Observations on Insanity Part 5

The good sense and experience of every pract.i.tioner must direct him as to the dose, and frequency, with which these remedies 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 has 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 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, by very high authority, had been raised in its favour. Where the tartarized antimony, given with this intention, operated as a purgative, it generally produced beneficial effects.

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 drams 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 melancholick 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 was intoxicated.

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: in some of these cases vertigo has been induced, and in others a considerable degree of fever. If I might be permitted to give an opinion on this subject, the benefit princ.i.p.ally derived from this remedy has been in the latter stages of the disease, and when the system had been previously lowered by evacuations.

Blisters have in several cases been 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[10]."

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, awoke in a state of increased violence.

FINIS.

FOOTNOTES:

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

[2] 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 arachnoid membrane.

[3] Morbid Anatomy, page 304.

[4]

"----Nessun maggior dolore, "Che ricordarsi del tempo felice "Nella miseria."

DANTE.

[5] Vide Report, Part 2d, p. 25.

[6] Report, p. 59.

[7] Ibid. 57.

[8] Report, p. 54.

[9] Vide Cullen, first lines, vol. iv. p. 154.

[10] Vide Remarks on Dr. BATTIE's Treatise on Madness.

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