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The Medical Treatment Of Insanity

Creator: Amariah Brigham (author)
Date: April 1847
Publication: American Journal of Insanity
Source: Available at selected libraries

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We are often questioned by letter and otherwise as to the medical treatment of the insane. To answer some of these inquiries, we think it best to very briefly state our views on this subject, and in a very general manner describe the practice adopted at the New York State Lunatic Asylum.

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No specific remedy for insanity has as yet been discov-ered. Different cases require very different treatment, and that which would be serviceable at one period of the com-plaint, might be injurious at another. According to our ex-perience, recent cases for the most part require a mild antiphlogistic course; but regard should be had to the cause of the insanity. If occasioned by a blow, or other direct physical injury of the head, or by some sudden and violent mental commotion, while in good health, free depletion by bleeding, and active cathartics are useful and often indispen-sable. But such cases are seldom seen in Lunatic Hospitals. We have very rarely considered it advisable to have re-course to general bleeding at this Institution. Only four of the 622 patients that have been here during the past year have been bled by us. In three of these cases the, bleeding did not appear to be serviceable; in one we thought it highly beneficial. Occasionally, when there is much cerebral excitement, we have resorted to topical bleeding, but more fre-quently, even in such cases, we derive benefit from placing the feet in warm water; the application of cold, to the head; and the free movement of the bowels by laxatives. Pour-ing cold water in a small stream from a height of four or five feet directly upon the head, is generally one of the most cer-tain means of subduing violent maniacal excitement, we have ever seen tried. But this should be done in a gentle manner and under the immediate observation of the physician, and should not be continued but for a short time; we also advise never to resort to it when the patient's bowels are confined or when he has just been eating and his stomach is full. The warm bath is also serviceable in many cases to calm excitement; but for this purpose it should be long continued at least half an hour and cold water should be gently applied to the head at the same time.

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In a few recent cases Croton oil has proved very beneficial, and we have thought particularly so in some cases, that seemed to be cured by the use of it, after other cathartics had been tried. Of all medicines, it is the most easy to administer to a patient that refuses to take any, and we have often used it, and never with any unpleasant result.

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Bathing in warm water we think beneficial in most cases. Bathing in cold water or showering, we seldom resort to, -- probably we should have recourse to the latter more frequently, if not from the impossibility of preventing patients from supposing it to be intended as a punishment.

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Most of the medicines we administer are liquid, or in powder. In addition to the preparations of the articles of the Materia Medica according to the United States Pharmacopoeia, we have a few of which we make use, that are prepared by ourselves. The following we often administer.

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R. Extract of Conium, oz. vi.
Fern Carb. Precip. oz. xii.
Molasses,
Wine,
Water, (warm) a a qts. ii.
Ol. Gaultheria or Ol. Sassafras, dr. ii. dissolved in Alcohol, oz. viii. M.

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Usual dose half an ounce -- to an ounce; if a laxative effect is wanted, we add one or two drachms of Tinct. Aloes and Myrrh, to each dose.

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We sometimes vary the foregoing preparation as regards all the articles except the Conium and iron, adding mucilage Gum Arabic, Alcohol, &e.

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The following preparation we derive benefit from in many nervous, sleepless, and hysterical cases.

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R. Tincture Luptdine,
Tincture Hyoscyamus, a a oz. iv.
Camphor gum, dr. i.
Ol. valerian, m xxxii.
M. Dose one to two drachms.

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The following preparation, we find useful in some cases of violent mania, and when as is often the case, the urinary secretion is deficient.

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R. Tinct. Digitalis,
Tinct Scillae, a a oz. ss
Vin. Antimon. Tart.
Spts. Nitre dulc. a a oz. i.
M. Dose 30 to 60 drops.

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Blisters, issues, and particularly setons in the neck, we have often tried, but rarely witnessed any benefit from them, unless they sometimes serve to direct the attention of the patient from his imaginary sufferings and delusions, and thus indirectly do some good.

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Emetics and Cathartics we do not often prescribe now, as we have seldom known them serviceable, we are however careful to avoid a constipated state of the bowels by the use of mild laxatives or special diet.

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Opium has always been used at this Institution in the treatment of insanity, and often with great success. In some cases it appears to be useless, and in a few injurious, particularly in those in which the skin is hot and dry, and the pulse full and hard. But such cases are rare. I do not however think it a remedy that of itself very often cures this disease, but it is a valuable adjuvant to others, and secures a beneficial degree of calmness, that can not be obtained without it. In some cases however it seems of itself to affect a cure. Of this we can have no doubt after having seen many patients apparently recover while taking it freely, and immediately relapse on its being withheld, and again recover under its use and finally, after continuing it for a considerable time and gradually diminishing the dose, recover and remain well for years without it.

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