Clinical lectures on the principal forms of insanity : delivered at the Middlesex Lunatic-asylum at Hanwell / by John Conolly.
- John Conolly
- Date:
- 1845
Licence: Public Domain Mark
Credit: Clinical lectures on the principal forms of insanity : delivered at the Middlesex Lunatic-asylum at Hanwell / by John Conolly. Source: Wellcome Collection.
Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.
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![irrief led Co oegiigejioe of her affairs, and to cmbarriunneiit. hhe often forgot what she wat about; nted to tit dowA to l>rrakfa«t, and then recollect tliat the hn^ not lighted the Are; and »he used to leave the doors of her liousc open, and her property was itoleo. She became, at length, evicfcntly insane To melancholia excitement succeeded; and she was taken to an aaylura near London. Here, tlien, was a recent case of acute mania; a ca*e, probably of pure irritation of the brain; requiring, by its nature, all the kind and tranquillizinj; treat- ment to which its unhappy history seemed also peculiarly to entitle it. You have heard lier account of what was done. <^>n Arriving at the asyiuiu,—one of the houses licensed tu re- ceive pauper lunatics,—she was rudely undressed by some young nurses, and put, without anj g;irment on, into a crib filled wich straw, a lar^t- dose of fiur(^ative salts wa.s given to licr; ehe was then fastened by her feet to the rrib, her liands weri' tKiund tonetber li^ iron fetters ruurnl the wrists, and she had a kjml of Blrait-jfuket on. .She asked what she was to do if she want<'d to get out of bed, and was answered in the most vulgar terms. Having in this miserable state t>e- co.nc dirty, she was taken out of lud, and to the iHimp. and pumped upon with cold water, ami tlirn, iindried, tiikeii back to her i rib luul frcpb straw. Shi' remrinhers and rejieats her womanly renionstranci n to the nurses, and t)ie iiiiK-kirig answers they maile to her. You have heard them, ar:(l can, I tliink, never forget llieiii. In the same room with this jMxir woman there were several iiianiaefl, all in (liains, some singing, «)nie swearing, some beating the w;ilis, and in these si-enes, tt> which this deei nl widow had Injen taken from a iWeent lionie. she iK'enine, she s;iys, immediately worse, am! b<ing still Insteni'd down eouhl only sing aloud, wliiili she did almost continually. Kor six weeks her hands were kept fa.stened night and day, and when the fetters wire removed, her wrists were in the eondilioii 1 have desi ribcd to yon. Su. li. until a few years ago, w as tiie treat mi nt of a reeent ease ol acute nuinia; and siult, in te>o ..iiiy mstit'ition.s, and in wttrkhouses, the treatment still coiitinm-. From sm li plarcs patients eome to us with iilrerated wrists ;iiid ankles, erippled i'rom King in a< lioii, irritable and violent, or cmaeiated, feeble, and sinking and they revive and improve under a kinder treatment, re- sume their activity. Iieeoiiie elieerliil and usrful, and get well. Several iiislaiiees of tins kind are mentioned in mv Annual Itcports. At your last visit you had an ojijiortunity of seeing n ncwlv- udmitte'd case, w hieli one might imagine to have been sent here, at this time eKiKTially.lor your i list met ion. M. A. (' . a yon rig Woman, aged twenty, a servant, ;inil unmarried, was reei ivedin the seventh or eighth week after exiiihitiiig symiitoms of mania. For tbrev weeks of that time she had lie'eii in an asylum lii'eiised to receive iniuiier Imiaties, and, she says, slie was kept in restraint the whole ume, because she would not remain in bed. She eume to us tightly iKuind up in a strait- waistctiat. Ilcr wrists and ankles weie marked with the restraints she had worn. (In arriving here she was in a highly e-xeited state, ami talked wildly, attirnung that Clirist »a.s li^r Roll; but she could oi'rasionally make a eompiised answer to a question. She sinned ]),irlieularly deliglited to Ix.' freed from restraint, and enjoyed tliu warm-bath e.\tremely; and slie passed nuieh of the first day in singing and laughing. For a little time her deiiiamns eonlimied, and she thought tbo.se about her were her ebildrt'ii. Within one week, this poor girl, who ha*l been lasteiied night and day U'fore she ciiiie here, was to be SLtn, as you now .see her, sitting very quietly m the ward, neatly drt-ssed, and i iigaged iiisewiug. We find that there is some utcrme excitement, the prohible cause of the mental muhidy, and tlus, as usiudly happens when restraints arc employed. apiK'ars to have receivisl no meilieal attention until s!ie uiiiie to this asyUim, but to liave be'cu retarde-d as an adililional reason lor rcsorliug to the uiuversiJ remedy of restraint. 'I'liiis, the protvable eause of the cerebral disorder, ajul the source of tlie iKvidiar dehisioiis, wa.s not looked upon in a medical iKiint ul view ui nil. This is tlic great evil of restraint, to whicli I pi-rticularly vish todirt'ct your attention. am painfiilly (.•onviiiccd that m bouses where restraints are used this disregard o'.' the enuse of the malady is often in e»ilable; and its m-glect makes the -i<suUing irritation of the brnin iRrmanent and ■.lu iirable. 'file nie.ins of rebef in this case, were, locclies to the pobie region, the warm lup-bath, mild aperient med'cine.i, rest, and tnuiqudlity liy these means wc induce suhsidenoo of the uterine symptoms, and tJie irritation ol tin brain and the \iclusions di6ap[x;ar For such means, 1 need scarcely observe to you, the striii-waistcoat aud iron leg-loek ;ire miserable and nusehievons tabstitutes. 