Part 10 (1/2)
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.