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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![tincture of hemp. I lU) not pn toiul to mention every thing in lljis short course; and it is uimocossary to occupy your time bT scparatciv discussini; the merits of se<l;itives of minor oliffcr. ;is the tx>lla(lonii:i, cainiihor. the tiiuliirc of Imp, S-c. rnon t!ie whole, the most useful nhsi rvalioii which I can make to vou conccrninir the employment of seilativcs in acute mania jj that their actual ctfects. immediate ami remote, yet cU'Servc attentive clinical stuily. ami that the ililiixent ol.serv.ition of manv intelh'jent meilical men, resilient amon'rthe insane, can alone ehieiil.ite the intcrestinv i|uestion of their ]irecise value. If their a.lministratiMn in acute mania is as ■uisalisfactory as my rem ;irk-^ intimate, it Ix'i'omes the more incmnhcnt ujion the practitioner to cmisliler what tramiuil intiuenecs, not in- cluiK-d in the materia meilica, he can lirin^ to liear on the patient. Kxerciso in the ojien air is one of the licst; ;\nil there are not many cases in which, durim; some part of the dav, it mav not he permitle.l. It the patient can he trnsteil, he mav he allowed to walk in an airini; court for an hour, when no other patients are out; and if an attendant is re- quired, or even if two attendants are necessary, he should he acv-ompanicd hy them; and the c'Xereise and ;iiv willludp to cnrc hi* distempered lir;iin. If the last \v:dk is t:iken :i Utile while U'tore the i>atHnt ltocs to hcd sldl LMiMter ;idvan- t.i'.'C mav he oht:iined hy it. The next renH'di;d influence is that of a niind rei\dered ipiiet hy the ahsenee nf every thin^' that can distnrh it; opposition, contrailiclion. reproof, :dl must be avoided; irentlcness. patience, forheanince must lie jver- pctuallv (■\erciscd. These ;ittentions assuaf,'e the irriliihdily and mmtterahlc anunisli of many minds. Nor nmst ordinary method* of procnrine me;ital relief hy jihysical eondorts he despised. .\ Slipper of plc;is;int food, ami a ,<;l;iss of liome- breweil h. er, or porter, or Scotch ale, are sometimes productive jf a iK'tier niu'lit thait poppy or m;indrai,'nr;i, or ;ill the Irowsv svrnps of the worM. Tlieir eth-ct is often so nmeh better ticin that of other -ji dativ,-- that it seems ri :i--onahlc to a.scrilK' it in some deu'ree t.. the mrnt:il, and in some ileLrree to the plivsical. s;itisfaetion v, liieh it ;_'ives to the p;itieiit. .\. few dav-i :ii:o. I fonnd ;i m;ini.u ;il lady—who had very recently i)Ccome insiiiu'. and was phu-ed in ii jirivate asylum—stru.L'.u'lini; «itli tile a-sendiled serv;inls, tryini: to run ;iw;\y, to undress 'uTSolf :ind to tlirioi her clothes, and the movc;ilile thrnitme, ;ulo the lire. 'I'liere w;is no lie;it of the he:id, or m hiteness ot the tonirue; tin- l.ne was p:ile. iiiid tiie pulse ti ehle. 'I'lie only sedative at Inind w ;is l;iud;iuimi, ot wlucli loi t \ drops wi l e ;iven to her, and llie dose w;is repealed in a tew lioiirs, witli I irreat inere;ise of violence. Tlie next evenint; tlie p;itiint iel|X-d herself to a lar','e L-lass of excellent lieer, iiUended tor ioin<;l)»ily else, and she Inid a tranipiil mudit. .\fli r that the x-er w;is friveii every ni!;ht. :ind i ther seihilive; and the laticnt slept well, and improved r:ipidly. In several eases at Ilanwi ll. I li:i\e ohservcd the i,'ood effect? 