Clinical lectures on the principal forms of insanity : delivered at the Middlesex Lunatic-asylum at Hanwell / by John Conolly.

  • Conolly, John, 1794-1866.
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on the principal forms of insanity : delivered at the Middlesex Lunatic-asylum at Hanwell / by John Conolly. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    33/64 (page 426)
    526 ■were appliiil t the head; lie had warni-baths; criitun-iiil v,ii» givta whin I'hmI was ri'fuseil; the liiicliirc lunhune at ntpht, mill, altiT a trial of this nicdiciiu'. purler; hut he siiiik rapidly; 1h-<-:miu quiet and sleepv, and di.-.l ten ilavs alter adliiis^i.'ri. We liKikiil with nuu-li inlin sl In the apijearances Rfl.T ill alh. ihe MoikI-vi-sm Is ol ihedura maler wiTe slitrhllv jnjivted; llu ii was a lillle si rnni at llie iiasc the brain; the ves>rls ..i'the pia mater wen- ■.'■■rirrd, and in some purtii'iis of it there wi ;e p;itches of snHiised hli«id. 'I'lie nu-inbrane cmild n..t Ih ilelaehed tVoni the l.r:iiii wilh..ut injury of the cerehr il sub<'.;inee; the irrev suhHance was pink :ilid nintlli-d; the whit. >iili<lanei rnuc h in. led ; tlie v, nlriele* enntained more s< rum lli;in i\:itiiral. In sU' h e;ise!', :\ttcnd.-d with the Sjiliploms 1 l.;ivi.- inenliiiiied. I Ie;ir there is hllle to \k- hopeil from any Ireatnieiit; ami. at all events, .sedativis ;ippe;\r to be quite ineless. The>;e ;ire all. r nearly all. the riises in whieli I h;ive wit- nessed ihi i\h.iustii>n oinseipietit im ;u-nte m:ini;i end in deJilb in this :isylnin; and ihi';ippear;uie( s :ifter di>;ith attiinl no iinifurm e>:planatic)n of a fact—with which mere einpirieal prartiee makes us aeriuainled—that there are very few eases of aenle mani:i in whieh sedatives are advant;ii.'eoiis. and that the most violent eases are f,'('ner;dly the h:ist under their control. ■^'et I have s.iid to you th;it in chronic- cases they are oflcn luL'hly serviecahle, ami I am eipially s;itisfied that in some of the acute cases—l-ises in which it is proli;ihle tlnit the cerebral irrit;ilion is not ;ici-finipaiMed with f.'ri';vi ;ictivity in the eerel)r;d circulation—timely sedatives ;ire salut:iry. A few dav8 a'.'o S. (' was admitted to the asylum. ;incl ]ilaced in tin- female infirmary; slie is twenty-tive ye;ns of atfC, umii;irried. :ind suildenly became insane four wee Us ai,'o. when she was about t( be married. I'our precious weeks Iiave Ix'en lust in a house liconseil to receive p;iuper8. The results are a budy I'ovcred with bruises, and wrists and ;iiikles Bcarred with restraints. She is restless, limiil. feeble, inco- licrent; she iloes not know where she is. or who is ;iliout her; the pulse is Mil. excessively » e:ik ; the tiin;_'ue is ele:in; the Bkin is now w;irm. but on admission it was cold, and she :ip- peured to b. sinkiii'.'; there is im particular lie;it ..f the sc:ilp; the counlen;iiice is distressed; she se;ircr!\- t;iki s fond; tbi- urine is se.inty; she U'ets little n;itiir;il nsl, Slu- tried to climb up a window, and she took ulVlu r ( Inile s. .u hue theni; she w as. Ilu reforc. placed in a ]iaddeil room. ;inil dressed in a ■warm sinm^' dress. She look a iitll,- wine with ^'reat satis fiu'tlon. ;ind then ale some hreiul; but contiiiuiuf.' restless in a liiKh dcKr.'e, by ni^ht and day. a sedative m;is t,'iven her. the tincture of henbiine. of wliieh she took two drachms. She w;is first put into a warm-bath, immediately after which she was more excited than bclbre; but sunn iifter t;ikinu' the sedative, and hiivinu^ cold water ajiplicd to Iut lie:id. she became c:il!tK-r; she bad ;i tr;in(piil nmhl; ;ind the next ihiy she was no lon^'cr disposed to te:ir her clothes, w;is ;lble toWldk about .a bale, and ;i]iiH-ared tti Ik-coinpar;\tively conilbrt:tble. In such cases, a dose ot :i sed;ilive at niu'lil sc i ins In bi c \ eleiUly t'ei viceable; but more frei|iii nt doses oidv stu|iiry the );atunt ami. as it were, mask the disiinUr. It seems to be in c;ises ji; which the ]>ulse is soil and \M':ik. the skin ot' mi»der:i!e warmth, :ind tiie whole bi>dily i-ondilioii of the p;ilii'nt hiiiL'uid. tlull sed;ili\es arc chielly useful, by alhiyinu' nervous irritability. In one of the excellent liepnrts of 1 )r, lliitcheson, of Ihe (ihisu'ow Asyluni. 