Case XX.

Mr. —, aged 25, of a full plethoric habit and sanguineous temperament, became suddenly insane without any obvious cause; his case exhibited nothing new or interesting, being accompanied by the more common characteristic symptoms of mania furibunda, which at lenght yielded to a system, the rationale of which turned on the abstraction of stimuli; but I mention it as one in which the swing was repeatedly employed as a moral mean, by way of punishment, and to induce a compliance with the remedies prescribed; and though there was a necessity for its repeated use, I never saw a patient more easily or powerfully affected by it, and though he always earnestly solicited for release and suffered so much, his obstinacy and perverseness were to be overcome by no other mean; his dread of the swing was extreme, and yet he would not yield to my wishes till it was employed; once he seemed impressed with the idea of its proving fatal, and previous to be being placed in the chair, as if going to be led to execution, he exclaimed in the most pitiable accents, "hear the last words, dying speech, and confession of —," &c.

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Practical Observations on Insanity, p. 175f.

Means: swinging .3

The impression made on the mind by the recollection of its action on the body is another very important property of the swing, and the physician will often only have to threaten its employment to secure compliance with his wishes, while no species of punishment is more harmless or efficacious.

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Practical Observations on Insanity, p. 159.

Means: swinging .2

One of the most constant effects of swinging is a greater or less degree of vertigo, attended by pallor, nausea, vomiting, and frequently by the evacuation of the bladder.

The singular and unusual motion of the swinging, when continued with increased velocity, induces first paleness, then nausea, and then alternately an obvious change in the circulation, and giddiness: these changes necessarily result from an impression made on those organs of sensibility, the brain and nervous system, and prove that the remedy acts on the seat of the disease; though the proximate cause cannot be satisfactorily ascertained.

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Practical Observations on Insanity, p. 156, 157.

Means: swinging

This is both a moral and medical mean in the treatment of maniacs. It may be employed in either the oscillatory or common, or the circulating form. The first, or oscillatory, is too generally known to require a description: the second, or circulating, is easily constructed by suspending a common Windsor chair to a hook in the ceiling, by two parallel ropes attached to the hind legs, and by two others passing round the front ones joined by a sliding knot, that may regulate the elevation of the patient when seated, who, besides being secured in a strait waistcoat, should be prevented from falling out of the chair by a broad leather strap, passed round the waist and buckled behind to the spars, while another strap to each leg may fasten it to the front ones of the chair. The patient thus secured, and suspended a few inches from the ground; the motion may be communicated by an attendant turnng him round according to the degree of velocity required.

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Practical Observations on Insanity, p. 152.

Means: stimulants

It frequently happens that maniacs of the melancholic temperament are torpid and apparently insensible to every agent; their mental faculties seem immovably fixed, as if some vow bound them to apathy; they resist and resent every attempt to attract and arrest their attention. In these cases stimulants of various kinds have been found expedient, and often very beneficial; but they must be used with great caution and judgment, particularly those applied about the head; such as volatiles, errhines, and sternutatories. Medicines of this class, which are more usually applied externally, have been directed internally with great advantage; thus mercury, squills, mustard, horseradish, and cantharides.

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Practical Observations on Insanity, p. 148-149.

Means: opium

From the sopoforic tranquillizing properties of this valuable drug it might seem indicated in maniacal affections; but I have tried it alone to an almost incredible extent, without perceiving any, even temporary, much less permanent advantage from it.

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Practical Observations on Insanity, p. 143-4.

Means: camphor

It has the reputation of quelling the passions and curbing venereal propensities; but I have never witnessed its producing such effects. However prepared, whether alone, or in combination with nitre, vegetable acids, foetid gum, &c., I have never observed any permanent good effects from its use.

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Practical Observations on Insanity, p. 143.

Means: blisters

I have proved the propriety of Dr. Monro's observation on this subject, that they are never useful when applied to the head itself; but to the calves of the legs and to the feet, in the form of sinapisms, they are frequently a powerful and efficacious mean.

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Practical Observations on Insanity, p. 142.

Means: bathing

The external application of cold to the head in madness is a very rational remedy, and has been often employed, with advantage, to appease irritation and fury, and to induce sleep. The modes of application may differ according to the degree of cold required, or the effect intended. In some cases, in which only partial application of cold is required, simple ablution of the head with cold water, or wrapping wet cloths around it, frequently renewed as they get warm, are the most convenient methods. In others where the application is intended to be general, the common cold or shower baths are preferable.

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Practical Observations on Insanity, p. 135.

Means: purging

This is a very necessary and generally an indispensable operation. As maniacs are frequently and almost uniformly costive, this should be constantly obviated.

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Practical Observations on Insanity, p. 131.

Means: bleeding

Since in most cases of mental disease there exist symptoms of high excitement, the use of the lancet would seem generally indicated; but unless there be obvious plethora or evident determination and congestion about the head, bleeding may increase rather than diminish the disease; when this evacuation be determined on, it may be offered either by leeches, cupping, venesection in the foot, arm or neck, or by arteriotomy.

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Practical Observations on Insanity, p. 130.

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.

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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.

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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.

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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.

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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.

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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.

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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.

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Practical Observations on Insanity, p. 59-60.