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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![vliolc <ltt.v. Till' piitient in frvMiiicntly iookfd at through the jnsi)ci tion-pliitc, without Ix in- rlistiii Ik'iI; aiiil Ills ici liwion ii not riiiUcrcd hitter to liiiii In rtjiraiiita, which are not only unnecessary to its cHicniy hut dcrttructivc ot it. Food it taken to liini; water is Kiwn him to drink; ami ull lue rciwonnblo wantu iiri' ulti iidiil to. Uy ilc'ifreea, the triinqiiiility ho unjoyn, niul the iihH'iiie ol ull irritations that cotilti excite ilinordered hruiii, imxhice entire culmiicss, and then he ii invited to cunic mit anil »lt ;it the tahle. or hy the fire. AttiT the seclusion, he eonies out ot t heruoni witliniit an^er.witlimit any senseol iiiorliticalion it aiinoyaiu e. 'J'liis is the Ncclunion which the admirers'il restraint term solitary ira)iri.>,oiiniciit ; lorixcttintj; that thi'V iirae.liso the same seclusion, liut with the freltuiK ndditiuii' ol' the .'•Irait-w alslcoaf, and straps or chains; for- Retliiij.' al.io, that in every other case of irritaljle brain, as in lever nr inriaiiiniations. a cnretul physii'uin ni ver tails to ex- clude noise, liKl't, I'r lialever a't.s strongly on the senses. The applieatiiiii of this salutary principle to a maniac is ncconiplishcd hy seclusion; and it hecuiues, thcrelore, at once 11 measure of siilety and a remedy. A.« when piir-uini; the simple medical trealment of the ni utelv inaniariil. \our attention must he actncly directed to iiu MMiri s Mf M l urin , S.I, on the other liaihl. when these arc coinplettsl. you must steadily eonsiiler whether any furthi r niedieal attempts are likely to he serviceahic'. When the scalp is liulter t lian usual, and reiieweil ( xciteiiient a))pcais.t he relict it ion of lecclicH. ajiplii d to the forehead or iH'hind the cars, is almost always of some servii e. lilisters are also oicisionally nsi ful ; and in those who are i \Ircmcly wild and uinManiiL;ealilo. tlio irritation nt the shaven scalp. The ditficulty to lie naturally cxpeeti'd in acciMnplisliin^ these puints of trealment j;ives wav ill must eases to the elliirts of patient iittendantH—and Is not, perhiipH, so ^rreat as that of ;idiiiliiisteriiii; nii'dicines— «lilcli H often opposed to resorting anaiii to tlio lartari/ed Riitimons as an iiitiTiial reiiiedy. When the atlonipt was first made to meet all the dilllrulties of acute cases of mania with- out n sliainls. it was II; iltIiI iiidispi'iisalile to aihl '.o the dis- conifiu t of a lilister, h.v piiltiiiL,' the patient's hands into a Jealhi'i- muir lor several days, that the lilislcr |or the drcssinf; mlu'ht not lie displaced. II you look at this iiiiieli praised invciiiiiiii, you will see tliiil it eoiilil nut hut heiif and irritate the hands, and make the ]iaticnt tlioroiiKldy inisi riihle. \Vc ndoplcd a simpler evpedieiit. lie c from lliesc ohjcrtiuns; and if necessary, we cover the hlister, and afterwards Ihc ilressiii^'. with ;i c;iRe miule ol tickinii, which is made, as \oii perceive, very iiiiich like a man's urdinary waislcoiit. hut Is lasleiied w ith litlie round locks insleiul of hullous. An inspection of this M'st (.f lilister-casc will show yon its ad\aiilaijis. Um the ciii-iiiiis cireuiiistaiice is. that these lilisti'r-cascs are now M ry lillh in nc|uisitioii. It wouhl seem as if renio\iiif.' hiisters, like many lUhcr inconvenient li;ihils, urvw up most stroiiuly iimidst tho diseoMiciil pi cvailin(,' ill asylums w la rr nicrlniiiii-al means ol o)iposilioii arc iiiiisl reliod ii]aiii. Itnl it is drsiralilc nlwavs 111 