1 tiave not a doubt that this young woman wdl reiu'.er. (She left tin- asylum quiu.- v»eU, wiilimlwo uqcUk *fkr Mixiue^iviL) Another female patient, M. F , now getting stoat and m was admitted, la« winter, in a feeble and depiorable conditio? she had been insane eighteen months; her cipresgion mil wild and fatuons; her habits mischievous and dirty- Bc«med to be nearly starved and mortifieation of theto^S commenced. TTiis poor won.an, whose age was only twantir five, ha/1 become weak and low during protracted nursing ^ then cj cited. She is now e-onvalescem; and tells us thatfoS several weeks before she came here, she wore a strait-waigfcoa* and iron wrist-locks; and that her hands and her feet wn. fastened to the Ix-dstead at night. She de«cril>*s these reT straints as having been very painfid, and thev have left indehbli' marks. Two of her tfypif arc lost, but she is restore^ to perfect health of Ixxly, has grown very stout, and is betominr quite sarw; having doubtless been saved from dementia, or from death, by the treatment she has reeeiveii in this asylum, Ixi'ehes were applied oiire or twice to the head; but good food, wine, fresh air, cleaii clothing, and liberty, have been the chief restoratives. No cases are more likely to be left without prop<-r attention, wlien the patients ;ire in restraints, than those in wliich severe gastric symptoms exist as a part of the malaily. I have often known such patients come to the asylum afleeted with vomit- r iliarrhcra, the api« tite depraved, the tongue red, and the pidse feeble and rapid. Tliere is a case of this kind now in tht male infirmary (1{. K. ). The jiatient is forty-five years of age, he was a small shopkceix>r, failed, and then aetetl as a clerk, until he made so many mistakes in the acrounts that he couM do so no longer. Then he wandercf) from home, and at length was sent to a lii'ensed asylum, from whence he came to Hsd- well, having then been si.x months insane. He had b«« constantly kept in severe restraints for threK;' months, and eaioe to us reporteil dangerous to those about him. He eomplaioeij of having lieen half starved during a welk in wliieh he wag at the workhouse; talked with proli.xitv, but not with nlapkffl incoliereiiec; called himself ;i wine-nierebant, a elergyman, and said he possessed all knowledge in the world; that lie wm not to see death, and should get a large hirtune by writing hit lile. It is evident that the bixlily symptoms in this aite whieli were severe, liad lie'en overlooked. The patient had been trjublesome. and restraints having n moved this troobl* in some degree, he was thought of no more. Soon after hi§ arrival here, leec hes were applied to the epigastrium; hii diet was eartfully attended to; he enjoyed perfect liUrtyof hi.H limbs and body, and he at once began to mend. He hiu now gained strength, lie works in the garden, anil (nines to chapel; he is growing stout also, and wears a chei rfill, eon- tented look. In a sliort time lie will leave the as; lura qoile Well. For awbik- the result was doubtful; he K'caiue ern»- eiated, ;ind his niind was so ileranp'd that !«■ would say he' wished to have fish for dinner lioeause his I'eavenly father- was g.iing to dine with him. If the system of per]KtuaI re- straints had Ik'Cii pcrseveri'd in, I cannot doubt that the gastrit' symptoms would Inive been ex.as(x>r;itiHl, and that the pfttiaifr- woulil have died. Sueh eases demand jieculiar eare, and they generally reward it. 1 suspect that the gastric disturbanceii p;irtly to In- aseritxd to moral e:iuses, resembling what ha iK'eii Eouiewhere deserihed as resulting tnim imprisonmenf. Without omitting ;iny means of ini)iroving the mental sla'e, the evident and great disorder of the stomach and bowels should be- the particnhir object. After leeches h;ive been ipplied to the epigastrium, small blisters an' sometimes ser- viceable; and t!ie t xhaustjiig diiirrhopais sometimes effectualty lieeked by the application of the spiritus terebmthnm> to the atidomen tor a short time. The warm bath helps to .,lLiy the general irritation. The diet requires general re»gulafioii; it should K' chiefly faiiiiaccous, but must bo varied, for the debility is eommonly very great; milk, arrow-nxit, sagi>, ma- caroni, jelly, geiuridly agree very well with such patients; but fish, ehieken, and even mutton may f>c allowed, with Inuled rice. SdidfcHKl is generally bi-tter tlian soups or brethsr vegetables are not desirable; a little porter may bi permitted; and it it disagTies with the patient, some wine is freqnently i»- dis[>cnsablc, although the gastric state would scarct-ly se*™ indicate it; for the p;itient is often restless, t:et« little^^P. and wastes his remaining strength in violent e.tertion, or iit odd muscular movements and gesticulations, which are prompted by some delusive conviction in his mind. WhfB the synip; mis arc obstinate, a few grains of the rotnpouaa calonn! pill, with one-fourth of a grain of the watery extrec' of opium, may b<' given every other night with probable ad- vantage. A dra-Jght ot' the infusion of eascanlla, with half » drae-hm of the bicarbonate of potash, may also be given , u-Uu^. In some cases the bydrocy aiuc acid seems best adapt* to the p.vLvti:. 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