5f some supper and heer. cm n iii llie iliroine eases; and some ren>;irk:ilile insl;iiii'es ot \ioliiilly iiiani.iiMl ii;ilieiits hein',' tr;iiiipnlli/ed hy Sijntcli ale ^'iveii ;it In d-time, tiilly eontirmmj,- the rem:irks lont: airo m;ide in .Mr. Tuke s work oti the York lietreat, an.I » hu h lemai '^s have, ilonhlless, led to the initi .ion of the h'l ot iu;iiiy ,i restli ss limatie. livery lioily knows the K-casional relief olit;imed, m states of i vluiiistion and irrit:i- (iliiy, hy takin:,' one or Iwii ^l;iss, s latieiits whose paroxysms ol niani;i ;i ire ordiiuirily c.insiilerid stirnuhinls. •inewli.it acted upon in tliesi i ;isrs lul'.'ed and confided in. We ohserve in a '.'re.it uiiiidn rof n lie patient is toler;il)ly (piiei ;ill dm of wine; il e even relii Tile mind hy .1 be II.SI ■I nt uses ol lit reslli il ill the dav time III there are ed hv what s. douhlless, ol Ik 111^' ill- itctllia that s .iiid iiiiisv ;i;mI \et at dl iii'.'lit. .\ few are iii.iniae liLdit sli..<'p Well. Some luive a;; allirnale noisy and ipiiet lav. What the preci.se i ondition of the hrain is in this rcciinviit .l;itc of agitation wc cannot say. or i .isily imaLOii. . ler tlie rdinarv .svmptoms reallv lom' us no inlorin.iticin alu.iit it; the lead aiid snrt'ai-e heiiiL'olteii cool, tlu- tn:i_oi,- i 1, an, and the >illse traiii|uil. It lias loie_'Ih'cii known, hy Ilios<-eonvi rsaiit »'itli the hahits of the insane, that many of tlieiii during' these laroxvsiiis of lAciteinent have an aversion to lyiiiu down, and iiaiiitest ;i sort of instinctive avoidance of the hori/oiilal H'silion, If sed;ltiv. s ,-1,, not reliev. tllis. :;lld sle. p is .still ler.ied to them, it is in v;iiu tn comhat the mere results-, ;ind '■orsf tliaii vain to ileprive the -iifTi rer of the [lonr miiilort ot .'ettint; out of l>c.l and w:ilkin_' ;ilMiiit, The nniiniet iiiu'hts are 1 part of f.is malarly. which for a time r>-sists all our ertorts; Old till- sli.,.p ohlaincd at inti rv.ils diirini,' the day is all that lie st;ilc of the hrain permits. Vet the ;;eneral jiraetice has «.tn to tastensueh patients to tin- Ik rf In our wDodeii bedsteads have p<Miited out to yoii tl;,- plai es whin- riii;;s or liiiekles fcr.. f iriii-.ii-. fi.V-d. at'tlis li^ut, at tlie head, iind at the tides; to these, straps were easily fixed, for the purpose I have men- tioned, but the strajis and the rin^s have disappeared. It was evi- dent that such honiia(;e did violence to an instinctive feeling wliich a physician oiiL'lit to res]H-ct; and it was probable that it accumulated some additional and iKculiar distress on tlie patient, which was only iivoiilisl when the recumbent {Hisition was refraiiieil from. It was opposed, also, to the commonest experience of us all. There are few sufferinds of the insane which have not transiently visited almost every sensitive mind; and on these visitations salutary synip.ithy has a part of its foundation in every breast. The temporary infliction of a ftatc of tlic hrain and nervous system which forbids sleep, is of all these the most common ; and common sense and experieiiee have taiinlil us all how it is titst relieved; to the insiiiie alone, where 'his restless state is mure ii^'LTfavated, we deny the relief A\'no anion;.'yon does not know, that in a Ion;; iind restless .li-lit the best refrcslinielit is obtained hy pettiiiL' out of a hot bed, and ilriiikiiif; cold water, and looking out at the tranipiil sky; or by readim; a hook, or by writing some of the thoii;;hts wliicii loivc kept us wakinij; or by walkiui; ibout in a cool room until both mind and body become less irritable, and we can lie do\i ii in a slate which permits the blcssint: of sleep to fall upon iis. .