have these uiiohicctioiialile dresses at hand, and to Insist W I heir lieiiiu' projicrly made, to iireveiit I'epn seiitalions of their heim; nf noscrvii-c. A cap of the same niiiterials, and sinidarlv fa>li lud, is useful when tlu' Kealp is irrilalcd, tn pie- Vent the irreal add it ion tot he irrital ion that niij;lit he oceasiiine<l hy the jialient's hands. ()n some oeciiBions, when llie iilteiid- anls wiTe yi'l reluetanlly ahandoniii;.' the impositiiHi of re- straints, il used tn he re\iiirted to me that, in sueli and sueli ii < :ise, the hlisi, i*-e:ise \\'as of no use w liate\er; and eii cvaiiii- IIat inn I hav e fi>iiiid I lie l ap fill't he head had Imk'H a|iplieil round the neck iiisteiid ol the priipcr ease for I he Iiur]iose. 'I'liis is hut (Mie of I he many illiislratiiais of I he neccssily t here is in an asylum fur vigilant ins|iecli,in li\ th,' physician, if he makes important chanj.'es in the ordinary lre:iliMiiit of the patients. In many cases, wla le it is not iiceessaiy tu appl\ irni:iliin.; ointliK lil to tile head, it is pr<iducti\e ut relict to sha\c the sealp. 'This, iilone. produces a l oolness whii li is j;r.itcful to the patient, ami it facilitates the apiilication of coM to the he.id, I'V means oi a wetted caii, or a hiaddcr conlaiiiiiie ice. Hut id all means of alhiyini; heat of the scalp, and of the stir- laee ill general, ami also yreiit eerehr.il cNcitcmcnt, the shower- hath, ii' properly administered, is the most elticacious. It has. ie'dnuhl,aii eircet on Ihc patient's mind, as well as on the l>d\,aiid is j;cner;illy disliked; so that its application should only he resortoil to for the actual relief of the excilcnicnt; and p.'iiiis should ho taken to make the )iatient imilcrstainl thai tliis is the iihjret ofit, and that it isa ruiieily, not a p'lnishnunt. 1 Ihinl; the or a eolumii ot' water desei ndim; ii)uin the lu .id. is I'hieelionahle; six ycaiN ayo I IVupantIv impl -U'd it, iiid it is doiililless im cftieaeioiis means olUllayin h '.^h i \cite cent, hut il disin.s-vs the patient mccl.. an 1 .i-it appeared ot cure a principle of which the tendency is t ol severity tonic that all its Rood fctlv. ts wtre olitaiutd by tii««hQ„ bath, w ithout the severe distress, I have * 'illv discontta^ its en.; IdWiicnt. The cold attiision. so mm li l'ra( tised insn of the loreiffii atyiuiiis, —the patient hein;; idaeed in a whilst a do/cn or more pails of colil water are thrown or hini.—seems to ine to be more a method of reprcsjion th** It is applied to tliose miahle to work, for instance em (lurat'e every kind I'he hath ot surpri.sc, or sudden plunging of (j. IKi'icnt iiitci culd water, is still more ohjeetioiiuhle. ' For the siiciess ot the shower-hath, in e;iies of excitement the hath should he wcll-i onstrueted, ami supplicnl from cistern, so as to afford a continuance ot the shower at the *^ of those superintcndini,' its applie;(tien. The feel and U'gt o the liatient should Ir-in v*arin water, ami the shower of coW water should he eontimied from thirty to fortv, or siiiy seconds at a tinii', or rather longer, if the patient seciiis in no decree atlccted hy it The patient w ill Jirohahlv dance, sins shout, and atteni))t to fialit, and Ret away from the hatli; bn, he should Im/ surrouniled hy attendants, who must try to k«r him in jfood liuimair. The continued shower usually tikes his hreatli iiway, and intc'rnpts his proeeedinu's; then, it mn he susi>ended; as soon as tin- is done, he lieijins airain, and Ih^ shower shouhl ho rcnewe.l. Witlenit the renewal, the bstli i, a mere recreation t'> him, ami )iri«luces mnre vicnrmis