NATIONAL LIBRARY OF MEDICINE




          Bethesda, Maryland 
 
 
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INSANITY.
 The following is Jan Appendix to a book, presented in manu-
   script  to  the  Trustees of the  Gen. Hospital  more than a
   year ago, entitled " Management of Lunatics, with illustra-
   tions of insanity, by Geo. Park man, M. D. " printed for
   information of those  who might commit  sufferers to  his
   charge; the edition of a pamphlet published about four years
   ago, when he first undertook the charge of insane personSj
   having been exhausted.

    [Read before the Boston Medical Association at their Annual Meeting, 1818.]

 .During the parliamentary inquiry,* the increase of in-
 sanity, in Great Britain, beyond that of population, was  men-
 tioned without reference  to the  fact, that  when insane persona
 become objects  of public  attention, their  number is  better
 known.  The same was mentioned  in some parts of France,
 when asylums  were enlarged or  improved  there, on account
 of the advantages of public over  domestic management:  also
 when  an  asylum near  Philadelphia was  proposed,  1810, and
 New  York asylum, 1808.  In  Massachusetts 285  male,  244
 female insane persons have come to my knowledge.

  * This developed faults in neglected institutions.  But  the healing art
 applied to insanity, has ever furnished illustrious examples  of men, indefa-
 tigably, feelingly, and enlightenedly devoted to their toils, discouragements,
 responsibilities, privations, and perils.   I desire publicly  to express my
 obligations to that head of Psychological science, M. Pinel,  to whom I was
 indebted for seven  months' welcome access to the  theatre of his suc-
 cessful labours  in Paris.  He early undertook the private charge of insane
 persons.  Afterwards  he was called to the medical superintendanre of an
 asylum of 300 insane men.  The last 16 years he has been  medical «uper-
 intendant of one much larger for women.  He has ever given best proofs
 of qualifications requisite to his station.  The results of his  experience are
 weightier, cost. par. than the dissenting opinions of others  of less experi-
 ence in  these  subjects.  His ripened years, 73, enjoy double experience
 in VI.  Ksquirol, his former pupil, conductor of an excellent asylum for 20
 insane persons.  Ideas resulting from M. PinePs experience  gain add tional
 force by passing before the eye of another Intelligent,  vigorous examiner.
 Had I not otherwise occupied much of this number of the Journal. I should
 refer to numerous similar obligations, in performing a sort of promise I
 made in a letter to one of the Fditors, published in the Journal Jan. 1813,
and which was copied into liond. Med. and Phys. Journ. Jan. 1814.  The
                             1

                                  t 
insanity.
        ANALOGY BETWEEN  SANITY  AND  INSANITY.

  Some insane  persons having exhibited  wonderful  changes
from  their ordinary  slate  and conduct, insanity,  according
to  the  common notion,  divests  its  subjects of the  proper-
ties common to  man,  and  represents  them  under  slates and
ailments, opposite from our common nature.  To these spe-
cific  states and ailments  specific management  and medicine
are thought  necessary:  till  these  are discovered, the  sub-
ject is in a mystery thought  to warrant  the vaguest specula-
tions.—Consideration  of the  most  striking  extravagances of
insanity in connection with phenomena  of  sanity analogous to
them, as in " Management  of Lunatics &c." p. 6—7, shows
sanity and insanity are homogeneous, differing  but  in  shades.
Many bereft of  reason are like children not having it  mature.
Some are not unlike people fallen  from eligible situations, who
persist in  notions fitted only to their former stations ;  E. g.
heads of families, accustomed to command, are unwilling to
consider themselves under direction.
  Aversion from society, desire of retirement,  is seen in the
sick,  as in some insane persons.
   Agitating  the fingers, feet, head or body, walking up and
down, muttering, humming, whistling, singing, biting the nails,
among sane people, often seem analogous to Ihe violent motion and
raving of insanity, and resulting from vacancy of a mind unfixed.
   Some see confusedly, like one half asleep, drunk, or dizzy ;
in reading, letters seem to run into each other.
   Involuntary  action, and  inaction.  Inactivity  of  the will,
and  indecision,  though often exhihited by sane  people, are
specially  characteristic of  low spirits and melancholy,  and
form  principal  points of treatment.  Dr. Gall told  me of a
mother, who said she felt  an almost irresistible impulse to kill
her children.   She had several limes  carried one  of  them  to
the river,  but  momentary honour restrained  her.  She had
sometimes sharpened  knives  and placed them under her pillow.
Her  husband, esteeming her a  pious  and  affectionate mother,
treated her  anxiety lightly.   Dr. Gall  advised  her to absent
herself from her family, as  soon  as  she should  first  feel the
approach of these attacks.
    Daily  other instances occur of inactivity of Ihe  will, which,
 though  not  designated specimens  of disordered intellect,  no

