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The functions of the skin are suppressed. The mucous tube is covered with secretions, which vary from yellow to black hues. If the malady takes an unfavourable turn, the pharynx or esophagus becomes paralytic or convulsed. Black and fetid dejections usually occur at this time. The bladder is sometimes paralysed. Delirium is, in general, a dangerous symptom.“ It announces the approaching and unhappy end of chronic affections. More than half of those who have it in a continued form, perish.” As this applies to delirium symptomatic of organic affections of the brain, the estimate is probably correct. The good effect of repeated small bleedings, almost to exsanguination, we have lately seen in a case of long-continued intermitting delirium, wbich must Jave otherwise proved fatal.*

The treatment of symptomatic delirium must, of course, be addressed to the organic lesion, from which it arises. Stimuli, as musk, camphor, &c. increase it. If irritation produces evident congestion of the brain, local bleeding and gentle reduction are indicated. There is a species of delirium, independant of serious lesion of other functions, and proba. bly, a variety of ataxique fever, in which, tranquillizing treatment, and opiate lavemens produce the best effects-as in deliriom tremens. + A table of minute diagnoses between acute delirium and insanity is drawn up.

Trentment of Insanity.-Medical enquiry in every form, should be directed to this difficult object. In the affections under consideration nothing is more necessary or arduous. Ignorance of the cause, has led to endless specific and fanciful methods of treatment; thence, organic causes have been attacked by such engines from the arsenal of therapeutics, as douche baths, and cold baths, baths of surprise, falls, leaps, rotatory swings, &c. Messrs. Pinel and Esquirol adopted principles of treatment more consistent with the philosophical progress of medical science. These are regulated by know

A case, probably, of chronic inflammation of the brain, according with cases described by Dr. Abercrombie on that head.

+ Mr. Hodges, an ingenious practitioner at Maidstone, and assistant surgeon to the West Kent Militia, has informed us, that a fever, which accords with this description, followed drunkenness in his regiment, after exposure to typhus in a low situation. Several were bled and invariably died, others were treated with antimonial emetics and opium, and invariably recovered.

1 A case is related of an epileptic brought to the La Salpétrière with a stomach eroded and stripped of its mucous coat by a long-continued course of lunar caustic. This is an excellent illustration of the folly, wickedness, and inefficacy of quackery.

ledge of the seat and nature of the disease, the mode of action of its causes, and the individual relation to sex, age, temperament, &c. To ascertain the morbid state of an organ, too exclusive importance is not to be attached to derangements of its action; these announce disease, but do not indicate what? Many cerebral lesions are attended with delirium; pulmonary, with dyspnea, &c. Unexpected phenomena in ihe diseased organ, as pain, change of texture and volume, disorders in the neighbourhood, afford guides to the desired discrimination. M. Georget vaguely says, in treating insanity,

“ We are to consult the absence or presence of excitement or asthenia, and not the species of delirium.”

“ The treatment of a malady, produced by any adventitious cause, requires no modification, thus, a pleurisy from suppressed menstruation, or suppressed transpiration, claims the same curative processes as simple pleurisy. It is vain to attempt to re-establish menstruation or transpiration; both would observe their usual periods. The removal even of a fixed (persistante) cause, does not always remove the disease; once altered to a certain extent, organization does not return to its natural condition, but with a determinate progress. A foreign body applied to the conjunctiva may cause ophthalınia, but its reinoval will not cure it."* 251.

This is very fashionable reasoning, especially among those who cannot, or will not, think or see for themselves. Doubtless it is true to a certain extent; but acute inflammation of an internal organ often ceases when brought back to the extremities, and inflammation following suppressed menstruation, often ceases when the hip-batlı, aloetic clysters, hellebore, and leeching the pudenda, restore the determination. We saw membranous ophthalmia lately cease immediately after removal of a mechanical irritant, which had been treated a fortnight in vain. To a certain extent, such reasoning is true, but it savors more of logical squeamishness, than matter of fact, and ought not to supersede the more rational indications, the success of which, when acted on, is verified by infinite experience.

The treatment of mental derangement is both moral and physical, but our ignorance of the relation between these two states of the brain, viz. intellectual disorder and cerebral alteration, renders the effects of remedies not only uncertain, but makes it often doubtful, whether that which is beneficial in one point of view, is not injurious in another.

Moral

* Yet, in page 311, M. Georget says, “ if you remove a foreign body from the conjunctiva in time, you will prevent ophthalmia, and the eye will suffer nothing."

treatment is more determinately useful than physical, which must be secondary and addressed to symptoms.

Direct Cerebral Treatment, moral and intellectual.-Cures effected by accidental agents do not admit of imitation; a fool is not to be thrown out of a window, or the house of a paralytic to be set on fire, because one recovered his senses, and the other the use of his legs, by such accidents. Philosophical treatment consists in lessening and extinguishing the causes which impelled the development of the disease, and which tend to keep it up, and renew it. Amatory and religious insanity are especially perverse. One requires great strength of soul, the other never gets well without an almost complete change to a state of religious indifference. That from jealousy is similarly obstinate. The indications are, to separate the patient from all objects which operate as causes or motives; to restrain formidable actions; to rectify errors of sense; to fix attention upon a limited number of objects; to encourage reflection on personal conduct and thoughts; and prevent mental aberration ;-to excite idiots to think, melancholics to firmness and hope; finally, to restore their habitual thoughts and particular attachments. These indications demand two methods of treatment, passive, or isolation ; active, or medical education. The former is almost indispensable in all cases, to facilitate oblivion of past impressions and causes, and excite new. The confidence of possessing authority, is superseded by isolation; and deference exacted by it to guardians.* Isolation by travel is but suited to the splenetic. Particular establishments, unless regulated with attention to reciprocity of condition, do harm. Nothing avails so much as the society of those whose sufferings correspond. The special establishments of France are maintained at the cost of government, especially those wbich receive the indigent. The Parisian, are the Bicetre for males, La Salpétrière for females, and the Clarenton for both. The departments are

