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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![patirtits aboTf psnporism, this nnhsppy propensity often e.xisls, I even amonjr women ; some ime< i-oniinfr on in pjroxysnis, which | Ia5t some weeks, nfier which, for as many weeks, the individual will he str-ctly ahstinent. Durinir 'tie parox\3n), the desire for drink is uncontrolhib'e in n private f:imily. as wine, spirits, beer, CTU de (^olopnc, essence of irinirer. spirits of lavend. r, vinep.ir, ketchup, fish-sauce, or any kind i>f slinuilaiit tluid, will he swallowed with avidity. This is a pure disease, and scarcely to be cured except in an asylmn. ^forc serii'us ci>n<e<)iie'ice8 arise from drinking in some con- stitutions, and in e.TrI\ life. .1. H , in the male infirmary, is thirty years of n^e. hut fir advanci'd in pi neral paralysis: he was a proom, and ncku 'wledn-es that he drank hard ; :in epileptiform fit occtirn-d not i|Uite two ye.irs a-jo, then he became insane, and his eond-.iion i*; nItoiielluT hopeless. Within ihe last four or five'vears, I have seen five or six ex- smples in this as\ lum of a fit of mania suddenly ensuiuf; on a long fit of drinkini;. The sii'j cis of these ex;imples were all, exceptin.: one, from (he north of l-'.npland, or from Scotlanil, and all yoii i^ men. In each ease the patient had only been a few days on shore, and had either drank hard at sea, or <m landinp. Ttiev were nitnost all inclined to ascribe their disorder to liavinn; had their drink dru<:eed. W'lih two exceptions they recovered rapidiv ; in one of the exceptions, ihe maniacal character was perceptible for some months; and the other exception was the Ceniian patient nienlioned in a former lecture, who had drank very hard on his voy;i'..'e to I'.ii^'laiul, hut had been once insane bef<»re. The sudden and troublesome violence of such patients usually hrinL'S them into the hands of the police; but when the cause of the attack is known, and no violent trealn.ent pursued, the brain seems soon to recover its tone. 'I'he tonpue is usually clean durip lbe«e short a'lacks. and the pener.il health seems to be little affected. It is a st iie of'.iin|>le excilemnnt. A far Miore frei|uent cause of all mental disorders in a larpe class of Ihe coiiimunily is pnveriy, whicli, with its various con- sequences, presses upon tlii'in from the cradle to the pravc. A neph'Ctetl infincv, ao nni strueted chtldli.'iod, scanty food, thin clollunp, and all the pinrhinp wants of tho'^e who de]iend on the labour of the d:iv for the food of the <lav, prevent the healthy devel'i'^ iient ol the bodv, of the brain, and of the mind. Karly appl cr^'ion lo t 111, the leuiptalion to re-ort to cheap stim«lan>5, loss of emplo\nient, disappointed affections, onha|ipy marriages, the wants of a la-ni'v, eiir arra'^sinents. irrepularii e^, and nun, briti'.^ numer^uis \ tetims to an as\ tnm — for them thi' only w orlilly refuse from wai.t and care. The comforts enjoyed in the asylum, and the fri'edom from all tlmt has ma le life a continual slrnrreh', restore irampiillity to the brain. The patients require little med eme — llu'ir best luedieines are f-'od and jieaee. M;in\ only parfally recover. A feeble brain, inherited from sever,il gcner;it;'»os of h.ill'-starve'l ancestm'';, has been unfit for more than a few veirs of exertion ; anil, beyond a certain point, the restoration of the faenlties is impossible. I'o\< rtv was Ihe oiilv cause iissipned in a e:ise admit'ed in Mtv, 1^4.). that of S. .M , a wiil.iw, a'Jed lifiv. ho h;id been insane on'v six weeks. Maniacal excitement bad i^npervened on distress, and the patient's miml w-as thencetorih filled with cheerful prospects. (Jeneral paralysis v»as soon n'ded to the syinjUoms, ns so ot'ten seen when the mania is of that ho|ieful character. There was extreme deliility from Ihe time of adniis- si ':i; and Ihe exeilent'-nt and delnlilv eoiitMiiied iiiilil Novenitier, w!in she died. .Serum » ,is .ff.is (i in the sic of the ar.iehnoid, and tlier • were pal'dies of lymph ;iiid milU\'ettusion beneath tli:it nfmbraiie: Ihe venlr cles were full of serum; the corlie:d snh- stanee «;is |'al ■, and the pia maler easily detached. Mv ittiinerli tie intention, in spe;ik np of the causes of acute mania, is merely to illiislrati' the occis'oiuil adv.mtap. s derived in the ireatmeni from an iiupiirv into them, and therefoi-e I shall only allude peie-rally to the exiens ve intlueiicc of moral einolioiis and Ihe passions in producinp insanity. .Much niiplit be said on this pan ot the Riibjeci, very important to mankind ; and useful ■w;»rn!n-_'s pi\en against orer-extrtion, a too eaper ambition, mer- cennry alliances, and ihe sleenl.