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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![»fi carefully rtsnovcd; and wheo the patient would lenr up shecti, Waij'i'-ts, C(>^::-.!orpsncs, it 6 nipht-ilress, in ordi-r to hang or yfrarjtli^ hini?olf, iht- shvi'^t aiul ciuuiturpants ari; taken away, and Vlist^'- ru- suppV.i.'d stwcd up in a stroiif; ticliiug ca^v; and B drpf ■ of Ihf same, nr of sonic slrong niaieri.'.lii, put oa for iho niphl. Hk- l aci'ut's ordinary clnilus are aln;iys reuioved frciu tht- l>«>d room. The patient is frequently \ii:led by the night attendants, nnd generally placed in a room Uiai: or iu tlie ijihr- maries, or » hen-ver the nighl-alleiidanl'; S'' \;p. If liut is not practicnbh'. exira-atifndants sit up, in order that tlie watching liMT he elBrienr. Tlierc patlenls in whom the suicidal teu- dfncy conies on in paroxysms, during whieh the utmost \ igilancc i«TicCMsary, pcrliap'; for ton ih-iys or ;i lurliiiglit. ^^'e spoke this niPrning to nn inlclligoiit patient in tlje male infirniary, who ap- pears at this tlnir to he perfectly rnlional ; but there are time? ■»rh«n he Veconies desponding and fearful, imagines he is to he shot, or ottierwisc ' illed, and yel, inciinsislenlly enough, tries to destroy himself I'l one sueli ollack, an attendant satu niglit and day in a sit i.-.'ion commanding a view of the patient in his bed, as he was not well . nnnjh lo sit up, and this was continued for about a fortni^lit. JSucti precautions arc absolutely renuired, for restraints not only aggvavate the glouiii of the patient, but are inffBcient preventives of suicide, of winch, indeed, they have, iu some nsjiuins, been converted into iiistrumirts. lustead of doing anything to add to the glmim of the patient, it seems scarcely necessary to say that he shoiild be cotisoled and soothed, and convinced of the kind anxiety I'.dt for him. \V)ien thus treated, I have known patients promise abstain from suicide, in order to avoid giving pain to those w ho were so good to them, or some- times to avoid throwing lU.scrvdit on the treatment pursued at Hanwcll. In the case just r,.en»'oned, there has been no return of the paroxysm for thrf-i years. A suicidal tendency comes ou in some female patients at each ;uon;aly jieri'.id ; such is the case ■with E. C , in ward No. I'l. :■ married woman, aged thirty, who has been alternatel\ lu.-.nijcai ind insane for eighteen months past. Her malady is useribea lo b-jing deserfed by her husband ; a great part of her time is -( assed iu t'ienco, but fits of excitement occur, in which she will attack ihose about her, and make Btlempis on her own life. In onv case, (M. A. G , lf'41,) the suicidal tendency was for some time recurrent at night, coming on wiiii febrile symptoms, and both being absent during the day. Patients affected with liysterieal mania are ofteu suicidal before the hysterical paroxysm ; they seem ipiite uncon- scious what they arc about, will leap out of a window, or into a pit, ordown a well, or get up a chimney, or try to straiigic themselves, or in some other way to put an end to their own life ; although, except at such tmies, they have no wish to do anything of the kind. The extreme suddenness of their attenvjits makes it diffi- cult to baffle Ihom, except by constant watching uutil the pa- roxysm subsides. All such cases create extreme i.nxiely in private practice ; and I always advise, in every case of iusanity in a private residence, that the w indows should be so secured as only to open a very little way, and that all suggestive means of suicide should be avoided as much as possible. The suicidal feeling is so gciier.illy in excess nn awaking in the morning, that all attendants on pa- tients should be csp.'Cially warned on nn account lo leave the room before the |iatienl is fully dressed aud ready to come down stairs. The absence of a few iniiuites has, in many instances, been fatal. So, also, bcll-ropes. strings hanging down from curtain- rods, a knife, a razor, a bottle of laudanum, an open w indow, seem suddenly to rouse the propensity to sclf-destruction, and, con- sequently, should never be presented to the patient's view. In these cases nothing should be left to chance ; and I think it is an error, for the mere sake of showing isow much confidence may be placed in the insane, lo lca\e windows and hres unguarded, when a patient has shown disposition to suicide. I am per- fectly salisfii'd, that by long-continued care, and by making tlie patient's lile coinlc;, ■able, and avoiding everytliing that can give strength to nvu'bid inipres-ions of being doomed to punishment, and be alte:iiion to the buddy lie;'.Hh, the suicidal tendency is oTten entirely removalile ,1. V> , a jiatient in the female iufirmarv, was admitted at sixty years of age. She was generally desponding, but had (its of sudden ex-itcnient, iu which she would run down into the basement story, or iuto other wa ds, and try III hang herself ; and she attempted to suspend herself by a garter thrown over a projecting piece of wood iu the inliiiuary gallery. She is now almost always engaged iu needlework, eheerful and content ; and yet now and then the stoiuacii becomes violently disordered, the has singular delusions respecting the nuiiiity of her foiKl, and the suicidal tendency returns ; bat ail the symptoms disappear when the slate of the stomach improves. ,S. II , a patient in the laundry, and now clu-v rful and almost well, ns-l i.) was, when I first saw her, always in leg locks, and o'trn fastened liy a str.ip to a bench or a Ijr. The reason asiigned was, that she was suicidal. Her appearance was miser^ able, and she would not speak. She has now betn two years an<t a half at litierty, nnd is laJkalive and hvely, ami w,il| sooq itWf tiie asylum. Now and then the dispositicm to suicide disapfx'ars rapidly tai curiously. S. E , a patient in the female infirmary, nearlr sixty years of age, suffering from melancholia and ocrasion»l tx» citement made several attempts to bang herself; she also refused iood, ;:•-! ^rcuid not speak. After the apphc.aion of a blister behind lt;e r.