A report on the recent progress of psychological medicine and mental pathology / by C. Lockhart Robertson.
- Date:
- 1848
Licence: Public Domain Mark
Credit: A report on the recent progress of psychological medicine and mental pathology / by C. Lockhart Robertson. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![48. Emetic*.—“ Much difference of opinion,” says Dr. Williams, “ exists with respect to the advantages or disadvantages of emetics in the treatment of the insane The objection often made to the employment of emetics is, that congestion of the brain caused by the violent expulsatory efforts; but Sir W illiam Ellis found the temporary inconvenience more than counterbalanced by the subsequent good effects. Many cases of vigilantia, dependent on monomania or even furious mania, will yield to ant. potass, tart., and often, on the vomiting ceasing, refreshing sleep will follow There are cases of excitement w here, although injudicious to bleed in any form, yet, administering an emetic will be found most useful. Patients who have not slept for several nights will often obtain many hours’ sleep after vomiting has ceased.” (Op. cit., p. 45.) [In recent cases of mania there is generally an accumulation of phlegm, bile, &c., in the stomach, the evacuation of which is often attended by the happiest results.] 49. Sedatives.—Dr. Steward entirely condemns the use of sedatives in the treatment of the insane. “ Sedatives with the insane,” he says, “ act gene- rally, if not invariably, as stimulants. They exercise little or no influence over the insomnia of mania, which seems as it were a part of the disease, which resists all remedies, and which yields only when Nature, fairly tired out by long exertion, sinks exhausted, or when sleep comes, the harbinger of re- turning health. In what dose opium, conium, hyoscyainus, &c., might each produce its sedative effect in the delirium ofmaniu 1 know not: neither should 1 dare to press the medicine so far, lest its sedative effect might be fatal.” In this sweeping condemnation of the use of sedatives in the treatment of mania we cannot concur. Our limits forbidding us to enter minutely into the value of each and every sedative, which, by different recent writers, have been recommended for the treatment of mania, we feel assured that we cannot better supply this omission than by quoting the following practical remarks on the use of anodynes in the treatment of mania, recently placed on record by so distinguished a physician as Dr. Alexander Sutherland. “ Anodynes. These remedies are, according to my experience, of essential service in those cases of insanity which border closely upon delirium tremens; in cases of puerperal mania in the acute stage, and particularly in the paroxysms and sleeplessness of mania ; in cases where there is great nervous irritability from poverty of blood; and in cases combined with cachexia from starvation and other causes. They seem to me to be contraindicated when there are symptoms of incomplete general paralysis and congestion of the head. Pre- scribed merely because the case is one of insanity, without taking into consi- deration physical symptoms accompanying it, or not in proper doses, or not given sufficiently often during the day as well as during the night—these remedies dis- appoint the practitioner. They keep up irritation, and add to the excitement, instead of allaying it. I have sometimes seen a very simple case converted into a very complicated one by the excessive use of anodynes. There is an idiosyncrasy, as every one knows, in some constitutions which does not admit of the exhibition of narcotics, especially morphia, even in the smallest dose. One eighth of a grain has been known to produce such incessant vomiting as to endanger the life of the patient. Great care should also be taken, even when the use of opiates is indicated, not to continue them too long; for if narcotization is produced, much harm will follow. The evacuations arc hard and black, and the irritation is extreme. At St. Luke’s, I have been in the habit, since my appointment to the hospital, of prescribing the acetate of mor- phia in solution with distilled water; in private practice 1 often combine it with distilled vinegar (a very old remedy in insanity). The hydrochlorate is](https://iiif.wellcomecollection.org/image/b21971699_0036.jp2/full/800%2C/0/default.jpg)
