that they are the victims of a fraud practiced upon them by their dearest friends. If we succeed in raising him mentally and spiritually we must begin by respecting him as a man. Every human being claims some degree of consideration and sympathy; and if we expect to succeed in drawing the wrecked mind from the ocean depths of despair, we must begin by seeking points of contact in his character as it is, by which we may gradually bend it out of its false direction, not attempting to break it abruptly off. The insane man, generally does not know that he is insane and inferior to others; hence the impossibility of gaining his confidence so long as you treat him with contempt. Indeed, as long as you mentally regard him as an inferior, you can exert no personal influence over his mind. One striking characteristic of the insane is a preternatural quickening of the perceptive powers, by which he is enabled to read, as if by intuition, the minds of persons around him; at the same time those persons generally betray by their actions their belief that he is deficient in those very powers. The ideas of Hahnemann on the moral treatment of the insane are thus given in the Organon: "When the extent of physical disease is small and the insanity has originated in mental causes; if it is still kept up by them, is still recent, and has not yet made any great inroad upon the physical organism, it may be possible to overcome it entirely by moral means alone. Whether this be attempted or not, it is still necessary to employ mental agencies in the management of the patient. He must be treated with a show of confidence, bestowing on him friendly exhortations and friendly advice.' But we are never restricted to mental agencies alone, though Regular Medicine is compelled to rely on them exclusively. In every case it is necessary that the physician, and all employed in the management of the insane, should exercise the highest degree of discretion. To the furious maniac we are to oppose tranquility and unshaken firmness, free from fear; to the patient who vents his sufferings in grief and lamentation, silent pity that is expressed by the countenance and gestures; to senseless prattle, a silence not wholly inattentive; to disgusting and detestable demeanor and similar discourse, entire inattention. As regards the injury and damage the maniac may commit, we are merely to anticipate and prevent it, without ever expressing a word of reproach to him; every thing ought to be so ordered that punishments and the infliction of bodily suffering may be dispensed with.'" (Organon, § 228.) Each patient should be allowed all the liberty consistent with safety; every effort should be made to excite in the patient's mind the senti ment of self-respect, and ambition for the good opinion of others; to draw out the sparks of social affection; to occupy his attention; to exercise his judgment in useful employment; to divert him from his hallucinations to amusements; to conciliate and soothe him by kindness and gentleness of manners; at the same time to make him perceive the impolicy as well as folly of his erroneous conduct by the constant privations, and the prompt and decisive restraints to which he must find himself immediately subjected. In England, Dr. Conolly has more recently attempted to carry the non-restraint system of practice to the highest perfection, at Hanwell, London; and his work, published in 1856,* gives the best view of this practice, in contrast with that which had recently prevailed in asylums generally. He says: "that the mere abolition of fetters and restraints constitutes only a part of what is called the 'non-restraint system.' Accepted in its full and true sense, it is a complete system of management of insane patients, of which the operation begins the moment a patient is admitted over the threshhold of an asylum. And it is a part of the non-restraint system to remember, whatever the state and circumstances of the patient may be, that he comes to the asylum to be cured-or, if incurable, to be protected and taken care of and kept out of mischief, and tranquilized; and that the straight-waistcoat effects none of these objects. It belongs to the days of mechanical restraints, when every evil of seclusion was combined with every possible suffering incidental to the confinement of the arms and legs, and the whole body; and the patient, excited and feverish from his malady, and heated and exasperated from the previous struggle, was left to lie in a constrained and comfortless position, and to suffer thirst, and to become subjected to all the miseries of unavoidable uncleanliness. With such treatment the patient commonly became furious. All kind attentions being incompatible with such disregard and neglect of him, there was no avenue to a good understanding between him and the attendants, whom he then, and long afterwards looked upon as enemies and tormentors. In the old asylums, every arrangement was principally made for security and control; in the new, every arrangement is made for the cure of the malady, or the comfort of the patient. The great principle of the new system is to exclude all hurtful excitement from a brain already disposed to excitement. We must study to remove from an insane person every influence that can farther excite his brain, and to surround him with such as, acting soothingly upon both body and mind, may favor the brain's rest, and promote the recovery of its normal action." Among the improvements yet to be made in the practical department of public asylums, arrangements are particularly needed for what may be called "an individualized treatment. None but those daily familiar with the events of asylums, can duly appreciate the "On the Treatment of the Insane without Mechanical Restraints." great effects of such treatment in special cases. The physician must be able to command the services of a staff of kind and conscientious attendants trained by himself. If they are accustomed to the sight of their patients in the humiliating condition of restraint, and allowed to impose restraints whenever a patient is wayward or irritable, for every irregular action, and for every violent word, they can not be taught to treat the same patient with any show of respect, much less with any constant manifestation of humane regard." The principal substitutes for restraint, in violent cases, suggested by late authors, consist only in short seclusion and the "padded room." The latter is regarded by Dr. Conolly as "an auxiliary without which it is questionable whether or not restraints could be entirely dispensed with in any large asylum." Its great advantage, "in all cases of high excitement, is that it renders both mechanical restraints and muscular force unnecessary for the control of the most violent patients." "By these various appliances-some of them simply of small significance, and perhaps almost wearisome in detail, but conjoined forming a system directed to one object-the whole constitution of an asylum, and the transactions and incidents of every day are made remedial. Every thing done by every officer, and every word spoken by the sane to the insane, is in conformity to one plan, directed by a chief phy sician, carried out in all its details by efficient and faithful officers, and having for its sole object the happiness of the patients, the relief or cure of all the griefs and troubles of the heart, and the restoration of composure and power of the mind. These in their union, constitute the system of managing the insane without mechanical restraints."