 promise refers to  a descriptive account of such asylums for insane per-
 son-  in the British empire, France. Italy, and Switzerland, as are most
 likely to offer themselves to the medical traveller's convenient inspection.
 Outlines  of this account,  embracing 91 separate receptacles for  insane
persons, were presented in manuscript to the Trustees of the Gen. Hospi-
tal, before their asylum for insane persons was planned. 
                         Insanity.                         «*

more than  transient  uneasinesses  are called  sickness;  yet,
(hough  generally  subsiding  spontaneously,  or  without-great
curative means, may be the nucleus  of great mental ailments;
K. G. staying in bed  late,  when we wish  ourselves  out  of
bed, and make fruitless  efforts  to  quit  it: also  at  the  fire-
side, at table, and  in pleasant society.  In anger we sometimes
use expresssions and actions disapproved by our experience and
the looks of those about us.  In high spirits we sometimes act
so sillily and extravagantly, even friends half amused  pleasant-
ly call us light-headed, half-crazy.   Then  we say—resentment,
or pleasant ideas overpowered  us.—So insane persons some-
times say—I could not help it—I  forgot.   They sometimes
beg  to  be  restrained,  to  supply  self  control.   In situations
seeming partly  bereft of motives to excite the will,  see ihe idle-
ness of  the rich heir, the  listlesness  of the pauper who finds
near him no means of employ immediately adequate to his need.
Under  the head here  referred  to are those conditions called
states of temptation.   People on an eminence feel strong pro-
pensity to leap  down.   Similar  stales appear in  cattle, when
their barns take fire ; and  in birds charmed.—Here  I  cannot
help adverting  to  the frequent coincidence of suicides, spe-
cially among friends   and persons  similarly  situated.    The
knowledge of such acts seems too horrid for some persons' con-
sideration ; the impression so fixed, they  kill themselves, ap-
parently to be rid of it, as  some convicts ask immediate  execu-
tion, to save consideration  of death ; or as some patients, almost
distracted in expectation  of a  surgical operation,  are firm in
suffering it; or as some shipwrecked people leap into the sea,
rather  than  view probable  destruction.   See also "Manage-
ment of Lunatics," p 8, 1. 9.
     *    *     after the  suicide of his bosom-friend, being
several  times accused of attempting  to  follow his  example,
said—though the world presented to him but little to live for,
his  friend's suicide had so painfully affected him, there  was  no
danger he should follow  his  example.—He shot  himself six
months  after his friend, holding in his hand a prayer for a per-
son in the agonies of  death.  I know other analogous  cases.
  When repeated suicides occur in a family, they are often im-
puted  to hereditary insanity, without  reference to the circum-
stances above mentioned.
  Suicide  by  drowning,  shooting,  throat-cutling, and  poison
sometimes occur when  the individual  chances to be near the wa-
ter, or  to be using fire-arms for common purposes, or when he
shaves, or chances to meet with poisonous substances;  though
a walk to the water, sporting, and shaving are often resorted  to
to  effect suicide without exciting  suspicion.   Almost every 
4
fnsanity.
body is occasionally indifferent to life, especially in Ihe nause-
ating and depressing stages of some diseases.   Under such cir-
cumstances, should they be placed in situations  ottering great
facilities for suicide, such an attempt would not be surprising.
   Persons  seemingly disposed  to  suicide should be kept from
objects likely  to excite their disposition ; manifestations  of it
are lo be met by most discriminating management tending rather
to divert it  from its purpose than evidently lo  thwart it.  This
