By M. Joseph Daquin, Doctor of Medicine of the Royal University of Turin,
Physician to the Hospital for the Insane and to the Hotel-Dieu of Chambery, 1792.

BAGLIVI observes that diseases of the mind should be mildly treated, and that we ought to abstain as much as possible from too many and too strong remedies. Case.-A young girl became insane from the repercussion of smallpox: she began to smile without apparent cause; she sang incessantly, or talked very extravagantly, and was exceedingly gay. Blisters to the neck restored her. Case.-A girl, aged 24 or 25, became insane from a suppressed arthritic humour; she wept incessantly, answered nothing to questions, but upon being pressed, got angry. Vesicatories at the same time to the arms and legs diminished the symptoms, and some mild purgatives, administered two or three times, completed the cure. The cure of insanity is more difficult, more nice, and, at the same time, more discouraging than that of any other disease. Patience and mildness are especially necessary. The physician should endeavour to gain the confidence of the patients, and to discover the moral means which may avail. It is not by a number of remedies that we must hope to cure: regimen, exercise, liberty, and, above all, great mildness in our discourse and manner, form a method of cure much more sure and reasonable. Above all things, we 14 should be very careful not to irritate them by awakening their dominant passion, or suggesting that which has caused the disease, either by conversation or in any other way. There is a medium to be sought between contradicting them on the subject of their derangement and agreeing with them concerning it: this it is important to attain. Case. -- Gassendi persuaded a man who fancied himself a sorcerer, to give him the necessary drug, that he might anoint and become one also: they passed the night in the same chamber; the sorcerer was agitated, and spoke all night: on arousing, he embraced Gassendi, and felicitated him upon having been at the witches' sabbath, relating all that they had done together. Gassendi then showing him the drug untouched, and convincing him that he had passed the night in reading and writing, withdrew him from his delusion. I am so far from thinking that we ought to contradict the insane, that I even believe that they should not be shut up, especially when they are not furious or mischievous, or, at least, when they do not bring into any danger those around them. I can relate many happy instances in which I opposed the shutting up of certain lunatics, who afterward recovered their reason, my counsel having been followed. It is not doubtful but that we should probably succeed in curing a much greater number of the insane if they were permitted to promenade freely in a spacious and agreeable enclosure, taking the precaution of having attendants employed especially in watching them. Nature herself seems to point this out in the invariable fact which I have constantly observed in lunatics, that when shut up in their cells they ever desire to get out of them : I have often complacently acquiesced in such a request, and I have never had reason to repent it. It is very essential to remove them from all objects, either of the sight, the hearing, or any other sense, which may recall their old ideas and associations. Neither strangers, nor but rarely their acquaintances, should be permitted to see them, as this is found to produce excitement. Even the accustomed visit of the physician has sometimes this effect, though I have also seen them calmed by it. When in a state of excitement, sometimes they will be calm on their door's being opened to bring them nourishment. Cullen recommends a tight waistcoat to restrain them ; but I think this irritating, and insufficient for the purpose. Since a man so celebrated has failed in finding out a proper means of restraint, it is useless to seek one: the same author recommends fear; I have found this to succeed, but it should not be carried too far.

Bleeding is doubtless a great remedy, but it is not useful except in the commencement, and it is decidedly hurtful when the disease is of long standing. If the patient is young, if of sangumeous temperament, if athletic, if in a paroxysm of fury, he gives, at the same time, proofs of uncommon strength-and, above all, if in the commencement of the madness-do not hesitate to draw blood, whose quantity should be proportioned to the symptoms. Bleeding from the foot, through a large opening, often works wonders. We must not be alarmed if the patient faints : it is a favourable sign; and we have often seen a lunatic faint, and then become absolutely reasonable. Bleeding from the temporal artery and jugular veins has also often been successful. We are frequently obliged to reiterate the bleeding, but we should not forget economy in the precious fluid, for from excessive loss the patient falls into an incurable hebetude. The cause of the madness is too 15 often neglected, whether as being of a weakening nature or not, and indiscriminate bleeding employed to the great detriment of the patient. Case.-A young man. From his visage, bodily appearance, and manners, I discovered that he was insane from masturbation. On feeling his pulse, although really not so indicating, I told him the cause of his disease, which he did not deny. From the cessation of this vice, his health, both bodily and mental, were restored. But, recommencing the habit, he relapsed; was bled excessively by a country physician, and fell into an incurable state of imbecility.

Emetics appear, after bleeding, to hold the first rank among the remedies administered to the insane. As for me, I regard emetics in general as very hurtful in madness, and only prescribe them when the disease has its source in the stomach, as I have twice seen, or when it may present some hurnoral engorgement in the viscera of the lower belly.

Purgatives produce oftentimes very good effects ; and experience confirms every day to practitioners the fact that purgatives lessen, in general, diseases of the head, from the derivation of the humours which they occasion to the intestinal tube. But of all remedies proper to lessen and cure madness, opium is truly the most heroic, especially in the maniacal and furious. It is the more useful, from the fact that in the calm produced by it they can be more easily induced to take other medicines. In ordinary doses this remedy has little effect; on the con trary, it augments the bad symptoms, as when given usually by physicians : the cause of this is, that the superabundant acid humours of the insane lessen the power of opium, as acids are known to do. I have employed the liquid laudanum of Sydenham (this is composed of Oriental saffron, canella, opium in substance, and cloves, which are digested in Spanish wine three days in a balneum marim), or opium in substance. I have given, at the commencement, twenty-five or thirty drops of the one, and a grain or a grain and a half of the other at a single dose. There is nothing to fear from forty to fifty drops of the former, and two or three grains of the latter, at a time : it is only by giving this, or a greater dose, that it is efficacious. The strength, temperament, &c., must direct us here. This medicine calms the agitation so common; it produces a sort of regularity in the circulation; it re-establishes order in their ideas; the melancholy and gloomy are reduced to the gayety natural to them; the pulse becomes slow; their physiognomy is softened, their features are no longer so much disarranged, and their whole countenance regains its natural state.

