Part 13

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 principal 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 practitioner. 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 practitioner, 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 circumstances. The different passions, 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 passion morbidly predominates, as frequently happens in mania, those species of simple or combined sounds, _capable of exciting an opposite passion_, 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 Eoelian harp have _appeased_ contending passions, _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 circumstances calculated to assist 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_ practitioner _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 diminishing 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."--_Gothicum 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 cum derivatis pullularunt."--_Glossarium Sviogothicum. tom. i. p. 778._

[4] Quere. Why should the most _active_ characteristics of our nature be termed _Passions_? The word seems properly employed in _Passion week_, the period commemorative of Christ's suffering or _Passion_. But we are said to _fly_, or _fall_ into a passion, and then passion _gets the better of us_. For the softer sex we conceive the most delicate, refined, and honorable _passion_, yet every one allows the dreadful consequences which ensue from an indulgence of our _passions_, and most persons agree that _passion_, carried to excess, constitutes 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.

[6] To illustrate how necessarily our sensations, or ideas must become confused, when their succession is too rapid, the relation of some experiments on that subject will sufficiently conduce.

"But by the able assistance of Mr. Herschel, I am in a condition to give some approximation, at least, towards ascertaining the velocity of our audible sensations. For having, by means of a clock, produced sounds, which succeeded each other with such rapidity, that the intervals between each of them were (as far as could be judged) the smallest posible; he found he could evidently distinguish one hundred and sixty of them to flow in a second of time. Now as each interval must in this case be reckoned as a sensation likewise, as it might be filled up with a sound thereby making it a continued one; it follows, that we are capable of entertaining at least three hundred and twenty audible sensations in that period of time."--_Vide a Treatise on Time, by W. Watson, Jun. M. D. F. R. S. 8vo, 1785, page 32._

[7] The late Dr. Johnson was remarkably distinguished by certain peculiarities of action when his mind was deeply engaged. Sir Joshua Reynolds was of opinion "that it proceeded from a habit he had indulged himself in, of accompanying his thoughts with certain untoward actions." "One instance of his absence, and particularity as it is characteristic of the man, may be worth relating. When he and I took a journey into the West, we visited the late Mr. Banks, of Dorsetshire; the conversation turning upon pictures, which Johnson could not well see, he retired to a corner of the room, stretching out his right leg as far as he could reach before him, then bringing up his left leg, and stretching his right still further on. The old gentleman observing him, went up to him, and in a very courteous manner assured him, that though it was not a new house, the flooring was perfectly safe. The Doctor started from his reverie like a person waked out of his sleep, but spoke not a word."--_Boswell's Life of Dr. Johnson, vol. i. p. 76._ In the same work other of his tricks are recorded, as talking to himself, measuring his steps in a mysterious manner, half whistling, clucking like a hen, rubbing his left knee, &c. Many sensible persons, with whom I am now acquainted, when particularly thoughtful, discover strange bodily motions, of which they are by no means conscious at the time.

[8] This gritty matter, subjected to chemical examination, was found to be _phosphat of lime_.

[9] This appearance I have found frequently to occur in maniacs who have suffered a violent paroxysm of considerable duration: and in such cases, when there has been an opportunity of inspecting the contents of the cranium after death, water has been found between the dura mater and tunica arachnoidea.

[10] Morbid Anatomy, page 304.

[11] Mr. Fourcroy does not appear to have given any particular attention to this fluid. He says, "Cette humeur ne parait pas differer de celle qui mouille toutes les parois membraneuses du corps humain en general, et dont j'ai deja parle. C'est un liquide mucoso gelatineux, plus ou moins albumineux, et contenant _quelques matieres salines_."--_Systeme des Connoisances Chimiques, 8vo. tom. ix. p. 303._

[12] It may be remarked, that all children in the early attempts at language, speak of themselves and others in the third person, and never employ the pronoun; they likewise never use connectives, or the inflections of verbs, until they begin to acquire some knowledge of numbers. Beyond this rude state our patient never advanced.

[13] For this term the indulgent reader must give the author credit, because he finds himself unable adequately to explain it.--It is a complex _term_ for many ideas, on which language has not as yet, and perhaps will never be imposed. Very unfortunately there are many terms of this nature, equally incapable of description--a smile, for instance, is not very easy to be defined. Dr. Johnson calls it "a slight contraction of the face" which applies as properly to a paralytic affection. He also states it to be "opposed to frown." If curiosity should prompt the inquisitive reader to seek in the same author for the verb, to frown, he will find it "to express displeasure _by contracting the face_ to wrinkles." He who would

"Finde the minde's construction in the face"

must not expect to be able to communicate to others, in a few words, that knowledge which has been the slow and progressive accumulation of years.

[14] These are the usual terms employed by writers on this subject, but the propriety of their use must be left to the judgment of the reader. Every person will occasionally hesitate whether certain occurrences, said to be causes, ought to be referred to one class, in preference to the other. They are loose and vague names: for instance, a course of debauchery long persisted in, would probably terminate in paralysis; excessive grief we know to be capable of the same effect. Paralysis frequently induces derangement of mind, and in such case it would be said, that the madness was induced by the paralysis as a physical cause. But it often happens that debauchery and excessive grief are followed by madness, without the intervention paralysis. Moral, in this sense, means merely habitudes or customs, reiteration of circumstances confirmed into usage; and these may be indifferently accounted physical or moral.

