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* HARVARD UNIVERSITY *

Library of the Medical School




f The Warren Library %

Y Dr. John Warren Y

I 1753-1815 ^

^ Dr. John Collins Warren ^

A 1778-1856 A

* Dr. Jonathan Mason Warren T

^ 1811-1867 I

$ Dr. John Collins Warren j^

% 1842-1927 ^

^ Dr. John Warren Y

^ 1874-1928 *



<?^ Harvard Medical Library
in the Francis A. Countway
Library of Medicine - Boston



VERITATEM PERMEDICIJSTAM QU/ERAMUS



Digitized by the Internet Archive

in 2010 with funding from

Open Knowledge Commons and Harvard Medical School



http://www.archive.org/details/managementoflunaOOpark



n



MANAGEMENT OF LUNATICS,



WITH



ILLUSTRATIONS OF INSANITY,



BY



GEORGE PAKKMAN, M. D,



Observez les raedecins qui guerissent le plus : vous veri'ez que.
cc f;ont presque tous ties homines habiles a manier, a touruer,
en qiielque sorte a leur gre, Tame hurnaine ; a ranimer I'espc-
raiicc ; k porter le calme dans les imaginations troublees."



BOSTON :

X'niNTED Br JOHX ELIOT

i8ir.




DISTRICT OF MASSACHUSETTS, to -wit •

District Clerk^s OJice.

Be it rememfered, that on the twenty eighth day of
Jujy, A, D, 1817, and in the forty second year of the Inde-
pendence of the United States of America, John Eh'ot of the
said District, has deposited in this office the title of a book,
the right whereof he claims as Proprietor, in the words follow-
ing, to wit :

" Management of Lunatics, with Illustrations of Insanity.
By Geoi'ge Parkman, M. D.

** * Observez les medecins qui guerissent le plus : vous verrez
que ce sont presque tons des hommes habiles a manier, a tour-
Tier, en quelque sorte a leur gre, I'aine humaine; k ranimer
I'esperance; h porter le calme dans les imaginations trou-
blees/ "

In conformity to the Act of the Congress of tlie United
States, entitled, *' An Act for the Encouragement of Learn-
ing, by securing the Copies of Maps, Charts and Books, to
the Authors and Proprietors of such Copies, during the times
therein mentioned :" and also to an Act entitled, " An Act
supplementary to an Act, entitled, An Act for the Encourage-
ment of learning, by securing the Copies of Maps, Charts and
Books, to the Authors and Proprietors of such Copies during
the times therein mentioned ; and extending the benefits
thereof to the Arts of Designing, Engraving and Etching His-
torical, and other Prints.'"



TrkHxr w -nAVTQ ? Clerk of the District
JOHN W. DAVIS, ^ of Massachusetts.



RESPECTFULLY DEDICATED



TO THE



TRUSTEES



OF TEE



MASSACHUSETTS GENERAL HOSPITAL,



INDEX.



Modifications of insanity

Analogies between sanity and insanity

Circumstances conducive to „

„ hereditary

5, from education

„ sexual

„ from youth

„ „ intemperance

J, ,, confidence in others

„ „ envy .

„ „ solitude

J, „ indolence

physical



Test of insanity
SensibiiitY of lunatics



page.

5

6

8

ib.

ib.

ib.

10

11

ib.

note ).

ib.

ib.

12

13

ib.



MANAGEMENT.

Seclusion ....

Safety , . . ,

Comfort ....

Neatness ....

Early Management '' . .

Advantages of Asylums

Introduction of patients into asylums

Separate rooms

Intercourse ....

Diet .....

Attendants ....

Employment ....

Religious Exercises

Music . ." .

Visits, " incurables"

Restraint ....

To allay excitement

Discharge

Admission, expense

Medical Superintendent

Surveillance . . . ., .

Construction of Asylums

Bedstead . . . . ,

Door fastening . ...

Heating rooms . .

Distention of the bladder

Feverish heat . . - .

Criminal lunatics . . . .

Innocent insanity

Prevention of insanity



15

ib.
ib.
ib.
ib.
16
ib.
ib.
ib.
18
19
20
21
22
ib.
24
ib.
25
ib.
26
27
ib.
28
29
ib.
ib.
ib.
30
ib.
ib.



t)



INSANITY

is want of control of our feelings and propensities*
(note a )

It is conceived of by adverting to dreams, absence,
reverie, fuJl influence of any strong emotion, anger,
(note b.) joy, giief, astonishment,

Appeariog only in words or little acts, it is delirium,
being to more active insanity as dreaming to sleep-
walking.