^-:k, she began to talk, took food well, made bo more attempts to hurl herself, and, gradually recoveriug, leli the asvluox well. Sedatives are occasionally useful iu thebuiciddl paroxy^jn, inducing foigetfulness and 6lee(i. That cuscs may be managed, even in private practice, in »hKK the most residiit disposition lo self-destruction exists. I feel jj© doubt, provided proper attendants cao be engaged ; wuliout lhai |irccaution there is no salely out of an asylum. And it shouk] lie remembered, tliat although some suicidal pau.nts attempt suicide in one way only, as by hanging only, or by taking poison onl)-, others proinptly avail themselves of all opportumues ef death—will throw themselves from a window, cut ihur throal* w ith a knile. or razor, or scissors, open tin ir veins with glass beat their heads against a wall, throw themselves di wu stairs, swallow pins and needles, or a w hole box of pills, take poison drown themselves, hang themselves, starve themselves to death, trying all methods in turn. Such instances are most common in melancholic patients, and it is long before improvement lakes place. I have known K-vfral unfortunate examples, in priv-ate houses, of the danger of leaving theni alone, even for a few minutes. (Jur strong dresses, whitS can scarcely be torn into shreds, and our padded rooms, in wlilcb there is nothing lo aid the patient's unhappy desire, aie, m these painful cases.of infinite service ; a;id soniecontrivanees, resembling them, must be adopted, if such patients are not permuted to b« removed to an asylum. i!ut neither in an asylum nor in a privatt house must these means be considered as rendering watching and care by night and day unnecessary. 1 do not menliou restraints i'.mong means of security—I have no dependence upon them i and il used as substitutes for superintendence, ihey ■will be worM than useless. Refusal of food is a method of self-destruction productive of great anxiety to the practitioner; but, with rare exceptions, 1 do not think that the forcible means formerly so of'ien resorted t6, in conjunction with the use of restraints, were a'.lended wuU ultimate advantage. In ciuiseiiuence of an imjuest having beea held in this asylum, five years ago, on a male patient who was pronounced liy the jury to have died in consequence of refusing food, I w as induced to look carefully throng',: the old records of. the asylum, and was struck with the circumstance, that almost every patient lo whom food h.id been forcibly administered liad died within a few days or weeks of such means being resorted 10. I do ijot mean to conclude that they died in consequence of Ul« application, although I have reason to suspect that such wai bouietiines the case, but that the patients were in a hopeless state, of which one of the s_\ miitoms w as an utter dismciiuatioa for I food. No distinction seems to have been made between the caset I in which food was refused from this natural cause, and those ia I which it was refused on account of some delus on, or with a sui- cidal intent. In the first onset of mania, refusal of food is by no means un- common ; and it regularly conies on with every paroxysm is some chronic c;ises. It is seldom continued lor many successive d.iys in either form of iiialady ; but there are eases in whieli il is more prolonged. ^^ here it is the result of delusion or determi- nation to die, it may be persevered in for an alarming length of time. Forcible means should evidently not be resorted to in all these different cises, without regard to the causes on which the SMuptoni depends. If sometimes necissary, such forcible lucsni are of.eu supertluons, and cerliunly sometimes hurtful and dangennis. During the last six years, we must h.ve had, at least, fifty instances of temporary refusal of food. Instrumental ine;ins have not been resorted to in more, 1 think, than half » dozen cases; and in one of these, in which the recolieclioo f» former inquest compelled me to sanction its employ inent, 1 am convinced that the effects were )iernicious. For three enure ye;irs it has now not been found necessary, in any one instance,on either the male or the female side (d the ns) luui. It is very probablt that refusal of food may be less diflicult lo overcunj among the poor than among the rich, the temiitalion of good .on! being les* easily resisted; but I believe the more geueral explouatuja ti> have been that no pains have be'en 6(>ured to overeouie ihe re- pugnance, aud to avoid resort ing to force. . VV. A , in male ward No. 9, occasionally refuses food m liis maniacal paroxysms, and I have known liiin, when talking loudly, violently, even abusively, suddenly a-.swer a ciuestion as](https://iiif.wellcomecollection.org/image/b21292140_0051.jp2/full/800%2C/0/default.jpg)
