Means: digitalis

This has an undoubted claim to rank next to emetics as a remedy in madness; indeed, I am of opinion no case ought to be deemed incurable till it has been submittted to a trial of this very powerful medicine, and its employment has been persisted in till some effects are produced.

C***
Practical Observations on Insanity, p. 126.

Means: vomiting

Though some physicians, reasoning more from theory than practice, have reprobated the employment of this remedy in diseases of the mind, experience has convinced me that it takes precedence over every other curative mean.

C***
Practical Observations on Insanity, p. 116.

Music

The concord of sweet sounds, however produced, may be often very usefully employed in the treatment of maniacs; it has hushed contending passions, allayed irritation, collected the wandering thoughts, and induced sleep.

C***
Practical Observations on Insanity, p. 92.

Unnecessary severity is criminal

Let it be indelibly impressed on the physician and attendants, that all the fury, disposition to mischief, attempts to injure, and all the noise and exertions of maniacs, as well as their abuse, keen sarcastic, cutting observations, &c. are the result of disease, and ought to be allowed for accordingly, and imputed to this source; that any virulence of expression should never be regarded by the attendants or physician; nor injury or violence inflicted on them be resented or returned; unnecessary severity is unmanly and highly criminal.

C***
Practical Observations on Insanity, p. 89.

Case history

In attempting the cure of insanity, we certainly ought, if possible, to inform ourselves of the remote causes, and carefully to collect the most minute particulars connected with the history of every case. In a great variety of maniacs, the employment of medicine is either improper or impractible; and here our curative attempts must be confined to what is called management, which often claims a considerable share in removing mental derangement. Strong coercive measures are seldom necessary in the earlier stages of the disease, though much address is requisite to secure tranquility and obedience; but more is always to be doen by firmness and tenderness than by violence and harshness.

C***
Practical Observations on Insanity, p. 81.

Mental and corporeal causes

Some physicians have laboured to prove that insanity is uniformly produced by a mental cause, or that it is in genral dependent on no bodily one; but their arguments are certainly inconclusive, and I am more disposed to subscribe to the converse proposition, that madness is always accompanied by corporeal disease, though this may not be obvious to the senses in every case.

C***
Practical Observations on Insanity, p. 81.

Deceptions

... it certainly is allowable to try the effect of certain deceptions, contrived to make strong impressions on the senses, by means of unexpected, unusual, striking, or apparatnly supernatural agentss; such as after waking tha party from sleep, either suddenly or by a gradual process, by imitated thunder or soft music, according to the peculiarity of the case, combating the erroneous deranged notions either by some pointed sentence, or signs executed in phosphorus upon the wall of the bed chamber, or by some tale, assertion or reasoning; by one in the character of an angel, prophet, or devil: but the actor in this drama must possess much skill, and be very perfect in his part. I might refer to a number of cases where such deceptions were had recourse to, with very varied results.

C***
Practical Observations on Insanity, p. 59-60.

Reasoning with manacs

Reasoning with maniacs is generally useless; but the ideas that partake most of the hallucination, may be sometimes very efficaciously combated by a few selfevident arguments or propositions often repeated; but the talking at will be found more efficacious than talking to a patient.

C***
Practical Observations on Insanity, p. 57.

Fear

Though I have only mentioned the employment of fear in maniacal management, yet the whole range of passions might be occassionally resorted to with advantage; and where these under our control, or could their action be regulated, or their effects limited, there can be no doubt of their being very powerful agents in restoring diseased intellect.

C***
Practical Observations on Insanity, p. 56.

Management of patients

The various means to be adopted in attempting the cure of insanity, for the sake of method, may be divided into moral and medical. Under the first may be ranked management, which is of the highest importance in the treatment of maniacs, in almost every case is indispensable, and has succeeded when the most active means have failed. The art of management results from experience, and the natural endowments of the practitioner: it partly consists of address; and is principally displayed by making proper impressions on the senses.

Maniacs of almost every description, are sensible to kindness and tenderness, and, in general, are to be managed and controlled with more facility by these than by harsher means, which ought never to be had recourse to but in cases of absolute necessity.

C***
Practical Observations on Insanity, p. 54, 56.

Evacuation

... it may be laid down as a general rule, with very few exceptions, to commence the plan of cure by emptying the stomach and bowels by varied means suited to the case, for even diarrhoea is not an unequivocal proof that purging is not necessary; ass indigested sordes, or indurated faeces, may occassion it.

C***
Practical Observations on Insanity, p. 54.

Necessity of medical means

As it frequently happens that insanity, if not occassioned, is continued by the very means adopted for its removal; as where a system of evacuations is persisted in when the symptoms of excitement result only from exhaustion, it is an object of the first importance to ascertain whether any medical or even moral means are necessary, instances having often occurred in which every symptom of mental derangement has gradually disappeared, as the vessels became filled, the strength recruited, and the health reestablished.

C***
Practical Observations on Insanity, p. 53.

On the method of cure

The first attention of the practitioner is to see that the proper means of securing the patient be at hand; or if he be under coercion, he is to determine, from the symptoms, the propriety of continuing or of removing it. His next care should be directed to the causes which are suppsed to have given rise to the insanity, then inform himself whether any peculiarities, natural or acquired, exist, either of body or mind; if the patient be the subject of sudden variations of temper, fits of any kind, such as epilepsy, and convulsions, headache or hernia; marking the leading features of the disease, the subject of hallucinations, the idea that most frequently occupies the mind of the maniac, and determining whether it should be combated or indulged in order to second his curative attempts.