Camphor bears the same relation to the insane as opium; it appeare even to merit a preference, owing to the action of its odour upon the nervous system ; the dose also, as with opium, is required to be large I have often combined, with good effects, the two together. It is a vain pretension, however, to assert that these medicines are specifics, for they often fail, as is also the case with saffron, castor, and musk.

I have not much confidence in hellebore, and cannot think it a specific, as it was considered by the ancients.

Baths have been much praised, especially those in a river, or common cold baths, when it is not convenient to bathe in running water. Cold water on the shaved head in the form of a douche, and ice in the form of a cap, have many times produced very good effects : these should not be neglected, or considered as indifferent. In general, cold is not absolutely hurtful. Warm baths may suit this disease, but only 16 in temperaments where the fibre is dry and hard. It is also sometimes useful to turn cold water on the head at the same time that they are in the warm bath. When the disease is not inveterate, and when the patient is not delicate or nervous, it has been useful frequently to make frictions on the shaved head with a rather hard brush, or with the hand simply, using some aromatic, penetrating, and spirituous essence; or even to apply vesicatories, whose suppuration should be encouraged for some time: in the same instances, we may try dry cupping to the same part, and afterward place leeches upon the elevations caused by the cups.

The above are nearly all the means which the medical art furnishes. They appear to me very bounded, not to say almost insufficient, if others are not united with them, which hygiene, gymnastics, and moral management suggest. Among these means, an assiduous occupation, con. stant and laborious, voyages, and a change of climate or situation, have often done more good than anything else. In general, a country too warm or too moist, or warm and moist, will foment rather than cure this disease, since experience shows that south winds singularly affect the head.

The custom everywhere has been to keep the insane shut up in dun. geons, from which they are rarely permitted to go out. Experience forces me to believe that this method, although sometimes absolutely necessary (though more rarely necessary than is supposed, is most adverse to their cure. I have observed that, by gradually going out, the state of violence by degrees diminishes, until at last they are tranquil both in and out of doors. A garden of large space, shut in by walls, would do for the purpose of carrying out a system based on such a principle; attendants being provided who were, at the same time, kind and robust: this means, I am persuaded, would be curative; at least, it could do no harm. Judging from its effects upon the sane, would not music be a serviceable auxiliary in the treatment of the insane ? M. Balbot, a physician at Chalons on the Marne, mentions a patient so violent as to require five or six vigorous men to restrain him. M. B. knew that this person, when sane, liked to sing and to hear singing; he caused musicians to execute, for nearly an hour, airs which he loved upon the violin; the patient, lending his whole attention while this sweet harmony lasted, even joined his voice to the sound of the instruments; and a mild serenity stole over his visage, replacing the previous excessive agitation of the muscles. After the administration of this means, he who for eight days had been entirely deprived of the use of his reason, demanded his wife, and had with her, in presence of the physician, a coherent conversation concerning the real condition of his domestic affairs.

Their manner of living, as respects the insane, is one of the most essential points in their treatment. Well-chosen vegetables, and rather better cooked than they generally are in hospitals, are the aliment which we should prefer for them. They should make only three repasts a day: a diet, however, too strict would be hurtful to them. If it is wished to give them four repasts a day, they may partake of fruit between dinner and supper. Wine and spirituous liquors should be wholly interdicted, particularly to the furious; pure water or hydromel is much more suitable; we may, however, permit, as the ordinary drink at their repasts, one third wine to two thirds water. The use of wine 17 is also salutary to the profoundly melancholy, and to those who are affected by a sad and languishing madness. Would not electricity be useful as a means of treatment in insanity?

IN the " Medical Repository" (vol. i., page 174) is mentioned the case of a girl who was taken August 16th, 1796, with a paroxysm of insanity. Very violent; tore everything to tatters within her reach; refused to swallow; remained so until 23d, with no treatment save cupping, without benefit. On the 23d, three drachms of strong mercurial ointment were rubbed in; and on morning of 24th, gums were affected. Better. Took cathartics. 25th, mercurial frictions renewed. Gentle salivation, and reason brought back. Mended gradually until September 7th, when well enough to return to her family.

In the " Medical Repository" (vol. iv., page 210) four cases are mentioned which were cured by winding a handkerchief around the head, and keeping it wet by a sponge dipped in cold water until it produced a shivering fit: desisted from for about an hour, and reapplied as before. From 7 to 15 days extent of this practice. In two more cases, application made also along carotid and subclavian arteries. Vitriolic acid alone, or with cinchona, in conjunction with the cold application, perfected the cure. (Page 313.) Case cured by digitalis. (Vol. v., page 409.) Wet cloth around the head with no effect. Thirteenth day, patient's head shaved; (16 Ounces - proper character not avaliable in HTML)3xvi. of blood from arm, and cathartic: succeeding night slept well, but remained incoherent. On 14th, purge, and blister to head, which cured him. A kind of epidemic madness.