16. Prussic Acid.

The effect of this potent agent was, a few years ago, tried in various lunatic establishments, but the report of its operation I found singularly to differ. The only person who spoke in favour of it was my friend, Dr. Balmanno, the able physician to the Glasgow Asylum. He told me that in furious mania he gave from fifteen to thirty drops of a diluted solution of it, preparatory to exhibiting hyoscyamus or other narcotics. This produced diminution of the pulse, exhaustion, slight twitchings of the muscles of the face, and slight subsultus; and that it was when the patients were in this state that narcotics had a full and good effect.

Upon this information I adopted it, strictly observing Dr. B.'s plan; but I never derived permanent benefit from it in any one case.

17. Camphor.

The antimaniacal virtues of this substance have been highly extolled, and some marvellous cures ascribed to it. Modern physicians have little confidence in it. Dr. Haslam says, he gave it in doses as high as two drachms without any sensible good effects. Cox, Hallaran, &c., confess its powers on the circulation; that it first exhilarates and then reduces the pulse, and even, at the same time, acts as a soporific; but neither of these authors attributes a cure to it.

When given in large doses, it has always been considered highly heating and stimulating; to counteract which the old practitioners were wont to combine, as a refrigerant, nitrate of potass with it. In a case of insanity, where two scruples were exhibited, it produced a fit, and a perfect cure followed. When given to the same gentleman two years afterwards, upon a relapse, i.e. a recurrence, it had the same effect, even to an alarm

ing degree; but the patient did not, as before, progressively recover from a single dose, for it was repeated afterwards in smaller doses of ten grains.*

Hence we may learn how far camphor can be prescribed as a remedy in the treatment of insanity. In rash hands it may prove dangerous to life, and in the most dexterous can rarely be used to advantage. If ever admissible by itself, it would be where, as in some longstanding cases, the system is extenuated and feeble, and requires stimulating. In combination with certain sedatives, however, especially henbane, it has proved beneficial.

18. Spirit of Turpentine.

Very few remedies are mentioned as having been tried in that worst of all forms of insanity, maniacal epilepsy.

Dr. Edward Percival, of Dublin, deserves much commendation for turning his attention to its cure. With that view he has strongly recommended the rectified oil of turpentine. He tried it in long-standing cases which were deemed incurable; and although he was unable in a single instance to banish permanently the epileptic attacks, yet in every instance they became considerably milder, less frequent, and remarkably disengaged from the maniacal excitement which had before attended

* Lond. Med. Journal, vol. vi. p. 120.

The experiments which MM. Bergogue and Gallois made upon themselves with camphor, if correct, ought to set the question of its effects on the human system at rest. They proved that twelve grains produced symptoms of the highest vascular and cerebral excitement, and increase of muscular powers; and that by weakening themselves by first taking evacuants, they were always able to repair their state by taking fifteen grains of camphor: finally, they conclude, that nitre joined to camphor does not at all abate its stimulating properties; and that when heaviness succeeds the taking of opium, or any other narcotic, the means of removing the torpor are, to employ camphor, which necessarily produces excitement.-Journ. Gen. de Méd. tom. lvii.

U U

them. He employed this remedy in twenty cases, thirteen women and seven men,-and in each case persisted in its use four months.

The formula Dr. Percival adopted was an emulsion, prepared by triturating an ounce of rectified oil of turpentine with as much loaf sugar, adding very gradually a pint of spearmint water. Of this mixture he gave an ounce thrice a day, as a full dose. He remarks, that the women bore the largest doses of it without experiencing catharsis, and that to them it also proved soporific, which was not observed in any of the men's cases. *

From this physician's account, I was induced to try his prescription in three cases of this hopeless malady; but it produced no good effect, and I therefore desisted from its use.

Dr. Knight boasts of unheard-of success in treating maniacal epilepsy; and he asserts that, among other means, he freely used the spiritus terebinth. rect. as recommended by Dr. Percival, with much benefit.‡

19. Tonics.

Tonics of all kinds are admirable adjuvants in the cure of insanity; but if administered in recent cases, before vascular action and excitation are abated, they may be decidedly injurious.

It is not enough to prepare for the exhibition of tonics by vomiting and purging, but the accelerated circulation and cerebral irritation, indicated by the symptoms I have described, must first be lessened by moderate local bleedings, refrigeration, and other remedies which have power

* Dublin Hos. Rep. vol. i. p. 116.

+ Gratified by Dr. Knight's success in this intractable disease, I requested a more explicit account of his mode of treating it; but I was sorry to learn that the experience of the medical officers of the Lancaster Asylum refuted Dr. K.'s statements.

Observ. on Derangement of the Mind, p. 65.

over the action of the heart and arteries, either by equalising or retarding their impetus.

This course seems to be now generally pursued by most judicious practitioners before they prescribe tonics in maniacal cases.

Medicines of this class are, more or less, stimulants, and are permanent in their effect. They cannot, therefore, be applicable where there is already strong evidence of existing stimulation, and consequent inordinate action, as in the incipient and confirmed stages of mania. Yet even in this state the immediate exhibition of the cinchona, and of wine also, merely preceded by clearing of the bowels, have been recommended by those reputed to have had great success in the treatment of insanity.

This practice is founded on the impression that insanity is a disease of debility of the nervous and vital principles.

It is avowed by Dr. F. Willis to have been the principle of his grandfather's and uncle's plan of treatment, and he himself therefore recommends, in every stage of mania, a tonic and stimulating system. In support of it, he maintains that every lunatic in a violent paroxysm is in imminent danger of life from consequent exhaustion, and must be sustained by the means of stimuli. I admit with him, that there is more danger of a state of exhaustion following that of violence than has been generally supposed; and that, therefore, depletion ought to be cautiously pursued; but I differ from Dr. Willis in thinking that life is frequently extinguished from the mere violence exerted by the patient, unless previously extenuated by long continuance of this or some other malady, or by injudicious depletion. If life be extinguished in the early stages of a maniacal attack, it more often happens from inordinate excitation; and this state would certainly be heightened by stimulants.

The imminent danger of pushing depletion to an

extreme in recent cases, is not so much in regard to life as to a very protracted case, or permanent insanity; and if depletion be adopted in an old case, the chances are, that complete fatuity, or, indeed, premature death, will

ensue.

Dr. F. Willis adduces a solitary case in support of his theory and stimulating and bracing practice, which is that of a young lady, who for six days from the accession of mania, and before he saw her, was very violent, and had been bled by leeches applied to her forehead and temples, and by cupping-glasses to the back of her neck. She had also had a blister on her head, been purged, and was only allowed barley-water, with weak broth. He adds, that she had ceased to rave, probably from exhaustion. She was sleepless, silent, and in perpetual motion; pulse 130, and all the symptoms of cerebral excitation; unconscious of evacuations; tongue brown; lips and teeth covered with sordes. Dr. F. W. inferred, that although there might be some disease in the brain, either congestion of blood or effusion of serum, yet the patient was necessarily worn out, and her life in danger. Under this impression, he gave her immediately two glasses of old port wine; and two hours afterwards, three ounces of decoction of bark, with some of the tincture, as the only means of saving her life. By these remedies her vital powers were quickly restored, and she soon answered questions correctly.*

The practice described in this case antecedent to Dr. F. Willis being called in, is that which I have too often met with, and cannot too strongly reprobate. It is applicable solely to high inflammatory action, and would unquestionably in this case have terminated in death or permanent loss of reason.

In a case similarly treated, I should certainly have

Suprà cit. p. 116 et seq.