Relating to certain subjects only, it is melancholt^
generally with dejection.

Relating to the patient or his ajQfairs, with distress,
it is HYPOCHONDRIA, (page 12, c.)

Weakness of understanding, of will and affections,
passiveness of mind, not connecting ideas received, is.

DEMENCE.

Obliteration of intellectual faculties is tdiotisbt.
B



e



Insane persons cannot direct their attention adlihi-
tvm^ as others cannot collect themselves, after witness-
ing uncommon events.

When objects presented are not noticed, and clear
sounds make no impression, there is no proof of fail-
ure of the senses ; the mind, intent on other objects
turns not to these, and receives not impressions they
can convey. Thus susceptibility to cold, hunger,
thirst, sound, and to fulness of the bladder, is lessened
even in "sane" people.

Imperfect memory is consequent to unsusceptibility
and deficient attention, all opposed to true judgment.

When the senses are blimted, while memory, imagi-
nation and association of ideas are entire, ideas from
these predominate, and produce corresponding con-
duct ; as in severe erysipelas, the eyes, ears and nose
being shut by inflammatory swelling.

When insane persons are asked the reason of certain
extravagances, they often say, "I could not help it,"
*' I forgot," " I was dreaming,"

Ubi sum, ibi non sum ; ubi noa sum, ibi est animus.

Insanity often resembles somnambulism. Some,
who have been insane for years, speak of events be-
fore insanily as late ones, and forget late ones, as
dreamers have no idea of the time they have slept,
as d often no distinct recollection of their dream ; and
as the aged remember the events of youth, not those of
recent days.

Little dependence is to be placed generally on the
promises and apparent resolutions of lunatics. — Terent"
Eunuch. 1. 1. 12—19.



When, ia suspicious insanity, the eye or ear is very
aci'le, or any sense or faculty, may it not be attributed
to constant use ; or is it aualagous to that sensibility
in other diseases, in which the sufferer, highly suscep-
tible to atmospheric influence, foretells storms, though
shut from seeiag the sky ; and by which a door's creak-
ing is so offensive, and certain sights so frightful tq
some ?

Some lunatics are wakeful, for the same reason ap-
parently as " sane" persons greatly excited.

The astonishing strength of some lunatics seems
analogous to that of some *'sane" persons, under
strong affections, and motives, as anger, sense of dan-
ger, wish to defend.

(d.) Strong sexual desires often seem independent of
the moral state, their appearance following applica-
tion of physical agents, effluvia of cautharides, cer-
tain food, &c.

(e.) Many apparent extravagances of lunatics are
measures indicated by their peculiar state. A lunatic
throws a chair at his window, not to break it, but to
be rid of tlie person he fancies spying him. Anothet
unconscious of disease quits home, to avoid restraints he
thinks arbitrary.

Some insane persons seem impelled irresistibly to
acts they abhor, murder, &c. and warn their friends of
them* It may be conceived of by adverting to burn-
iQg lust with the power of gratification, to a ferocious
hungry animal in sight of prey, to man on a lofty emi-
nence, to women's " longing." " A pregnant woman,
seeing a baker with naked arms, made her husband
hire him, to let her bite his arm."



8



Is not '* charmiag" ia animals attiibutable to similar
principles ?

Persons experiencing noise in the ears, with increase
ed activity of imagination, sometimes fancy distinct
sounds, revelations, an animal in their head. Increased
susceptibility makes them alive to such alTections, and
subjected to them ;

Omnes se terrent aurse, sonus excitat omnis.

Should any one, in the irritability induced by mid-
night study or similar causes, consider this subject in-
tently, even a short time, let him move from his reach
every means of self-destruction and maniacal extrava-
gance, and quit his study as soon as he feels that ex-
altation </' imagination, its almost necessaiy elTect, and
analogous to effects of midnight frightful tales, &c. and
to the state att8:idi':g niauiacai eiitravagance.

Disposition to insanity, like other qualities of parents,
seems transmitted to children. (l|. f.)

Many, become insane, have showed peculiarities of
mind from early infancy.

(g.) Constant reciprocal action appears between
mind and body, (note h.)

That each mental power do its office is esseadal
to rationality.

(h.) Strength of each power and propensity is
proportioned to its use.

Inaciivity or undue exercise of any po-iver or
propensity disturbs the intellectual equilibrium. /i****

Disease, apparently from difficult accomplishment
of puberty, oftener attacks girls than boys. The womb



9



and breasts are often disordered, and specially affect
the mind ; the cessation of their functions is often
unfavourable.