was signally evidenced by  Dr.  Willis, according to a narrative
I received  from a physician to  whom Dr. W.  communicated it.
The King proposed one day to shave himself.  Dr. W. feared
to hesitate in assenting, lest  he  should seem to  suspect the King
of intended suicide, and give him dangerous notions, of the pre-
existence of which there was no certainty.  Dr. VV . called  lor
the razors,  and in Ihe mean lime engaged the King about some
papers on the  table.  The razors were  put  on the same table,
the King still attended to his papers, which encouraged Dr.  VV.
to believe suicide was not  intended.  After shaving, the King
returned to his papers ; the razors were not removed immedi-
ately, lest Dr.  W.'s  anxiety  about possible  mischief should
appear, and occasion a dangerous train of thought.
   Of 9'd suicides in  and near  Boston, 19 were committed  by
females. Propensity to suicide has repeatedly seemed arrested
by strong  counteracting impressions.    #    #     #     in
mid-winter tried to leap  into  ihe neighbouring  sea.   As  she
passed, 1 had thrown on  her a tub  of water.   This producing a
vivid impression sufficient to attract her attention from her pur-
pose, she ran back shivering, and never repeated such attempts.
Cheerful scenes gave her only transient diversion ; the contrast
from  Ihem  she found in her situation depressed her.   I showed
her Ihe whole inleriour of Ihe alms-house ; Ihe dislressed objects
here  convinced her  she was  not "the most wretched in   the
world" as she called herself.  Such modes of relieving melan-
choly deserve attention.   Few persons  righlly value their  ad-
vantages, not knowing other's sufferings. Most men lhinkmore
of their troubles than if they knew those of others.  Cheerful-
ness  oflen  irritates  melancholies, as singing and levity is offen-
sive to some people occupied by  thought.
   Lord M. requested our distinguished artist, Gilbert  Stuart,
to paint a  portrait  of his  Lordship's brother, Capt. C. P.—
The artist, considering this no  common call on his talents  and
friendship, availed  himself of  uuch  familiar  intercourse v iih
Capt.  P.  to witness in him those  variations of  countenance
which best exhibit characteristic animation.—Lord M. saw the
portrait, and exclaimed, with a sigh, " it is  not my brother, it
Ipoks like  an  insane  man!"  In  consequence, the  artist had 
Insanity.
5
another sitting with Capt. P.   Lord M. saw the portrait again,
and exclaimed  "it  is yet more like an insane  man!"   Three
weeks after,  Capt. P.  shot  himself.  This, which  might be
thought Ihe result of momentary impulse, seems  a consumma-
tion  of a  mind  in  which disease had accumulated: insanity
seemed to show its early stages.  We cannot foresee the par-
ticular extravagances it  may exhibit,  but we can use precau-
tions likely lo obviate probable evils.
  Sensibility, and insensibility to heat, and  cold.  In some
persons of great  energy, vital  heat  seems  superabundant.
They  wear no  great  coals, under-dress,  gloves, or  boots ;
sleep on a lightly-covered mattrass, open the window at  rising,
dress and  undress in the cold, use cold bath in winter. Charles
xn.  of Sweden  is  said lo have  slept in mid-winter in Norway,
in the  open  air, on straw,  or  a plaint,  covered  only with a
cloak.  Another warriour is said lo have harangued his army
an hour in the streets  of Warsaw, clad in white dimity.  I
know no insane persons' resistance to cold, more wonderful than
is exhibited by mariners on our coasts.  Sometimes in our cold-
est  nights a wave cases their clothes with ice, when they dare
not quit duly a moment.   Their resistance  seems to depend on
strenglh with mental energy excited by danger; in insanity, by
a real or supposed state of things exciting  energy.  Security
from cold  seems to depend partly on (he same mental principles
by which  some persons are  unhurt among apparent contagion.

