Hints on insanity / by John Millar.

Date:
1877
    that they have no right to take it; and the same feeling leads to a neglect of the bowels, which become much confined. Sedatives are as useful in this as in other forms of mental derangement, and it is often astonishing to see how they improve the ap- petite and general condition of the patient. At the same time, attention should be paid to the state of the bowels, since the digestive organs, as I have said, are usually out of order. To relieve the constipation so constantly pre- sent, small doses of castor oil are of great use, or a pill containing two grains of watery extract of aloes with two grains of compound rhubarb pill every night; whilst alteratives, together with the mineral and vegetable tonics, are constantly required to improve the tone of the stomach. When there is a strong suicidal tendency, I have found large doses of tartar emetic of the greatest use, and the tolerance of it in determined cases is very great; one grain to begin with rarely produces sickness, and I have often increased the dose at bedtime with a decidedly sedative effect. When there is total rejection of food, and after the second day’s complete fasting—or- earlier, if I see the patient becoming weak
    even from partial abstinence—I have no hesita- tion in using the stomach-pump, and by this means I throw into the stomach milk and eggs, with some suitable stimulant. Upon these alone, and administered only once a day, I supported an elderly lady for a period of nine weeks, who, during the whole time, did not voluntarily partake of even a drop of water. In using the stomach-pump, I prefer laying the patient in the recumbent position, with the head w'ell thrown back; the mouth is readily opened by tickling the fauces gently with thefeather end of a quill passed behind the teeth; a short conical notched wooden gag will keep the mouth open, and prevent the teeth from injuring the tube until it can be passed a short way into the oesophagus. Three or four eggs, well beaten up, mixed with about ten or twelve ounces of warmed milk and a little brandy or wine, and sugar to make it palatable, is the dose I find most beneficial. When, however, the stomach is irritable from 1 long fasting, a smaller quantity should be i introduced slowly, and repeated in a few hours, i If there is much difficulty in getting the : mouth opened, there is none in passing the
    food through a catheter inserted a short way in the nasal cavity. It is well known that the great majority of cases of suicide occur where mental derange- ment and a suicidal tendency have not been previously suspected. After the event, how- ever, many circumstances come to light which lead to the conclusion that the mind must have been affected ; and the evidence brought forward at the inquest almost invariably shows that the deceased had been exposed to some mental anxiety or irritating annoyances. It then also appears that he had not been quite himself for some time, that he had been de- pressed and out of sorts, that his appetite had been impaired, and he had not been able to sleep as well as usual. The disturbance, how- ever, was too slight to create any anxiety on the part of his friends, or to induce them to seek the assistance of their medical adviser. The propensity to suicide often shows a marked hereditary tendency, and it becomes necessary, therefore, to watch that family in which any member of it manifests such a propensity. This becomes more important if either of the parents has so fallen ; for there are many instances recorded of a portion, and
    even of the whole of a family with this pre- disposition, making aAvay with themselves. The mode in which they effect their intention is often peculiar. They will avoid obvious, direct, and simple means of accomplishing their purpose, and select a way least sus- pected, and frequently one which does not offer the best chance of success—such, for in- stance, as hanging themselves from a peg placed at so short a distance from the ground as to necessitate their leaning forward to pro- duce the necessary pressure, as their feet touch the ground.* The presence of a razor, knife, or other means of committing suicide, often excites in such persons a sudden desire to use them. Many insane persons also who believe that i persons are attempting to .poison them, or ) who believe that they are to be destroyed for I • some imaginary crime, anticipate death by I ‘suicide. ! If there is anxiety and want of sleep, there I rmust be exhaustion ; and in proportion to the I * I heard of a lady who fastened the end of a shawl i^to the bedpost, whilst with the other end in her hand ■ -elose to her neck, she turned round and round, tighten- Bdng it at erery turn, until she effected her purpose.
    degree of exhaustion there must be a weak- ness of judgment, which will allow the cause of the anxiety and its consequences to stand out in stronger relief than they would otherwise do, and thus the prospect of ruin, disgrace, or degradation to acquire an undue prominence. Such a condition leads to a suspension of the strongest instinct in nature, self-preservation, and from “ a mean conception of the great moral purposes of life, such persons terminate ; their existence the moment it ceases to im- 1 I part its usual gratification.” The treatment in this latter condition should be precisely the same as that recommended for the ordinary form of mania. IV. RECUBBENT MANIA. This peculiar form of insanity is not often i seen in all its phases out of an asylum, though it is one which requires to be noticed, as it is * not of unfrequent occurrence, and may, during i the period of excitement, be mistaken forg acute mania. It is characterised by attacks g of insanity, coming on without any apparent cause, followed by depression and recovery,^, the period during wliich these states continue" ; being very uncertain. Sometimes the excite- w,