Females are obliged generally to be cautious, which
saves them the consequences of many false steps.

Through life most of them look to some one for sup-
port and advice.

Men have more objects and anxieties than women ;
but each object has but a share of attention and inter-
est. If any fail, attention to others diverts from disap-
pointment.

As soon as girls are marriageable, their principal ob-
ject is to please men, for physical reasons, and for
prospects in life. If they fail at the expected period,
especially if their views centre in an individual, they
have small defence from extreme disappointment,
(note j.)

Without prepossessing qualities to secure common
civilities of society, they often suffer severely.

Men's profession is their principal object, matrimony
an occasiooal one, often subservient to business, and
suggested by circumstances. Disappointment from this
source is generally counteracted by business.

Widows suffer more than widowers, their chance oT
repairing their loss being less.

The generally extravagant anticipations of marriage-
life especially depress females, as affecting their chief
interest.

Disappointment tn facility of living, pecuniary
means, and personal estimation immediately affect the
husband ; but in his known affections, the wife partici-
pates considerably.



B2



16



Sickness shows special elTect on men, keeping thern
from activity and means of subsistence, and making
them anxious about their affairs.

Sorrow, mortification, suspicion, caprice, prejudice,
unnatural gratification of lust, show respectively equal
effect on the sexes.

These show special effect on men ; impatience, petu-
lance, responsibility, rashness, avarice, pride, extrava-
gance, dishonesty, political and professional enthusiasm,
gormandizing, venereal disease.

These show special effect on females ; jealousy, ir-
resolution, religious enthusiasm, ennui, fashion, seduc-
tion, abstinence.



From puberty, brilliant talents, astonishing facility
of receiving and communicatiDg ideas often appear
suddenly, especially in females, followed by mental
mediocrity, disappointment and supineness.

Some, with conscious energy, and premature or pro-
fessed estimation of friends, especially in families less
informed than themselves, begin life with extravagant
expectations of success, think themselves objects of in-
terest, and adopt peculiarities,

Digito monstrari & dicier " Hie est !"

That they fail to conciliate and are of the multitude
paralyses their efforts, (note k*)

Some seem to think industry alone required, and but
in the favourite branches of their pursuits, not regard-
ing the management and drudgery essential to success
forgetting that though " knowledge may give weight,



11



and accomplishments give only lustre, many more pe©-
ple see than ^veigh." (And Chesterfield. 296 let,)

Some, expecting inheritance, think erertion unneces-
sary, society's estimation worth little. They often show
extrePLie eflects of ennui, and irrationality. /^^^Xa .



Intemperance may be consequent to maniacal dispo-
sition, and aggravate it, or precede it. ufx^/if^.i-.

InteTsperate parents are o^ten succeeded by insane
children. (8, f.)

Misplaced conildence in others is a great enemy to
mental repose and sanity.

Nemini confide secures constant exertion of the in-
tellectual po^vers, (3. h.) instead of reliance on others.
(And Earl Clarendon's Life continued, ed. 3, vol.
3, 977, and Tristram Shandy, vol. 1, chap. xi.
"Gravity.")

" Treat your friend as if he may be your enemy,
and vice versdy'' secures caution and prudence, protect-
ors from disappointment and its consequences, en-
couraging constant connexion in the mind betwceQ
present conduct and distant consequences f

nullum numen abest si sit prudeutia.

" Dismterestedness" shows no immediate reference
to self, but looks generally to distant self-profit, repo-
tatioD, satisfactory occupation, power of patronagCj
grateful return. ucftlkki^L.

Parents are often grateful for kindness to their chil^
dren. (And Rochefoucault's Max. " Gratitude")

(note 1.)



12



b (40: g.) When changes io the miad follow effects oq
the body, we know not whethei thej are from these
elFects, or distant conseqiiences from interiuediate ones.

" Man is a harp, whose chords elude the sight."

Sometimes peculiarity of mind coexists with pecu-
liar form of head, eBpecially in idiots from bhth, as
often with common form* Dissection of the head
shows the same.

Other disorders show as freqaeflt disease of the
li€adj and the same as insanity.

The digestive organs ofteaer show disease in insani-
ty, than the brain, particularly before and during ky-
poclioiidria. A fit of anger in " sane' persons is often
succeeded by increased bilious secretion and vomiting
or purging, or copious salivation.

Some idiots exhibit the manners, voice and pro-
pensities of some animal, refuse other than its pe-
culiar food, and show no acts like men's. "An idiot
not only exhibited the manners ol a sheep,but his bacli,
loins and shoulders were covcied with a sort of hair
Hesible and blackish, an inch and a half or two inches
long, in fineness approaching wool."