C***
Practical Observations on Insanity, p. 52.

Madness is always to be considered as a chronic disease.

C***
Practical Observations on Insanity, p. 47.

Otium cum dignitate

The more distant the peculiarities of the patient from his natural habits and disposition, the less hope of cure, and vice versa. Rich citizens who, from a bustling active course of life, retire into the country to enjoy the otium cum dignitate, frequently become hypochondriacal or mad, and are with difficulty cured.

C***
Practical Observations on Insanity, p. 46.

Proof from dissection

We only know, for certain that, in the majority of maniacal persons that have been opened after death, more or less organic injury of the brain has been discovered, and that the said organic injury seems to be, for the most part, the consequence of an inordinate determination of blood to the head, a fact of extreme importance in a curative point of view.

C***
Practical Observations on Insanity, p. 42.

Corporeal occasional causes of madness

The corporeal occasional causes of madness are as varied and numerous as the mental; and many of them, by their frequently repeated action on some systems induce a predisposition. Excessive venereal indulgences, intoxication, heat, previous fever, suppressed evacuations, repelled eruptions, old sores and rains dried up, injuries done to the head, profuse haemorrhages, painful protracted parturition, tumours, and peculiarity of shape of the parts about the brain, are the principal among many other corporeal exciting causes of mental disease.

C***
Practical Observations on Insanity, p. 36.

o-sake

Religion and Love

I have found Religion and Love the most frequent among the exciting causes of madness: both may produce this dreadful effect by an intense and exclusive direction of the mind to one subject, by the action of opposing passions, such as hope and fear, or by rendering the sensibility morbidly acute; thus individuals, whose judgment is not proportionate to their feelings, are peculiarly liable to become insane from these sources.

C***
Practical Observations on Insanity, p. 32.

Close and severe thinking

Slight desultory contemplations leave transient impressions, but deep continued study exhausts both body and mind. It has been supposed, and perhaps justly, that all our thoughts, sensations, and intellectual exertions, are accompanied with correspondent motions; close and severe thinking has a direct tendency to weaken, confuse, and destroy the intellect.

C***
Practical Observations on Insanity, p. 31.

More predisponent causes

External heat, especially when applied to the uncovered scalp, has induced a predisposition to insanity, and in some cases has proved an exciting cause, as in coup de soleil.

Intense study, neglect of exercise, and a sedentary life have a similar tendency, as also certain chemical poisons.

C***
Practical Observations on Insanity, p. 30.

Spiritous or fermented liquors

Among the required predisponent causes may be reckoned that state of the mind and body which is induced by the intemperate use of spirituous or fermented liquors producing intoxication.

C***
Practical Observations on Insanity, p. 29.

On lunacy

It has been generally supposed that the influence of the heavenly bodies is connected with diseases of the mind, and that the periodical returns of their paroxysms are regulated by the moon, hence the term lunacy; but I am decidedly of the opinion, after much observation, that the moon possesses no such power.

C***
Practical Observations on Insanity, p. 28.

Excess of circulation produces insanity

From this lamentable habit, the finest forms and most transcendent mental endowments are frequently destroyed, and it is observed to have a direct tendency to increade the excess of circulation in the vessels of the brain, which I conceive to be so peculiarly calculated to produce insanity.

C***
Practical Observations on Insanity, p. 27.

Excessive venery and monkish seclusion

Excessive venery, and the profuse and unnatural expenditure of the seminal fluid, may be enumerated among the acquired predisposing causes of insanity. However unable we may be to explain the action of inordinate sensual gratification, and of the banefulband detestable habit of monkish seclusion, in producing those effects which occassion the predisposition in question, they are the most prolific source of diseased intellect, and often induce that species of madness which resists the most judicious curative attempts, so that both mind and body fall sacrifice; the first losing all its faculties in idiotism, and the last all its locomotive powers in palsy.

C***
Practical Observations on Insanity, p. 26.

Peculiarity

Whereever singularity of natural temper is strikingly obvious, there exists a connate predisposition to insanity: this may be difficult of explanation, but it is reasonable to conclude that where such peculiarities exist, analogous states of the organs of intellect are present. These causes may arise from a certain structure of the primary moving powers of the nervous system, as where it results from hereditary taint; or be occassioned by the frequent or continued agency of causes tending to produce such peculiarity, such as habitual intoxication, protracted lucubrations, or the inordinate indulgence of any passion.

C***
Practical Observations on Insanity, p. 24.

Fancied whispering and distant voices

I have often observed in examining patients, whether convalescent or during a lucid interval, that many of the unnatural, peculiar, extravagant acts, which accompany the mental derangement, seemed to have originated in, or arose from, impressions on the organ of hearing occassioning false perceptions.

C***
Practical Observations on Insanity, p. 21.

Methodus medendi

Insanity, more than any other complaint, seems to take entire possession of the whole system, and almost secures it from other morbid attacks. (...). From hence a degree of improvement has arisen in the methodus medendi, by the introduction of some new disease into the system of maniacs; as where the patient has not had small-pox, this complaint may be communicated by inoculation.

C***
Practical Observations on Insanity, p. 16f.