• The abuses of asylums are prevented in France by legislative control. A gentleman in full possession of his intellects, in Lincolnshire, was put into a house famed for “des manæuvres, aussi viles que odieuses." He wrote to a friend who knew the nature of these intrigues, and who, being well aware that, whether mad or not, he never could get out during life, immediately wrote to the keeper, that the affairs of the patient would never enable his friends to discharge the costs. The consequence was, that the patient immediately got free! The house, we were informed, exists in the capital of a neighbouring kingdom, which exhibits men degraded to bestiality, and treated with as little consideration. This too is daily visited by hospital surgeons, men of education and liberal sentiments, who, for reasons best known to themselves, see and say nothing !!!

deficient, and deranged persons are thrown pêle-mêle, into the worst parts of hospitals. La Salpétrière contains 1200 persons, and is separated into two sections; the one destined for idiots and alienées en demence; the other for the maniacal, mono-maniacal, and the alienées stupides, incurable or under treatment. The latter is subdivided into large dormitories, for the classes under treatment and convalescents, and separate beds for the refractory. Gardens, baths, promenades, &c. are attached. It is suggested that these establishments should be built on the ground-floor, and have no large dormitories, because one violent patient disturbs all the rest; that the incurables should be entirely distinct, &c.* La Salpétrière is directed by a physician, who has notice of all alterations and punishments, receives parental expostulations, &c. There is also a chief inspector, of mild and amiable habits, sub-inspectors, and female servants. The second class protect the timid from the violent, and repress ontrageous conduct : the former is the centre of general confidence and authority. Mildness, persuasion, and strict fidelity in promises, &c. is advised. The turbulent are secured by suddenly enveloping the head; they yield immediately when they cannot see where to strike. Change of rooms, the grated court, strait waistcoat, bath, and seclusion, are the only corrective means bad recourse to. Men most readily subinit to females and vice versa. “ The latter, seldom entertaining a good opinion of their own sex, usually ascribe the worst faults to their governesses, with whom they are almost invariably on ill terms."

Medical Education, or Treatment. This requires profound intimacy with human dispositions, motives, and affections. It applies to that period of the disease when excitement and general or cerebral irritation is abated, when the ideas are less fixed and tenacious. Patients sbould never be flattered in the false constructions which they put on their own situation; by such a course lover, devotee, king, &c. are confirmed in their deranged personifications. The exercise of such ideas is to be prevented; yet, on the other hand, vehement contradiction merely exasperates to no purpose; but the best of all inanifestations, viz. doubt of the correctness of their own perceptions, points at the period for persuasion and conviction of error. (Who does not recollect the well-timed arguments of Imlac to the astronomer in Rasselas ?) The excitement of new turns of thought, the rousing of inert faculties form a

* See Art. Hospital Aliené de M. Esquirol.—Dict. des Sciences Med. Vol. III. No. 12.

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third principle of medical education. For instance, endea, vour to convince a king that he is without power, with the Jope of his reflecting that he may have been in error. Take hallucinées to the situations whence the object of the hallucination proceeds, e. g. fancied enemies, voices, &c. search and assure them of the non-reality. Awaken the passions of aliénées stupides by reproaching them with indifference to parents, &c. The physician is recognized by the worst patients; and readily obeyed when any other influence is defied. He possesses great power in exciting their confidence: and may make excellent impressions by oracular efforts; e. g. by relating to them their past conduct, telling them of their designs, as self-murder, destruction of children, hatred of husbands, &c. Cures are sometimes thus effected. The physician ought to pass some time in the midst of these persons; study the motives of their actions, the varieties of character, and compel them to perform his injunctions and their own promises. Nothing accelerates recovery more than the mutual association of convalescents; for this purpose gardens and refectories are especially necessary. Mechanical employments are of the greatest use, except with individuals wliose rank interdicts such pursuits. Bodily amusements suit the latter class. Travel, where fortune permits, is an excellent method of relaxing the mind. Family interviews may be granted when the patient is so far recovered as to demand them. Approach should always be announced. At this period very digestible aliment in small quantities should be used. Agitations are to be avoided.

Happily in France these unfortunate persons are not exhibited like curious beasts."'* 294.

Cerebral Treatment. Excessive bleeding, purging, and the use of pretended specifics has constituted the empirical treatment of insanity. M. Pinel and Esquirol reduced the treatment, first in France, and almost the first in Europe, to physiological principles, but without the wished-for success, from the nature of the disease. Asphyxia produced by banging, drowning, or blows, the practice of our quacks, is justly condemned. As is usual, these feats are said never to fail; one cures every patient with emetics, t another with vinegar, &c.

This does not occur so unreservedly in England, since the exposure of the intamies of the old Bethlem Hospital.

+ Sir Astley Cooper has told us that the use of tart. emetic internally in a large Establishment merely suspended insanity during its action on the stomach.-R.

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