Insanity : its classification, diagnosis, and treatment; a manual for students and practitioners of medicine / by E. C. Spitzka.

  • Spitzka, E. C. (Edward Charles), 1852-1914.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Insanity : its classification, diagnosis, and treatment; a manual for students and practitioners of medicine / by E. C. Spitzka. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    the scale sufficiently on the side of struggling nature to overcome the pathological influence. He should bear in mind that mania disappears, not suddenly, as a rule, but by a series of oscillations between the healthy and the diseased state, which finally merge into a healthy equilibrium, and that in the absence of a specific remedy it is wisest to fol- low physiological lines of treatment. No mania was ever choked down, but, at most, prolonged or diverted into the channel of deterioration by the excessive use of hypnotic and calmative drugs. It is even desirable to permit a ma- niacal patient to remain excited at some periods and within certain limits, as only under these circumstances can that men- tal influence which is often more important than the drug be tested and exerted so as to permanently benefit the patient. In paretic dementia it should be particularly carefully watched, and in the later stages of that affection is al- together contraindicated, owing to the fact that it may in- tensify the angio-paralytic phenomena of that disease, or produce cardiac paralysis directly. Among the procedures which are recommended for the treatment of sthenic delirious conditions, and of such which, like delirium grave, are associated with incipient and acutely inflammatory states, venesection at the mastoid process, the use of ice-bags, the cold pack, baths, and of hydragogue cathartics are the most efficient. Venesection is very rarely applicable, because the period when it might be useful is usually past when the patient comes under the alienist's cognizance; its use should be limited to cases of suppressed menstruation and grave delirium. In insanity with excite- ment we have usually to deal with a condition rather of under nutrition than of over-nutrition, and it is in obedience to a rational meditation on this fact that phlebotomy and the leech are almost banished from asylums for the insane.* The use of baths, originally recommended by de Bois- mont in recent cases of mania and melancholia with ex- citement, is most beneficial. Baths of nearly the temperature * In a number of recorded cases a sudden shock, either mental or physi- cal, has been followed by rapid improvement. Thus melancholias who have wounded themselves with razors, appeared to be relieved by the unsuccessful attempt at suicide, and thenceforth recovered. Of this nature probably was the result published by Fordyce Barker, where vene- section in melancholia was followed by almost instantaneous recovery. This procedure would probably not have the same happy effect in that large proportion of cases where an anaemic condition is a marked feature. Severe burns have also been followed by amelioration.