(c.) Some states of body are attended with analogous
delusions. Insane persoiifi, with commotions and rum-
blings in their bowels often attribute them to animals
within. Some, with bowels morbidly swollen, fancy
themselves pregnant. Some with eruptions of the skia
fancy they have the itch. Some who have had vene-
real disease, or think they have been exposed to it,
attribute their uneasinesses to its fancied existence.
Some who have had piles attribute theirs to a growing
fistula Some, subject to sensation of light-heacledness,
fancy they have lost their head.



An invalid rich man loses a small part of his for-
tune, poverty stares him iu his face. Another suf-
fers opthalmy, the horrors of blindness beset hira.
Anotlier, with superabundant health, gains a little
bodily weight, and is haunted by apoplexy. What is
there surprising in the delusions and extravagance of
those whose reasoning powers are yet weaker !

Even " sane" people are subject to delusion, appar-
ently unconnected with and dissonant fiom their bodi-
ly state. Persons having suffered amputation express
feeling from the amputated part. Memory of sensa-
tions or ideas strengthened by their force or repetition
gives the impression of reality. To this are attribu-
table many delusions as to fear, hope, expeclatioHj e. g.



To ascertain the existence of insanity, or the feint
of it, unless the intention of the examiner be concealed
from the patient, the enquiry must be extensive.

Melancholy from homesickness hides its cause*



That lunatics are insensible to suffering, is a cruel
error.

Strangiilat inclusus dolor, atque ex»stuat intas.
A raving maniac^ under my care became stu-
pid, and apparently indiflerent to every thing, ex-
tremely filthy, and as would be called, a most disgust-
ing object. He pasFcd some weeks like an animal,
-wilhofjt speaking or seeming to regard the endless and



14



severe attentions he needed and received. His first
speech v as, -with emphatic sobs *' did you ever know
anij'Owe half so wretched as I ?"

Quoc sua soi'S hodie est, eras fore vestra potest !
Do dreamiug men, or unjust5y angry, anxious, dis-
tressed, envioiis, suspicious, prejudiced, impatient, pet-
ulent, avaricious, proud, enthusiastic, jealous, irreso-
lute, sulTer less because their feelings result from delu-
sion?

O munera nondum intellecta Deuni !



15



AS soon as maniacal disposidon appeai-s, let the suf-
ferer be secluded, to counteract it, and that it may not
be exposed to society, on whose estimation he depends
after recovery. Specially important is this step, if, as
is generally the case, he has been suffering bodily
infirmity. Then insanity is not recent, but needs ef-
ficiency to dislodge it.

Lunatics should be deprived of means of injury, and
placed in situations least likely to excite or continue
their extravagances, most favourable for self-com-
mand, and for coutroling them by gentlest means, when
self-government is insuflflcient.

As their extravagances result from some uneasiness,
their situation should be comfortable as possible, with
-such domestic circumstances as they can enjoy.

I^eatness is essential to sende of personal dignity.

In early stages, arrangements peculiar to well-con-
ducted asylums presently relieve many, without ac-
tive medical treatment. Later, the disease is more



16



complex and fixed, especially after injudicious man-
ageraent.

Let one, who has required fullest coercion, be
brought to an asvlum, in the irritation generally pro-
duced by domestic restraint. Receive him with cour-
tesy due a stranger he finds nothing there to which
he can refer such feelings as have agitated him ; feel-
ings arise corresponding to his new situation.

Bring one, whose caprices have been indulged, and
tyranny dreaded. Oppose his extravagances at once
by eifective energy, he sees the futility of resistance.

Asylums should seldom be viewed as objects of ter-
ror, nor be named to patients before entering them.
Patients should be conveyed there without exciting
suspicion. They need not learn the nature of their
residence, till maniacal extravagance discloses it.
Generally surprize arrests their attention for the dis-
closure of the leading principle of the establishment,
the inseparableness of self control and comfort, of ex-
travagance and irresistible constraint.

Those who wish them phould have separate rooms,
not be forced into society they do not desire.

Intercourse with each other may be encouraged,
while it is free from av,j thing unpleasant. It should
be so conducted that the parties be not injured as to
their disease ; nor, in cases of mutual convalescence,
as to after-acquaintance.

Those disagreeable to the rest should be removed
from them, as should every cause of discontent. Ad«
dress should be used to separately satisfy each party.



Yl



(ra.) Generally improper behaviour should be follow-
ed by seclusion, l^ometiroes maniacal extravagance has
contagious effect, especially on recent and perhaps
transient insanity.

