i.+ng painful sensations, and ultimately rendering both mind and body sensible to impressions, and _all this has been effected by music_. Every individual is not capable of accurately estimating the _extensive powers_ of this agent; but I would ask the _musical amateur_, or the _experienced professor_, if he have not frequently felt sensations the most _exquisite_ and _indescribable_; if he have not experienced the whole frame _trilling_ with _inexpressible delight_, when the _tide_ of full harmony has FLOWN on his ear, and the most _wretched miserable_ feeling, UNIVERSAL HORRIPILATIO and CUTIS ANSERINA from the _grating crash_ of discord? All the varied sensations from transport to disgust, have been occasioned by the different movements in one piece of music. I might _amuse_ my readers with a great variety of instances where persons have been very singularly affected by means of music, and where its powers have extended to the _brute creation_, but this I purposely avoid."

FINIS.

Printed by G. HAYDEN,} Brydges Street, Covent Garden.}

FOOTNOTES:

[1] The choice of these words must be left to the taste of the reader, Dr.

Johnson not having thought proper to admit them into his dictionary.

[2] Some doubts are entertained whether Dr. Boord was physician to King Henry the eighth, but he was certainly a fellow of the College.

[3] Apprehension of sensations. This is perhaps only an endeavour to explain the thing, _by_ the thing, or producing words of similar import with different sounds. Junius, speaking of the word hand (as derived from the gothic Handus) says, "Quidam olim deduxerunt vocabulum ab antiquo verbo HENDO, _Capio_: unde PREHENDO, APPREHENDO, &c."--_Gothic.u.m Glossarium_, p. 188. Professor Ihre conceives it equally probable that the old latin word _hendo_ may have had a northern origin. "Id vero non possum, quin addam, oppido mihi probabile fieri, ipsammet hanc vocem latio olim peregrinam non fuisse, quod quippe augurar ex derivato HENDO, capio, unde prehendo c.u.m derivatis pullularunt."--_Glossarium Sviogothic.u.m. tom.

i. p. 778._

[4] Quere. Why should the most _active_ characteristics of our nature be termed _Pa.s.sions_? The word seems properly employed in _Pa.s.sion week_, the period commemorative of Christ's suffering or _Pa.s.sion_. But we are said to _fly_, or _fall_ into a pa.s.sion, and then pa.s.sion _gets the better of us_. For the softer s.e.x we conceive the most delicate, refined, and honorable _pa.s.sion_, yet every one allows the dreadful consequences which ensue from an indulgence of our _pa.s.sions_, and most persons agree that _pa.s.sion_, carried to excess, const.i.tutes madness--we live in a world of metaphor.

[5] In many instances, although it is far from being general, pain of the head, and throbbing of its arteries precede an attack of insanity; sometimes giddiness is complained of as a precursory symptom. Those who have been several times disordered, are now and then sensible of the approaching return of their malady. Some have stated, a sense of working in the head, and also in the intestines, as if they were in a state of fermentation. Others observe that they do not seem to possess their natural feelings, but they all agree that they feel confused from the sudden and rapid intrusion of unconnected thoughts.