1 have seen the same opinion expressi .l; .■ind I iloulu the useful exieiisicin of this class of remedies to uther I'lrnis of acute neini i. Their adimnistral ion piDdiiers. in snim- in- 6t;inei s. ;i ei'eat :niLoiient:ition (^t the cxciieini nt; and. ;_ri ner;illy spcakiiiL'. wli. re ilu y tail to act as seilalivi s. they ;ire jiosi- tiveU injure.11'-. I believe it to be true. ;is observed l>y l)r. Seymour. Ileal wie. re vnscnhir cxcilemeiil exists. tOL:elher with inerea.sed seiiMbibly of the brain, the restUssness is :ie!u;ill\ iiicreascd by the ;idiniiiistr;\tion ot o]iium. As re.L'.irds the meilieine to be seleetii! in siudi c;\s(s, 1 luive also to l uTib my iiuibilily to per ■ ive the nice .iill'ereiiees in the etVecIs ■ i| t he various :ind iiiimei.e;v prep:i r.i t iuiis of opium of wliich I re;id, ;iiid which entitle :iny mie of tluni to :i constant preference, Tn ordinary iir.u tiee we liiel tlu ir ctfects contiTiu;illy modified by idiosyiicr;iey; ;uid this is i-'piidly or Rtill more the- c;ise in ineiltal or nervous disiinU rs, AVilh some ]iatients laudriiium acts with cert:iiuty, and like ;v ehariii; otb( rs derive comfort for loni; perioils from the acel:ite of moridiia; to some the li(|Uor o]iii sed;ilivns is alone toler:ible; and so of the rest, for their eoutimuilly inerc:isin^' immlHT testifies the frequent disaii]iointment inciilent:d to the u.sc of those whii h went before. In acute mani:i, I t;ive the (.refer- ence to the ]irep:iraticuis of hyoscyaniiis, and the nrdin:;.y dose of the tincture—the form in wliich we most cununynly give this medicine—should !><■ two cjrachms; or of the extract oijfht or ten Krain.i. Indeed, whatever seilativc is einidoyed, the ilose slioiil.l bo lar(;c. Ia.-ss than a (rrain of the acetate of moriihi:i is iirodiictivcof no^;ooil efrect whatever; and laudanum recpiires to be iiivcn in iloses of :i ilrachm. or :it |e:isl of forty or fifty drops. 1 :im speakiii}.'of acute cases, for in those of lon;;er eoutimiaiice use often in:ikes much hirtrer iloses necc». sary. WInitever sedativi- is triven, it is pru.'ent. if the head is at all hot. to ;ipply i-old to the he;ol by means of small napkiiu wruii),' out of 1 old water, or :i double i ap of thill in-.tiriali, kept wel. The lnili:in hemp, which h:is been lately introduced into l.ii;;lish pr;ietice, seems to be :i valu:ible addition to our inoanjl of ei.nlridiiii;: \elierncnt nervous disorders. I belii vi- th.Te ia Very lillle i>( the j.'emiine Indian hemp imw in Kurope, luit if our observaliiiii of its elleets in this a.sylum is not alto(jcth(;[ erroneous, it must become ;in im)iorl;nil arliide of commerce, l eiv pr;ictili.iners :ire less disposed lh;iii myself to trust in the :illeL;ed powers of new medicines, iir more difflcult to convince of the ;ictu;d ellt cts of niiiny of those of ohkr repulalioii; hut ;if'ter siiiiie e;irefiil Irials of the tincture of hemp I feel justi- fied in spe;ikinu W II of it. It is diielly useful, I think, in chronic c:'.ses, in w hich my uw ii opiniuu of ils jjood i fTects is slroniily confirmed by the iiumeroiis Irials made of it on the nude si.le ..f ibe ;isyluin by |)r. lii vdey; and on the female sido by Dr. .Nesbiit, :ind