[15]

"----nessun maggior dolore, Che ricordarsi del tempo felice Nella miseria."--_Dante._

[16] The Jews also were particularly instrumental in the practice and propagation of medical knowledge at that period.

[17] Cogitatio, (hic minime praetereunda) est motus peculiaris Cerebri, quod hujus facultatis est proprium organum: vel potius Cerebri pars quaedam, in medulla spinali et nervis cum suis meningibus continuata, tenet animi principatum, motumque perficit tam cogitationis quam sensationis; quae secundum Cerebri diversam in omnium animalium structuram, mire variantur.--_Tolandi Pantheisticon, p. 12._

[18] 1796, 1797.

[19] Vide Report, Part II. p. 25.

[20] Report, p. 59.

[21] Ibid, 57.

[22] Report 54.

[23] "We shall use the general term of methodism, to designate these three classes of fanatics, [Arminian and Calvinistic methodists, and the _evangelical_ clergymen of the church of England] not troubling ourselves to point out the finer shades, and nicer discriminations of lunacy, but treating them all as in one general conspiracy against common sense, and rational orthodox christianity."--_Edinburgh Review, Jan. 1808, p. 342._

[24] Traite Medico-Philosophique sur l'Alienation Mentale, 8vo. Paris, an. 9, p. 47.

[25] The late Reverend Dr. Willis.

[26] With respect to the persons, called Keepers, who are placed over the insane, public hospitals have generally very much the advantage. They are there better paid, which makes them more anxious to preserve their situations by attention and good behaviour: and thus they acquire some experience of the disease. But it is very different in the private receptacles for maniacs. They there procure them at a cheaper rate; they are taken from the plough, the loom, or the stable; and sometimes this tribe consists of decayed smugglers, broken excisemen, or discharged sheriffs' officers:

"All that at home no more can beg or steal."

How well such a description of persons is calculated to regulate and direct the conduct of an insane gentleman may be easily conjectured. If any thing could add to the calamity of mental derangement, it would be the mode which is generally adopted for its cure. Although an office of some importance and great responsibility, it is held as a degrading and odious employment, and seldom accepted but by idle and disorderly persons.

[27] Vide Cullen, First Lines, vol. iv. p. 154.

[28] "_D'uno luogo chiamato Timarahane, dove si castigano i matti._

"In Costantinopoli fece fare un luogo Sultan Paiaxit dove si dovessero menare i pazzi, accioche non andassero per la citta, facendo pazzie, et e fatto a modo d'uno Spedale, dove sono circa cento cinquanta guardiani in loro custodia, et sonvi medicine, et altre cose per loro bisogni, e i detti guardiani vanno per la citta con bastoni cercando i matti, et quando ne truovano alcuno, lo'ncatenano per il collo con cathene di ferro, et per le mani, et a suon di bastoni lo menano al detto luogo, et quivi gli mettono una catena al collo assai maggiore, che e posta nel muro, et viene sopra del letto, tal mente che nel letto per il collo tutti gli tengono incatenati, et vene saranno per ordine, lontano l'uno dall'altro numero di quaranta, i quali per piacere di quelli della citta molte volte sono visitati, et di continovo col bastone i guardiani gli stanno appresso: Percio che non essendovi guastano i letti, et tiransi le tavole l'uno a l'altro: et venuta l'hora del mangiare, i guardiani gli vanno esaminando tutti per ordine, et trovando alcuno, che non istia in buon proposito, crudelmente lo battono, et se a caso truovano alcuno, che non faccia piu pazzie, gli banno miglior cura, che a gli altri." _J. Costumi et la vita de Turchi di Gio. Antonio Menavino Genovese da Vultri, 12mo, in Fiorenza, 1551._

[29] Traite sur la Mania, page 103.

[30] The frequent recurrence of any propensity leads, by sure steps, to the final adjustment of the character; and even when the propensity is ideal, the repetition of the fits will, in the end, invest fancy with the habitudes of nature.--_Criticism on the Elegy written in a Country Church Yard, p. 3._

[31] Remarks on Dr. Batties' Treatise on Madness, p. 38.

[32] Dr. Cox, Practical Observations on Insanity, p. 28.

[33] Dr. John Monro's Remarks on Dr. Battie, p. 39.

[34] Vide Dr. Cox's _Practical_ Obs. on Insanity, p. 42.

[35] It is a painful recollection to recur to the number of interesting females I have seen, who, after having suffered a temporary disarrangement of mind, and undergone the brutal operation of _spouting_, in private receptacles for the insane, have been restored to their friends without a front tooth in either jaw. Unfortunately the task of forcing patients to take food or medicines is consigned to the rude hand of an ignorant and unfeeling servant: it should always be performed by the master or mistress of the mad-house, whose reputations ought to be responsible for the personal integrity of the unhappy beings committed to their care.

[36] Dr. Cox.

[37] See Dr. Cox's Advertisement prefixed to his book.

[38] Vide Report from the select committee appointed to enquire into the state of lunatics, page 25.

[39] Remarks on Dr. Batties' Treatise on Madness.

[40] See Dr. Cox, page 102.

[41] Dr. Cox, p. 61.

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