  Others, with  the  various preservatives  of  heat, are  chilly,
and pass  the winter in trying  to  be warm.  In some, insanity
is so depressing, and  inactivity so great, their susceptibility
of cold is  not  strange.   Hence the importance of encouraging
activity in  them  in  winter.       #      #       #      ggt#
17, had his  toes  frozen  a very  mild  night, middle  of Oct.
in a  close  room 6 ft. sq.  He gave no previous  intimation of
suffering.   Two others died, apparently chilled to death, Oct.
a year before, in a warmer climate, the weather very moderate.
Some  will not be clad, others  inadvertently kick off the bed-
ding.  If  crawling infants play as long as they please in parts
of a  room  distant from  the fire,  in severe weather, their fingers,
ears and  nose will be  half-frozen, without interrupting  their
pastime.  Intermittent fevers present opposite extremes of tem-
perature showing little connection with atmospheric  influence.

  Some who have been insane and relieved never recover their
force of mind,  as some who  have had  bodily disease  never
recover their firmness.
  Those  who have been insane are very susceptible to exciting
causes, as those who have had bodily disease. 
ti                        Insanity.
   * * *  had an epileptic fit at a lecture in C.   When  it
 had subsided he  knew not the place  he was  in, nor how he
 came there.   Presently he remembered, in Ihe order of occur-
 rence, coming to C,—for a lecture,—entering the chapel,—the
 prayer,—text,—introduction of the lecture.

   Painful  dreams seem to result generally from baneful habits,
 ill health, or a mind  disturbed when awake.


                         CAUSES.

   In taking charge of insane persons, their friends' conjectures
 of the cause of the ailment have sometimes been given me.   In
 25 cases, physical causes have been mentioned;  in  27, moral.
   I have witnessed at least 24  other cases, with  the origin of
 each of  which, physical and moral circumstances seemed inti-
 mately connected.
   Is hereditary influence a merely physical  cause?   At least
 30 cases imputed to it by friends  have been presented  to me ;
 2 others  combined with other or additional moral circumstances.
 1   »        »      »    »   »>     »    physical        „
 3   „        „      „              „     „  and moral  „
   Three other insane persons have been committed  to me, be-
 cause their presence showed injurious effect  on some of their
 family.   A person told  the physician  of an  asylum  I visited,
 —with a near prospect of marriage, he thought of one  or  two
 instances of insanity  among his relations, he had painful  doubls
 as to the propriety  of fulfilling  his  marriage  contract.—He
 now inhabits  that asylum, perhaps  from dread of insanity, from
 painful scruples, from disappointment,  from reproaches or sus-
 picions of  his intended relations, aggravated by maniacal pre-
 disposition.  This is not a solitary case.
  In eight  cases insanity was imputed  by friends  to  intemper-
 ance in strong drink.—In five others, before decided insanity,
 intemperance and other circumstances physical and  moral  co-
 existed,  apparently  conducive  to  insanity.—In three others,
 intemperance  coexisted  with  moral circumstances;  which  I
 believe frequent ;  intemperance destroys property and estima-
 tion, and begets disappointment, despair, &c.;  strong drink is
often resorted to, to exhilarate  depressed  minds.—In three
 others,  hereditary and  moral  circumstances  coexisted with
intemperance.—In another, hereditary with intemperance.
  Some  persons, habitually temperate,  previous  to exciting
suspicion of insanity show  propensity to strong drink.  Is  not
this an  early effect of their insanity ? 
Insanity.
7
  Some persons after long intemperance may be debarred from
strong drink.  Others may be supplied from a set  of vessels
the capacity of which lessens in almost imperceptible grada-
tion ;  or by  diluting the draught; or  by less stimulating sort
of drink. I have satisfactorily substituted nice coffee or strong
hot mint tea, or high-seasoned solid  food.  A child  had got
into use of opium at night.   I occasionally lessened  the opium
a quarter, without his knowledge, and added  rhubarb to pre-
serve the accustomed size of his pills.  He always d.scovered
the difference.

  A person  has been presented to me insane apparently from
"home-sickness."   Such  patients  generally try  to hide the
source of their  uneasiness.   Those seem  most exposed to it
who have been accustomed to  industry, temperance, domestic
enjoyment, retirement, and scenes peculiar to their home.

