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the repressing of the importunities of the patient himself, and also of his relations and friends, to allow of communication. When convinced that it will be detrimental, resistance to such communication should be carried to the utmost point, and should be yielded only when importunity on the part of those who have authority assumes the character of command. In yielding, contrary to his judgment, the physician should distinctly throw all responsibility on the applicant; otherwise, the consequence, if injurious, will certainly be cast on him.

When allowed to follow my own course, before I permit the visit of any individual, I examine the state of the patient's feelings and views towards that person. Moreover, I always select the one who the least interests the patient's affections, for the first interview. If that is borne without ill effect, I next fix on one who is nearer, and reserve, as the last trial, communication with the object of warmest attachment.

Proceeding in this cautious way, the mind too sensitive or too enfeebled by recent suffering is gradually brought to bear a renewal of intercourse with long-lost friends, without being too much moved.

Frequently, however, all the sagacity of the physician is deceived by the art and dissimulation of the patient, who will assume an appearance of amendment merely to obtain an interview with a friend; his only object in seeking it being to request his release, or perhaps to make accusations respecting his treatment.

Should the mental derangement have proceeded from habitual intemperance, a longer confinement after convalescence is obviously required than from any other cause; for the more it is protracted, the greater is the probability of that habit being obliterated, and the permanency of recovery.

Suspicious and sensitive as the public mind is respecting separation and seclusion of the insane, I lament

when any case occurs that seems to militate against this most important part of their moral treatment.

I have, therefore, always felt much regret at the publication of a case by Dr. Gooch, of an insane lady who recovered, as it was supposed, from the effect of a visit which her husband paid her, contrary to the advice of her medical attendants. It will be conceding nothing more than must be granted in the curative treatment of all diseases, that remedies sometimes act contrary to the expectations of the wisest. An exception does not disprove a general rule. Nor is this case a justification of departing from the inductions of experience.

It appears that this lady fancied her husband was dead, and that his spirit haunted her. As soon as evening closed, she would station herself at a window, and fix her eyes on a white post that could be seen in the dusk ; and this she imagined was his ghost.

Now it is obvious, that such being her delusion, either she ought not to have been indulged by being allowed to stand at that window, or the post, the object of morbid association and delusion, ought to have been screened or removed.

Where an error of the imagination like this exists, and is persisted in, I would have tried the experiment, and permitted an interview with the husband. To withhold it in this case was, perhaps, injudicious.

I am certain that the talented physician who relates this case never meant to inculcate, that intercourse with the insane was to be encouraged from the result of any individual case. Neither his own judgment, nor that of his colleague in attendance in this instance, advised the husband's visit, or anticipated such an effect from it. It cannot, therefore, be adduced as an example for imitation.

Yet, such has been the impression made by the recital of this case, that I know Dr. Gooch has been consulted

in several cases of insanity, from an opinion that he would not countenance the removal of an insane patient from home; and farther, when I have recommended separation, this very case has several times been quoted in opposition to it.

I am ready to own that I have not always been right in my judgment, and that sometimes no harm has followed from a visit when I fully expected it. But this does not alter my opinion, that, as a general maxim, it is wise to deny intercourse between the patient and his friends, except under the circumstances and restrictions which I have pointed out.

COMMENTARY VII.

EXERCISE, OCCUPATION, AND AMUSEMENTS.

INACTIVITY debilitates the powers of body and mind— due exercise strengthens both.

Muscular exertion increases the momentum of the blood in proportion to the degree used, and, provided it be judiciously regulated, tends to restore the balance of the circulation when that is disturbed. Hence, exercise is peculiarly appropriate for the insane.

The impetus of the blood may also be accelerated by other causes; such as mental emotions, heat, wine, full ingestion, &c. But the effect of exercise and of such stimulants on the corporeal functions differs very essentially the one, at the same time it acts on the arteries, and propels the blood into the veins, carries off a great portion of it by the exhalants in perspiration; the others stimulate the arterial system, while the venous is comparatively dormant.

Whenever, therefore, the circulation is already excited to an extraordinary degree, as it is in most recent cases of mania, violent muscular exercise would only increase the malady. Moderate exercise only is applicable in such cases; while for those in whom the momentum is reduced, or is languid, or unequal, the more violent and brisk is required.

Exercise, constant exercise, is advised for the insane. But I must insist, that unless a judicious limitation be observed, the malady of some will be greatly aggravated by it.

Constipation, in extreme cases of mania and melancholia, does not always proceed from indifference to the calls of nature or want of attention. It may arise from other and opposite causes, viz. over excitement, and defective excitement: too much cerebral activity may impair the influence of the nerves, and impede the peristaltic motion; too little may render the liver inert, and the bile inadequate to stimulate the bowels to action. As the effect of moderate exercise is to quicken the circulation, the peristaltic action then becomes uniform, and secretion and excretion are duly performed. Exercise, therefore, for insane persons ought to be varied according to the form of the malady.

Thus, for such patients as are easily excited, swinging, riding in a carriage or gently on horseback, or slowly walking in quiet shady places, will, under certain restrictions and modifications, be sufficient and beneficial; while for those in whom the circulation is languid and sluggish, active exercises, and every degree or kind of muscular exertion they can use, will conduce more to their health.

A due medium, therefore, in the exercises of insane persons should always be preserved; for if carried to excess in either case, greater excitation, or so much fatigue and exhaustion, is produced, that harm, instead of good, will result.

It cannot be necessary to point out particular species of active exercise suitable to the insane. With the cautions premised none can be objectionable.

Occupations and amusements are used almost synonymously; but they differ materially, though equally essential as exercise to recovery: it is fortunate when they can be combined.

Each should be suited as much as possible to the rank and taste of the patients. A man of refined education would find exercise and occupation in digging, but no

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