* Though the padded-room, so highly commended by Dr. Conolly, may not be in all cases a substitute for mechanical coercion, it may essentially aid in the exercise of that systematic kindness and forbearance which is the sine qua non to successful medical treatment of the lunatic. It at least gives essential assistance in the delirium of epileptics; in "many states of extreme exhaustion, with jactitation of the limbs occasionally occurring before death from acute mania; in some suicidal cases; and sometimes in the conduct of a patient suffering a paroxysm of acute mania." It also possesses the property of deadening sound and diminishing the disturbance of many patients by one." † Personal Restraint in the treatment of the insane should be avoided, except in extraordinary cases, In some extreme cases of puerperal and other exhaustive forms of mania, and in cases in which * Dr. Conolly on the Treatment of the Insane, p. 106 delusion compels the patient to stand on his feet until utter exhaustion, some degree of personal restraint has been found necessary. The best mode of securing this restraint, without injury to the patient, is that devised by Dr. Wyman of the McLean Asylum, (Somerville, Mass.) It was called the bed strap, and consisted of an arrangement of webbing and buckles, by which the patient could be kept in the recumbent position in bed, yet with liberty to change from side to side, effecting its object with the greatest gentleness. (Report for 1849.) Influence of the Passions in Causing and Curing Insanity.— The resources of medicine are not confined to the Materia-Medica; and all our resources are in this day needed. In the treatment of every form of disease, it is, says Sir Astley Cooper, "The duty of the physician to support hope, preserve tranquility, and to inspire cheerfulness, even when he is doubtful of the issue." A kind expression, an unobtrusive inquiry, a word in season, betokening interest and regard, may serve to draw out the real cause of a pining malady, which has long resisted the best efforts, and may thus lead to its cure. And a noble effort of the soul may bid defiance to physical agony, and put a temporary check to the onward march of death. If a patient submits himself to his fate without repining; if he yields to the advice of friends, and consents to all the remedial measures proposed, he generally does well. On the contrary, if he bitterly deplores his fate, is too anxious about the means of cure, and impatient when relief can not at once be obtained; we may then consider that a constitutional irritation highly unfavorable to recovery exists. In the present period of high political excitement and mental disquietude "moral therapeutics" possess a higher value than in former times. Among all classes of the people we see the effects of the various excitements of progressive civilization, of misdirected education, of commercial vicissitudes, political agitation. To these causes of physical and mental disease we must add the influence of the various passions, of which the effects of a few prominent ones may be briefly given: Grief-The specific effects of grief are often witnessed by physicians, when their efforts to prolong life have been unsuccessful. It lowers the action of the heart and arteries and all the physical powers; arrests the secretions, especially that of the liver, and produces a low feverish state; there is defect of animal heat, the appetite fails, the mind becomes weaker. The three worst forms of disease to which man is liable,―insanity, cancer, and fungus hæmatodes may arise from excessive grief. Anxiety of mind produces diseases of the chest. The nerves and muscles lose their accustomed tone and energy. Over-anxiety sometimes causes sudden death from cerebral or cardiac lesion. A clergyman who had preached at an hour when he was in a state of great anxiety to return home to his wife, who was dangerously ill, fell dead in the pulpit, immediately after he had finished the services. Diseases of the heart were little attended to before the French revolution; but the trying scenes of that period called forth such a multitude of cases of that disease that a volume was soon written on the subject by Corvisart, who ultimately died of the same disease. The state of the stomach is modified by every impression on the mind; and thus arise dyspepsia, hæmorrhoids, hypochondriasis, jaundice, &c. Grief-Consequences of:* Remedies. Ignatia.-Silent concealed grief, combined with mortification, suppressed vexation; silent grief, caused by misplaced affections or losses, and constantly preying upon the the mind. Spasmodic fits, caused by grief or mortification. Also when vomiting, sickness of the stomach, headache and giddi ness. Phosphoric-acid, when Ignatia fails. The patient is very quiet, taciturn, has a slow fever, great exhaustion, the patient scarcely able to speak. Phosphoric-acid.-The patient is wasting away, treats others contemptuously, does not wish to speak, perspires much in the morning, is sleepy and stupid. Hyoscyamus.-The patient is jealous, violent in his motions, quarrelsome, delirious. Lachesis-He talks much, changes the subject of conversation abruptly. Platinum. He treats with contempt persons previously esteemed; confesses that he is tempted to kill them. In females menstruation is excited by fright, grief, or fear. Cocculus.-Headache and nervousness following grief, loss of sleep from watching over sick friends. Sulphur-Entire sleeplessness, continuing for many nights. Derangement of Intellect from Mortification, Belladonna, Phos phoric-acid after Bell. fails. Hyoscyamus.-Sleeplessness from home-sickness; hot flushed face. Capsicum, when Hyoscyamus fails. Merc.-vivus.-The patient is very weak, trembles, is uneasy, agitated at night, is chilly, perspires during the night, quarrelsome, obstinate, sensitive, manifesting great anxiety. Staphysagria.-Protracted effects of grief; the patient is irritable, cross, uneasy, fearful, dejected, anticipating danger, dreads the future, frets and grieves constantly, is sleepy during the day, restless at night, perspires night and day, loses the hair, the voice becomes feeble. * Hering. |