  Insanity after bodily diseases seems often imputable to them ;
to anxiety as to their event; to affairs embarrassed, or supposed-
ly embarrassed  by them ; to shame, when they rise from begin-
ning vice; to premature return to accustomed occupations: all
these aggravated by susceptibility increased by disease.   In-
sanity after childbirth should be  viewed in connection with  the
changes consequent on sudden removal of distention and weight;
new secretion and  discharge, with their causes and consequen-
ces ;  sudden joy, and  relief from  anxiety ; sometimes  disap-
pointment and new anxieties; exertions induced by friends' con-
gratulations.  Of insanity apparently from more or less of these
combined causes, at least eight cases have been presented to  me.
   A  person with great irritability,  impaired memory, unplea-
sant dreams, shame, doubt, discouragement, and sense of moral
depravity, asked me if  his  disease  did not tend to  weaken his
intellect: if I did  not think  he had  less sense than  others?  I
asked as to  his  success in  life.   " He  had  prospered the  last
two years." I  named to him one of his  acquaintances, who
had not  prospered, yet thought well of himself.   1 concluded,
apparently to his satisfaction,  my patient had most sense of the
two.
   Many cases of  insanity, imputed  to intense study or bodily
 labour, occur under exertions conducted in  ill  health, prejudi-
 cially, or about objects perplexingly various, doubtful, or  dis-
 tant  in event;  then, study and labour  show  no necessary
 connection  with insanity ;  they generally seem  highly preven-
 tive and curative of it.
   Besides the  general apparent agency of  climate, and change
 of seasons  in causing disease,  lassitude opposed  to salutary
 exertion attends people exposed to warm seasons. 
8
Insanity.
   Dr. Wistar, one of the Friends, told visitors to Pensylvania
 asylum for insane persons,—insanity among Ihe Friends serins
 often  imputable  to unduly active  imagination exerted  about
 the  spiritual  faculty they  believe men  have independent of
 intellect.
   Insanity is often attributed to circumstances showing nothing
 specific apparently capable of producing it.   Any exciting or
 depressing cause, acting on persons predisposed to  insanity, may
 be followed by action of the predisposition. This remark seems
 applicable to some cases of insanity imputed lo avarice, disap-
 pointed love, and religious enthusiasm.   Five cases imputed to
 religious enthusiasm have been presented to me ;  one of them
 combined with disappointed love,  another with other moral
 causes, another with physical causes.   See also " Management
 of Lunatics," &c. p. 8—13.
  To investigate thoroughly the  causes of insanity, we must
 consider those pursuits  of men which prevent full action of the
 intellect, also the general destitution  of fixed principles,  and
 the  insubordination specially of the  young to  their natural
 guides.  It may  be necessary to fix a general  period,  styled
the season of discretion ;  this ought  not to be  acknowledg-
 ed  when  it  proves false.   As soon  as  an individual  shows
 insensibility or disregard to the safeguards of his estimation
or property, whatever  be  his age, it is the natural  right  and
 duty of those most interested in his welfare to seclude him from
 objects which excited  and mdnlain his delusion.   If they
 scruple to perform this duty, they are responsible  for his conse-
 quent  derangement or vice, the probable results of undirected
 minds impelled by excitement.  See also "Management of
 Lunatics," p. 30, 1. 16.
  To ascertain existence of insanity or feint of it, unless  the
examiner's object be concealed from  the  patient,  the enquiry
must be extensive.
  A physician in this town  asked me to  see a female in  his
house, whose conduct was strange.   He doubted  whether  her
strangeness was involuntary, or  assumed  on account of some
domestic  crosses.    I  went to her  chamber on  pretence  of
seeing the house with a view of hireing it.   Being left with her,
I asked her why she put her  hands to her head?  She said,
" she  believed she  had lost her  head !"   From such expres-
sions,  and from her  general  air, I concluded  she was insane
or knew how to feign insanity.  The first was  true. 
                         Insanity.                       r'

  The strongest evidence I know of certain changes in insane
persons, at certain lunar periods, is in  " De 1' influence de la
nuit sur les maladies. 231—235.  a Bruxelles, 1816."


                     RESTRAINTS.

      See Management of Lunatics, &c. p* 26-2—26-3
  I know no sure proper means of confining the upper extremi-
ties of ingenious patients, perseveringly impatient of restraint,
but a canvass-strait-jacket, the  lower parts of the arm-pockets
sewed very strongly, the back  held together by buckles and
wide straps instead of cord, the  bottom secured round each
thigh by a  strap or string.
  The following means may be  exactly proportioned  to  ex-
travagance or resistance, and are less heating and irritating.—
To confine the  fingers, thick leather mittens without thumbs,
the palms  covered with sole-leather, the mittens secured round
the wrist  by a  wide and strong strap, with a melaliic ring,
through which a cord may pass, to hold the  hands behind.—
In sitting and lying, the  hands are  kept  in  front  by a cord
passing through a staple in the floor near the feet.—To confine
the ankles, similar straps, the cord  through the rings passing
through the staple.—  To confine the breast, a strap round it
and the back of the chair.—To confine  the  thighs, a strap
round each of  them and one of the chair's  hind  legs.  The
chair is fixed.
   When restraints are easy, and exclude idea of escape, irrita-
tion and revenge consequent on painful  restraint, and risk and
uncertainty are prevented, and the sufferer  is impressed with
the advisableness of submission, and with respect for Directors
able to accomplish judicious measures.
   Restraint, unless conducted  with  judgment,  is likely to in-
crease fury, excite hate, revenge  or despair.  Each patient's
situation and  relations in life are to be considered.  Whatever
peculiar  measures are advisable are  to be executed  with  a
persuasively commanding tone  of conscious  power, and with-
out a chance of exciting ludicrous ideas.
   Properly constructed double  apartments for each  patient
present most  efficient  and  easy  means  of  requisite  general
restraint and  quiet.   See plate described in  " Management of
Lunatics,  &c" p. 27—30.
   In Mass. asylum for insane  persons the window-sashes are
ash,—glass, 6 in. by 8, 24 \ anes,—stiles and top-rail 2 in. sq.—
bottom-rail 2|  by 2,—meeting-rail  \\ by  2,—intermediate
bars 2 by 1.  Upper  sash falls, lower sash rises 7 inches.  The
                          2 
10
Insanity.
 room doors are fastened by a mortice or box-lock or bolt, kept
 in its place by a spring, and moved by an arm attached to the
 tumbler which is turned by  a square socket  perforating it to
 receive the key.  The box is 3 in. sq. i  in. thick.   The bolt
 and sash were recommended by one of the  Trustees*.