oxcitp ment, instead ot siihduiiii; it. This, with snnie patients, rp- (piires to he done lialf-a-ilo/en times; hut, commonly, two or three visitatinns of the shower make the fiatient williniftfi listen to |iacitic oi-ertures. If he promises to try to control h'Miself, he should instantly he removed from the hath; but i' he w ill nut iinike any promise, humanity, nnil e ven prudenrf. dictate moder:itiiin, and he niiiKt at IciiLrth he removed, andthi' remedy tried another day. .Sometimes n patient is exfxw\-elj suhdued for a time by tlii' hath thus ajiplied; and in all casts. tTcat care slioiilil lie taken to add to the !?eod cfl'i'ct! of lie bath, hy kiml attention paid to the patient after leaving il. and hy friemlly and explanatory wurds. It is often desirablj. after the iiaiii'iit is e:irefiilly dricii, to place him in bed. »nd Rive him seme brnth, and to sit by him for a time and try to console hiin. In the ease of female patients, these attcntionii are frei|iiently much required. [ shall make no npolojrv'for inentioiiiiiR all these minute matters. Nothing is iiisipiificanl in the trcatineiit nl disonleis of the mind; and all thescatten- lliiiis arc not only ct em!s,,||uence to the patient, but difltUf sahitar> intlueiices through ;i house full of disordered fMlinfs and )iro])ensitics. There arc e:ises (,f ai iite mania in w hich the shower-bath is of less service than the w arm nr Imt bath, and others In whicli more heiietll is derived ti-nm poiiriiiR a moderate quantityo! cold \Miter on the lii'iid trnin a jui.', or hy the liand-sliowr bath, w hilst the (uitii'nt sits up to the nec k in the warm h«th. than frnin ;in\ ol lu r ;i],]ilie;it ion of bat hi iiR as a lenieilv. t'onjnine.l u nil the iise.ii haths, in whatever fnrni emplored. the sciistinii and ap|i|iealion of sidative mcdieinis e\crci»« • i-eniarkahli- iiillnencc over this st;iRc of the malady. J)iir atteiitiiai is naturally directed with anxiety to this inili')n''r'- c lass id reiiicilies. concernin;,' the ett'ccts of w hich, as of mortol till' arti'des of the materia mediea, our supposed knowMgeu found to he. peilia|is. the move Ulucrtain in proportion tooor ac tual mc'ans of asciTticiniiiR them. '\'et thc' rc;i«onaWe Wiff. almost iinioimtin;.' to c ertainty, that in many exnmple« w recent and acute mania, as well'as in the recurrent panix>W> of chronic ciisc's, the stutc' of the briiin is merely one of irnts^ tion—a state w hieli si-dativ i s are well know n to rc•llc^•e—aB'* a promise id Rreat luncft Ironi siiidi medicines, ''j'^**: known cH'eets cd sedatMcs in the treatment of dehmW' tremens, a ver\ aL-'ravated form of cerebral ''■''''Ji^ the authentic' eases on record of a eomiili te cure beinp ofiefnj^ in sonic loriiis of inuTperal mania, in dc hente and irn > IKTsons—partic-ularU in the highe r ranks of scx-icty.inwhom^ nervcnis svstem has hec-ome exees«ivc lv sensitive—strenp our e\pi i t;itioiis. and impart much inti rest to the consi ^ tion of the seiKiratc sedatives and their ctTccts. on wW shiill lav lH•fc^re vou the results of siu li observations ns 1 11 hs'f had opi>ortnnities of niakiiiR when residiiie in tla lile to \c,it, Il the actn.il ctlects iii the medicines prcscri TiiiMMiM (u W viir.s.- The In soKcd n, nale.', :u,,l :'ic l.yiir.ii hlorat, inc.Ills iiiM, sirn_\iiij; them, ihc pious: is \cry slow, ;iiid deiii.md- [H-r-eveiii: the pvopi r c, i. .' ad\;u,:.i.;c i; dcri ir.ahlccrate of ammomsjJ- ofhnie are i!..'UK'^t c<rt»^_ ,i,ow.N T, in boll. m»i»>;.^J; ec t\ ■■ if di>' .aliia^'d^-'](https://iiif.wellcomecollection.org/image/b21292140_0029.jp2/full/800%2C/0/default.jpg)