more recently by Dr. llili limaii who, how- ever, luis observed llnit ils elleets are uncertaiii, and that when it does not lu'oduce slee]> it i iiuses p:iins and twitchin|{8 in tlie limbs. This is exempliMed in M. A 1' , in female ward, .Vo. 10; :ind it su),'),'''Sts eaini(m in the euililoymi..nt of the n iiiedy. I luive know n the linclurc of licm|) useful, although less ^'eiu r;dly. in ai ute c:ises. In one, « here the symptoms closely resembh<l those of delirium In ineiis, all the unfavour- :ible (diaracters of the dis.irder dis:ipiieared in two or three days, during which the ii;i'.ienl look ten drops of the tinclure every four hours. :iiid no other medicine. In this, :is in some chronic c;ises. it seemed (,'rc :itly to incre:ise or to restore the desire for food, '^'ou have nolii'cil all active yoiin).' imin in the :iirinp court of the refr:iclory wanl, w:ilkiiv_' 'piickly about with a kind of milit;iry :iir; he is coiiv;ilesceiit from acute mania; too much menial exertion, too muidi care, and, t:iken for relief of this, too much opium disordered his br:iin ;ind inti rrupted his piu suiis, which were those ot a man of education. A .lilHcully existed in the w:i\ of t:i\ in'_' him sedatives, in coiisi-ipieiwe of ;i \ow he had nuide never more to take ;iny (d' Iheiii. lie knew the t;isle :ind smell ot ..)iiuiii ;ind llcnb:ine too ell to be de- ceived into sw;dlii»iii>; ;iny; yet his irrihd.le si;iu-seemed p;irliciihirly to require some seihilive ap|iliaiicc beyond leeches, aperients. ;ind the shower-b:ilh. He w ;is unaeqiuiinted w ith the tasle or pro|ieriies of the hemp, and it w;is j;ivcn to him, ill the form of extract, with such marked adv;iiita^'C that wi- consider his present favourable coii.lilion in a ^.-reat me:isure to be ascribed to its us..; ;iiid we now enlert.iiii no doubl of his entire recovery. In ,1. li ,ayoun^'Si-olcbman, nut loiu; maniac:il, the ine.in iiie st t-med to In-cqmilly l>ciiefi- eial. The dose of the extract L.'iven li;is been Iroiii one t.. two L'l :i:ns, A ilr:ielim and a IkiII, and soiiu liim s two dr;uliins, of the tmetiire bin e treqiienlly be. n L;i\eii in ebronic c;ises of recur- rent niiiuia, :uid althout;|i i,'eiier;illy willi .i,'ood eHects. sonic- liiiies wilhinii iiiiy etleel wieiiever. The tincture employed has bi'eu proeiirc.l t n.iii I he .\ pot hecaries' Hall. Some tinc- lure prep.ireil Iroiii l',nLdi«h lump entirely ilis;ipiiointed us. The w;iriii siii; ;imi \\;iriii soil ..1 .i tr.'pu;il eliniate seem to be reqiiiri'.l for the de\elopiiieiil of the iiiediciiial lu'operiies ul the plant. ! 11 1 liosi'disfres^iie,' cases, mi ntioiieil m a f.iriner leclun— in uhieli niaiiei comes nil with symptniiis ot fc\er. ami the patii'Ut is excessively leeble and yet I'Xtreniely restli ss and violent at the same time, the t'Mii.'Ue iH'insr coaU'd and brown, and scarci'ly any looil beiiii,'taken—all sedatives seem to me to be iisi-less, or worse tleiii useless; and ill every case of acutC mania it is iinpi>rtant I.. :n nul l;i\ uil.' >ed;ilives for a loui; time, lU- in frequently reiK-ated il.is..s. :is they either obscure the symptoms or modits wiihniit iiiiiemliiiLr the palieiit's coiuiition- In private practice 1 have nut with cases in which patients had been kept more or less mi.ler the influence of the acetate of morphia for many months; and tiTtainly with no i;i>od ett'ect. Their reiietitiou in increased do.ses. where they dis- appoint the first trials of the practitioner, may lie tnUowed by very distressiiii; cmisi'quences; by wilder excitement, and rapidly iiicreasimr debility. Tu all the prci>aratiiais of opiiun the pt neral obje^clion exists of their jiroiiuciiig constipation, an ubjectiou to which the liyoscyamus is not liable, or the