                MEDICAL  TREATMENT.

   Of  the action and state of the brain and  nerves during life,
 as  of  many internal parts, we  know but little.  Their minute
 structure shows their functions but imperfectly.  The time of
 commencement of merbid effects and peculiarities apparent on
 dissection cannot be known, nor the connection between them
 and insanity, nor whether many of them have not taken place
 since death, or  are consequences of previous affections not now
 apparent.  Insanity like  other diseases  sometimes leaves no
 visible traces after death.
   In what part of the system disease begins, in any ailment,
 we seldom know.  Its origin is seldom so marked that its prima-
 ry symptoms are noticed. It first excites attention generally by
 several coexisting phenomena  interfering with the individual's
 comfort, and apparently emanating from parts remote from each
 other.  If intellectual "derangement" be a primary affection, but
 little can be known from the sufferer's account of its origin. When
 bodily ailment precedes insanity, we seem to have more light at
 first:  but we cannot, from the sufferer's experience, trace the
 steps by which physical ailment  blends itself with intellectual.
   In a system intimately connected, affections are participated
 according to each part's susceptibility. Some parts, remote from
 the apparent or supposed original seat of the  morbid action or af-
 fection, are sometimes more pressingly disordered, and seem first
 to ask  aid.  The healing art consists often in seizing these indi-
 cations and relieving such parts: renovation  is thus participated
 through the system, and  satisfactory results  follow the judi-
 cious physician's labour, characterized by energy and patience,
 though  often by doubt.  Health consists in  the due  action of
 each bodily organ ;  what plan is so likely to cure'disease, as
 that which tries to restore each  organ to its accustomed action,