\sk yourselves, then, for what reason, or on what priiieiiile, the poor, fretted, lieate<l, irritable iiiaiiiae, w ho tosses about in his narrow crib, ;iiiil cannot close his cms, ;iiid whose active tliou^dits torture him, and w ho, therefore, gels up, and walks to ;iiiil t'ro in his cell, should be forced back again, and tied down hy strap or chain ill a bi'd from which all rctiesliing slnmK'r is driven, and all peaceful and eoiii]iosiiig associations? The patient's state is made worse by what be feels to Ik; an injury and utr;u;c; and it was by patients, thus fastened, that the cries iind how liniis, yet ri'ini'iiiberi'd hy those \\ |h) used to pass the s ot' tin.' ancient Itedtain, an- desi-ribed as having made iiijtht biileoiis. The iiiiticnt can scarcely use his limbs, and ho tberefoiv shouts or sings with all his might; and be vents the bitterest execrations on all who I'omc near him; for be feids that they come as tormentors, not as friends. All these symp- toms, the creations of restraint, are adduced as iipoliigics for its aiiplication. and ri-asoiis tor its coiitiiiiiance; and all g(K)(l feeling l« tccn the iialient and the alleiiduiits, and tin' patient and his priysiclan, are at an end: if lie recovers, it is not tliO result of treatment, hut a happy and a rare escape. liut the siilii'rings of the insane are not only more intense, they are also more various than any that arc ineiilcntal to jiersoiis in health. Sensations ot* buriiim; heat of the skin, or in till'eliesl. or ill f he bo» els, lormeiit tlieiu; and when they throw off all dress, and slirii'k from tiiiu- to time, it is cruel to look u]ion these as mere refractory (aillireaks, which are truly the ex)iression of what they endure. The heal of an ordinary bed adds to their discomfort; they seek coolness, wherever it can Ik- found, and ;ire ulad to lie on a stone floor, or close to the cold walls of their beil-roonis. The least covering oppresses fhein. Some sillier to such all excess that they w ill run, if permitted, into the snow, with scariely any ciocrmg; and they have iKSen know n to gather np the snow and let it melt on the eliest, with all the aiiparent satisfaction which others fiid from lireathiiig the fresh air in the liottest weather. All this wild language of siiHeriiig the physician should anxiously interpret; :iiid not punish it, or im ii he eonteiil to siipjircss it bv eiiemii- passint; the iialieiit w illi plivsical reslraintH. IlisofJiee is to relieve the siilli rings, and, il po.ssilile, to divine and to remove their cause. I'atii Ills thus all'eiieil iMcome literally ravin){ iii.ul if lasii iieil lo their hcils ill a el.ise iipartmenl. Il I ;tii seaii i ly he ol herw ise. 1 ,ook, tor one moment, at tins In^liilnl ;:liparaliis called the sleeves; a strong canras s hixly, and deep ha^s of si ill'saddlc-leallicr lor the liaiids; the sleeves stra]iped to the waisi, .iiid al.so to the side of the bed. JjOok it these broail long ilowli the iKiilii il and of the body and hind either siile fnr n In f locks to fasten tin fi niercil'iil ap)iiM iilioii often nuidi ;iin it !ut i vol! can se.ini K woi straps to po round the neck and fusti n M sill ss head, or to pass over the trunk it ilowii without the |M)Mer to turn to i;\aiiiini these iron and leather ankle- 1 lo the loot ot the iH'dstead. The most of these was scparatily, hut each too eccssary, until all were put on; and then der that even these dreadful iron screw- gags bee.iiiie iiii e-sar\ to forci'open the |iatieiit's jawt^, and compel hiiii tf. prolong his writclied existence by taking fixnl for w hieh hi Inol lo-t all n;itural desire. Imagine the condi- tion of wretched men and helpless women invested with these oppressive dresses and bonds; which were, 1 sincerely believe, more freiiucntly ajiplied to save trouble than for any other [iuriiose; more freiiuently iuHictcd on the iniliecile who were trouhlesiaiie than on patieiiis »hosi' violence was extreme. In other asylums mure ingeiiionslv-severe instruments were](https://iiif.wellcomecollection.org/image/b21292140_0035.jp2/full/800%2C/0/default.jpg)
