Extracts on madness
1758 "A Treatise on Madness By William Battie MD. Fellow of
the Royal College of Physicians in London, And Physician to St Luke's
Hospital"
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"It was the saying of a very eminent practitioner in such
cases that
management did much more than medicine; and repeated experience has
convinced me that confinement alone is oftentimes sufficient, but always so
necessary, that without it every method hitherto devised for the cure of
Madness would be ineffectual."
...
"Madness is frequently taken for one species of disorder,
nevertheless, when thoroughly examined, it discovers as much variety with
respect to its causes and circumstances as any distemper whatever: Madness,
therefore, like most other morbid cases, rejects all general methods, e.g.
bleeding,
blisters, caustics, rough cathartics, the gumms and faetid
anti-hysterics, opium, mineral waters, cold
bathing and
vomits."
1758 "Remarks on Dr Battie's Treatise on Madness By
John
Monro MD. Fellow of the College of Physicians in London; And
Physician to
Bethlem Hospital"
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"Notwithstanding we are told in this treatise, that
madness rejects all general methods, I will venture to say, that the most
adequate and constant cure of it is by
evacuation;
which can alone be
determined by the constitution of the patient and the judgment of the
physician. The evacuation by vomiting is infinitely preferable to
any other, if repeated experience is to be depended on...
I never saw or heard of the bad effect of vomits, in my practice; nor can I
suppose any mischief to happen, but from their being injudiciously
administered; or when they are given too strong, or the person who orders
them is too much afraid of the lancet.
The prodigious quantity of
phlegm, with which those abound who are
troubled
with the complaint, is not to be got the better of but by repeated
vomits; and we very often find, that purges have not their
right effect, or do not operate to so good purpose, until the phlegm is
broken and attenuated by frequent emeticks.
Bleeding and purging are both requisite in the cure of
madness... Issues between the shoulders, have been of great service in the
removal of this distemper; cold bathing likewise has in general an
excellent effect, but as it is sometimes apt to hurry the spirits, it is
not to be prescribed indiscriminately to every one."
15.6.1830 Printing of 1829 Report of Metropolitan Commissioners
Bethlem Hospital Minutes of Evidence taken by the Committee, appointed
to enquire into the charges against Dr Wright, The Apothecary and
Superintendent of Bethlem Hospital, and his answer pursuant to the
direction of a special Court of Governors for the said hospital holden on
Tuesday, the 28th Day of September, 1830, and directed to be printed for
the use of the Governors, by a special court, holden on Friday the 15th day
of October 1830. Reprinted for E. Wright, MD, President of the
Phrenological Society of
London, Member of the Royal Medical Society of
Edinburgh, of the Medico-Chirurgical Society of London, and twelve years
superintendent of the Royal Hospital of Bethlem, London. Printed by Mills,
Jowett, and Mill, Bold Court, Fleet Street, 1830.
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During the inquiry, Dr Wright examined
Drs Monro and Tuthill, the joint physicians
to Bethlem, who he had called in his defence. He examined Sir George Leman
Tuthill respecting aspersions that had been cast on him (Wright) about his
removal of heads from dead patients:
"In your opinion, as a medical man of many years standing, is
it good and profitable to inspect the heads and bodies of the dead?
Certainly it is
Did you, of your own knowledge, ever know that any inconvenience arose from
that practice in Bethlem Hospital? Certainly not
Do you not believe that it is one of the grand means, by a sedulous
prosecution of which we can, and can alone, expect to better our knowledge
of insanity? I do
Did it ever come to your knowledge that I had made such dissections?
Certainly"
December 1830 Haslam's Letter about the 1829 Report
A Letter to the Metropolitan Commissioners in Lunacy containing some
strictures on the Act of
Parliament and observations on their report. By J. Haslam MD of
the Royal College of Physicians, London. 1830.
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p.2:
"In whatever asylum they may be placed, the means of cure ought to be
furnished; the general health ought to be promoted by adequate exercise and
wholesome diet; and when the recovery of the patient has been established
and thoroughly ascertained, his liberation ought necessarily to follow. It
must be evident that all these desiderata are to be accomplished by MEDICAL
science and experience."
p.3 Haslam says that if insanity is a "morbid" condition:
"the incorporation of benevolent ignorance with medical science will be a
serious impediment to the hopeful exertions of the accredited practitioner"
p.10: Haslam objects to the Commissioners' speaking of "imperfections of
the
present system" without saying what the imperfections are:
"... does this imperfection consist in an excess or deficiency of bleeding,
vomiting or purging? in administering or withholding the tribe of narcotic
poisons, belladonna, conium, hyoscyamus, opium and prussic acid? Does it
arise from protracted confinement or severity of coercion, or is too much
liberty permitted to the sallies of the madman's dangerous volition?"
p.11: Haslam objects to the Commissioners' statement that fewer persons
recover from insanity than "a rational expectation justifies"
"It is generally understood that insane persons are restored to
mental competency, by appropriate remedial agents, and by such occupation
and rational direction of their intellects as may be suited to their
several conditions. These later attempts have been termed
moral management, a science at present very
little understood, but to an intimate knowledge of which most persons,
especially such as are least qualified, urge the strongest pretensions."
Haslam argues that it would be difficult for the commissioners to
determine:
"what, under the circumstances of recent attack, and with the
immediate assistance of the best medical aid, is the percentage of
recoveries that a 'rational expectation justifies'"
The statistical implication of what he writes appears to be that the way to
determine this would be by looking at a series of percentage recoveries
over time. He has found it difficult to ascertain if there had been any
diminution in "numbers formerly restored" and suggests that, if there has,
the reason may be that people are less inclined to send their relatives for
asylum treatment because of the intrusion into their privacy by the
commissioners.
p.13:
"The framers of the Bill, without any knowledge of the subject, and against
all reasoning and experience, have set forth in the
38th clause that
'the hopes and consolations
of religion may soothe and compose the minds of patients, and
thereby tend to subdue the malady under which they are
suffering'"
p.23:
"During a period of nearly forty years, the treatment of insanity has been
my constant and professional occupation, and it has uniformly occurred that
when persons not medically educated have attempted to meddle with the
regulation and care of lunatic patients their interference has always been
detrimental"
John Haslam, 2 Hart Street, Bloomsbury, December 1830
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Battie 1758
Monro 1758
Wright 1830
Tuthill on heads
Haslam 1830
Haslam on moral management
Hanwell 1834
Hanwell 1841
Mania 1844
Dementia 1844
Melancholia 1844
Monomania 1844
Moral Insanity 1844
Idiocy 1844
GPI 1844
Epilepsy 1844
Delirium Tremens 1844
Hanwell 1848
Progress of Psychological Medicine 1841-1881
Scotland 1881
Sanity and insanity 1890
Broadmoor 1903
1924
1924
Model answers 1928
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