  * Ebenezer Francis, Esq. under whose special  superintendence the
 buildings have been erected.
  Here we may offer the meed of praise in mentioning the respected names
of Francis C. Lowell, and Geo. G. Lee, separated  by death  from active
agency in this work of humanity.  It  will be a more durable, honourable,
and useful memorial of them, than any which could be raised by friendship
 or respect. 
Insanity
11
 in the order of apparent severity of its respective  ailment.
 The records of five lunatic asylums give together 5351 admis-
 sions,  2792 cures.  Even idiots have  acquired or recovered
 some reason, after a steady  course  of judicious discipline ;
 many such cases seem attributable to  baneful habits, or mis-
 managed insanity.
   Few bodily ailments presented in insanity seem essential to
 it.  They are as various as the symptoms of other  disorders,
 and resemble them.
   lo eveiy step of the  medical  treatment, it seems specially
 advisable, considering the imperfection  of our  knowledge, to
 bear in mind the constant tendency of the diseased  system to
 spontaneous changes, generally salutary, to which physicians
 are often  indebted  for " the triumphs of art."  Medical appli-
 cations should be  made in  a manner  least likely to interfere
 with such tendency.   Imitations are attempted of these saluta-
 ry changes.   But  we can know the  external marks  only of
 these changes, perhaps their effects only.  Our  production of
 some appearances like nature's may be mistimed, injurious, and
 is not likely to be  attended with such combination of  circum-
 stances as precede  natural changes, and without which similar
 effects are not to be expected.
   In undertaking  the charge  of an insane person,  we should
 bear in mind—it is  not unlikely his disease will not prove tran-
 sient; it may be very long, very violent; his physical powers
 may be exerted by it  to their  utmost,  though they may now
 seem equal to great exertions.   Under  such circumstances
 I have been told by  patient's  relations, " we have no  hope of
 relief for our friend, but from a process by which his maniacal
 vigour shall subside under genera! prostration."   So  often is
 disease aggravatad  after such prostration, and such satisfactory
 results follow the system referred to in " Management of Luna-
 tics, &c." p. 22, expedients, the good success of which  is not
 at least probable, seem inadvisable.
   Some patients  when  first presented  to  me exhibit obstruc-
 tion  of bowels, with great extravagance and violence.  Under
 such  circumstances,  a purge  or  cathartic  may  be needed.
 Daily discharge from the bowels seems indispensable to good
 success:  for this, laxatives seem best,  as they leave the bowels
 a chance of resuming their functions.   Inordinate action of the
 bowels induced  by purgatives, is followed  by corresponding
inaction ;  this  renders necessary a repetition of the purge, &c.
   If under use of mercury as a laxative, mercurial action ap-
 pears, its  worth  as  a remedy will be known.   I have seen thin
 persons,  one  of them insane, emaciate under una'iccessf-:1
 attempts at salivation. 
1-2
Insanity
  The  case in p 5, 16 b. was very severe;  it presented  no
mark  of amendment till after  the accident: from  that time it
began to mend, in four months it recovered.   The irritation,
and discharge from the feet seemed  highly useful.   A  great
variety  of analogous cases show the same.
  A labourer, under most severe erysipelatous inflammation of
his face, his eyes and  ears  closed, was uninterruptedly deliri-
ous, fancying himself lifting heavy bales,  made corresponding
exertions, and sweated profusely.   Thinking this  would soon
exhaust him, I thought it necessary to change the train of  his
ideas   Thinkiug nothing likely to do this but a  most  vivid
physical impression, I produced a great irritation on his crown ;
he did not recur to his delusion, and became  in a  situation to
receive  the remedies to which his restoration seemed owing.
  A slender female, uninterruptedly delirious, constantly stamp-
ed with her feet.  To interrupt this exertion, which threatened
to enfeeble her  irrecoverably, I advised  blisters to her  soles.
I have given similar advice for patients disposed to run  away,
kick, or strike, when this  seemed preferable  to other restric-
tion.

   Some foreign medicines used in  insanity have been shame-
fully  adulterated;  others, even  of domestic  origin, mistaken.
Hence, and from the difference in the  physical and moral man-
agement of different patients, and the  diversity of  disease,  rise
some discordant accounts of medicines.
   Much advantage has been attributed  to the warm-bath, at
 82° to  88, combined with the douche, i.  e. the patient, under
 excitement, being confined in  the warm bath, by  means of
 a wooden  cover to  the  tub,  with a notch  for his  neck;  a
 stopcock from  a  reservoir  above is turned, so  cold  water
 falls  on his head  by  drops, or in a small stream.   The falling
 water is generally an object  of terrour. Perhaps  a vapour
 bath, described in Lond. Med. and  Phys.  Journ. No. 205.
 may be used for the warm bath.
  Feb. 24, ev'g. died Archibald Bruce, M. D. »t. 42, Physician to New
York asylum for insane persons from its establishment;  'endeared to
numerous friends by acquirements, integrity, generosity, and hospitality.'
 
 

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Insanity
G. Parkman
1818
National Library of Medicine
Bethesda, Maryland

CONDITION PRIOR TO TREATMENT
There was no cover.  The sewing was intact.  The wove paper text was
very brittle, and discolored with many edge losses and tears at the head,
tail and fore edge.  There was a  label adhered to  the front, with an
inked inscription.  The first  leaf was stained from  adhesive from the
label. The text was stained from water throughout.  There were library
stamps in the text, on the front page.  The surface pH of the text was
5.8.

TREATMENT
The text block was disbound. The fust and last leaves and heavily soiled
leaves were surface cleaned with grated and solid white vinyl  erasers.
The  text  was  washed  in   calcium  enriched  deionized water  and
deacidified in magnesium bicarbonate (IM solution in water). The leaves
were lined recto and verso around the text with acryhc toned handmade
Japanese paper and methyl cellulose. The book was resewn by hand with
unbleached Irish linen thread with the addition of  new end leaves of
handmade paper. The spine was lined with both Japanese paper using
wheat starch paste, and unbleached Irish linen with PVA adhesive. The
book was recovered in a non-adhesive paper cover reinforced with acid-
free buffered board. The surface pH after  treatment was 8.2.
and Historic Artifacts 
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