-ss pursuit of pain, liiil to such warnings mankind are not prepared to listen, iiefore these caii.ses cease lo fill our asylums, the motives o' hum.in actions liiu't i«e chaiiL'ed ; as in some future ape, by means scarcely now conceivable by u«, they may he. Our task, in the meantime, is to try lo eiire those whom (he lo s of mental power ha.s com- peted to t'le rei>ose they would not t:ike before. Too t'reiiuently our care Comes loo late. the patient has pone . Indinp on f rom one obji ci to another in a full caiver of succiss, until Ins excite- ment has passed ilii. bounds of lieallh. and all his activity is brouL'hi lo a slop ut once. Kxcileinent, irriialion, or intiamma- tion of the brain exists ; serum is ellnsed from ihe cereb'al ves- sels; tile fine sii' st.nie. of .is envelopitip nienihr.Tnes uiid' r::oes a tliplit chan^'e, and ill..' rest of lite is an insane dream of crandeur, preserved even nftcr paralysis has gradnalty crept n-ver ill th* muscles of locomolion. If the cerebral alfectinn is less vloWr and tlie mania uncomplicated with ihis fatal disposition {J paral)sis, we may succeed in saving the patient by the cartf^ application of the treatment proper for acute mania, combiaej with an entire intermission of every kind of business for a Ions period. The same tendencies are seen, and the same treattn«ti( is rei]uired, in men of fcience, and of the various profession*^ who have persisted in t.iiployinp the brain without allowing needful rest or relaxation; in whom a short maniacal attack ij often the precursor of an old age of imbecility. These ohser- vations are not meant to apply to the industrious and zealom application of llie faculties, hut to the neglect of apporrionin ft Ihe brain only as much work as it can perform without bet^r)^l)g| diseased; for there can be little doubt tliat the best way of prj- serving the faculties is lo employ them ; ;ii,d that there is grejt wisdom in the apliori'm 'if Lord Hacnn which enjoins thrt ij sickness w e should respect health principally, and in henhh, actjoj. NVhere acute mania has been all at once occasioned by a sndd^ shock, I ft-ar the br.iin is seldom one which affords us a stroof hope of its perfectly recovering from its effects. Such instanwt are not very common, the effects usually coming on more sWwIy. W. C , no« in the male infirmary, and affected with genefi] paralysis, was an intelligent active woollen-draper, steady, indus- trious, and in comfortable circumstances. His wife went awir from his house with a lodger, immediately after w hich, his roisii bepan lo fail. He was no longer able to attend to his bnsinea, he wandered about, went to I'rance, an'l when he returned, sold his furniture and went into lodgings. After many irrcgularitif!^ he atiem(ited t'l set fire lo a house in which he lodg.'d, and bij insanity being manifest, he was sent here. In tins case, ths pradual advance of the malady is exi'inplified. In a patient who died here in the spring of 184U, after being two ye.irs insane, iht malady came on suddenly at tneniy-nine years of age. The patient, T. 11 -, was an upholsterer, and had furnished i iiouse very expensively, from w hich tlie tenmt ran away wiiKoot pav ing the rent. The key of the house was brought to thetU- fortunate man one evening, and, in the cuirse of the Difil, synijitoms of acute mania came on, to which general paraljsu soor. supervened, and deatli followed within two years of tie commencement of his disorder. Extensive disease existed tn'fce brain, hut, as is perhaps gener;illy the case, could scarcely it looked upon as tlie c:iiise of the first symptoms. There ■»» efTiision in tfie s;ic of ifie aiachnoul, and beneath the membr«i(e; Ihe brain was firm ; the medulUiry suhslaiice red at the u;ijitr part, and of a shining white colour in the central portions. .'FIk grev port-on of the corpora striata was also of a red or ptiik colour; the left corpus striatum soft, and containing 3 jteU ancient apoplectic cyst. The ventricles were full of senitn. ^ Another example of the siid len inv.ision of acute mania » exemplified in II. .A , in t, in;i|e w :inl No. 8. She waj io hot. l-keeper in London, and her l isters lived with her BM'»e suihlenlv iiiformc'l that a y oung m.ui to whom she was allafliH hail married another perMin. she becime the same eveninjin- sane. She is liable to recurrent att.ieks of violent mania sofrr- quently, that no hope can he entertained of her recovery. To- day she was sitting ipiietly at the work-table, and when Jpotf to. answereil me in a mild and gentle voice: m a tew dnys *lit will probably rush out of lier room to strike those who pa'sK or thrmv scmietliing violentU a! them. ]{. S , III m:ile ward No. II, appears to be recoveries a very short attack of acute mania, the re-ult of a moral imfifK- sion. On the oeeasion of a late murder near London, an ««'j|- dent il expressi.m of his landlady made him feel ahinned, and lhon;;lit Inmsi ll suspected, and That the police were in search him, and would shoot him. Soon after th s. his appeiite bfeto I r.ivenous, and he coinniiited many nets of violence. He is'*' I years of age, sober and industrious, and for some years •'J*' I pl.iined of headach and indigestion. His fither is dcscriW^, ] being a very timid, nervous [ erson. He is <^'''^'^^;'^'''l„, has lost all'liis former fears, hut has .some '■^''f-'' l,,,,^ ' In this case there is eviiiently a strong disposition to '^^^^ and I should fear its being again produced by any shock p\_ to the feelings. It seems remarkable, that in m.iny nsisff' I' which eith r mania or nuhincholia is induced by a nicnw sbetl. the original occasion of it is not afterwards alluded lo^ pat'ent' The brain seems to be weakemd. and tlje renilt' -^^ delusion unconnecled with the grief which injuri-d it. treatment of such cases, we can hut give repose ' ' y^oik watch the general healih, and lead' the pinent, J^^^^i efforts, to some occupation that inav divert the it their delusions. The ch.ince^ of recovery n the«e i^^' pj the cases of exh;.usiion from too much labour of ■ ^,j.5 on the original strenirlh of the brain; hut we -''^^^^ towards removiug impediments to its recovering its en](https://iiif.wellcomecollection.org/image/b21292140_0045.jp2/full/800%2C/0/default.jpg)