Generally idiots should not be seen by other pa-
tients.

To those who show extravagant lust sight of others
is often aggravating; their own example danger-
ous. (7. d.)

Cheerfulness often irritates and distresses melan-
cholicks, making their state more conspicuous to them.
Greater sufferers than themselves offer them compari-
son in their own favour. (22 p.) Sight of distress is
more likely to effect content and cheerfulness than gay
LCenes.

■ Similes aliorum respice casus ;
Mitius ista feres.

Some patients resist regulations, thinking them made
for themselves. The sight of other's extravagances
serves them as a mirror, and shows them the necessity
of order and direction. A useful competition often
follows, as to the rationality each can exhibit.

Classing them according to their self-control strength -
ens it.

Note cc.

(n ) Placing boisterous patients within hearing of
each other is often useful. They are generally timid ;
and fear of each other calms extravagant excitement.
Tliey sometimes " beg to be removed from such fright-
ful noise." (24. o.)

Some use habitually high tone of voice, to be
cjiecked by addressing them in a low tone, and dis-
C



18



regarding questions and requests, made in a differ-
ent tone. They should be separated from the more
quiet to prevent annoyance.



Those under particular diet should take it separate-
ly, lest they ciave the common diet; others may meet
at meals.

It should be understood by the patients no intem-
perance is allowed ; stimulating diet is fuel to their
disease; therefore (q ) only those who act rational-
ly will have a common diet ; the quantity of each
one's food is to be proportioned to his activity. This
will be a great inducement to employment (20. r)
and will counteract a propensity common especially to
female lunatics, of staying in bed, which excludes in-
ducements to action, and invites recurrence to circum-
stances which excited, or continued the disease.

Indifference to food must be steadily counteracted.
The sufferer may generally be induced to take nutri-
tious liquid at meal time.

(v.) The food should be pleasant and well served.
Sausages, aiichovies, oysters, smoked beef, ham, sal-
mon, often excite appeti-e.

When patients show determination to fast, attempts
to dissuade often confirm it. "VV hen it shows vsish to
give anxiety, apparent indifference is likely to arrest
it. Attention to the digestive organs, exercise, diver-
sion, sight of the family enjoying a good meal, none of
it being offered to the sufferer, as if he could not eat,
are useful means.

When it has been necessary to oblige a patient to
t^ke food, I have used satisfactorily a flexible bottle



19



and stop-cock filled with milk, or rennet-wey witk
wine. Medicine too may be given so.

In urgent cases, nutritious clysters may be used, the
patient being first made quiescent, if necessary, by
mechanical means.

Inappetency of food appears in " sane" persons, un-
der strong emotions, as anger, fear, surprize, expecta-
tion : and voracity sometimes in adverse circumstances,
the result of which is pretty certain, and for which they
are prepared ; as is sometimes seen in families bereav-
ed, or who have a member very sick; and iacondemn»
ed criminals.

Voracity may be corrected by various measures re-
lating to the preparation and kind of diet.



Some lunatics are worse in the morning. Then un-
occupied by the occurrences of the day, they are
most susceptible of their subjects of delusion, which
then have special influence from the contrast they ex-
hibit from sleep. (28. t.) The consequent paroxysm may
be interrupted by employment, breakfast, &c.

Sometimes a patient needs an attendant, whose con-
stant presence supersedes much confinement ; w ho by
judiciously checking each rising extravagance, saves
greater restraint. Should he fail to conciliate, and to
acquire due influence, the patient should be told "he
acts by orders he dares not disobey." Confinement,
with privation of his attendant, will show the worth of
his services.

To some, absolute confinement is less irritating than
personal guardianship, which, as conditional, favours
the patient's reluctance to resign self-direction.



20



Propensity to suicide seldom appears but iu solitude.
Patients of whom there is doubt on this subject should
have a room-mate or attendant. (20. u.)

Should a female be so outrageous as to need a male
attendant, he should be accompanied every moment by
a female attendant.

^ Most patients show undue deterniinatiou of thought
io a particular subject, excluding due influence of oth-
er subjects. They must be separated from objects
which excited and cherish it, and attracted by others,
(r.) Hence the necessity of employment. Where
other inducements fail, (17. m. and 18. q.) rewards or
small wages may be used.

Domestic concerns of Asylums may be transacted
mostly by patients, in certain states. Cows, poultry,
bees, &c. may be committed to them.

Females may sew, knit, make lace, chords, tape,
&c. and wash clothes for neighbouring families.


1

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