INSANITY TREATED AT THE HOME OF THE
PATIENT, WITH ILLUSTRATIVE CASES.

BY B. F. JOSLIN, JR., M.D., NEW YORK.

The treatment of Insanity is usually regarded, more particularly perhaps than any other disease, as the province of the specialist; and the very general practice when a patient is considered to be clearly convicted of mental disorder is to consign him to the charge of some Institution, specially devoted to such persons; in other words to a Lunatic Asylum.

In the North American Journal of Homeopathy for Feb. 1857, I published several cases of mental disease, treated with some success by homoeopathic medicine, with a few remarks upon the advantages afforded by our system of practice in such cases, and some of the objections to the general custom of sending Insane patients to Asylums when it can possibly be avoided. I now propose to continue the subject: my object being to show the possibility of curing such patients by following the method we find so efficacious in diseases in general, and that it is by no means necessary, at least in a considerable proportion of cases, to take the patients from their friends and relations to an Asylum. Both of these propositions are illustrated by the cases published

as well as by those I shall now report, which have occurred more recently in my practice.

I do not assert that at the present day our system of treat ment is so complete as to enable us to cure every case of Insanity, nor that instances may not occur where, owing to violent Mania in the patient, or to want of sufficient means on the part of the friends, we may not be compelled to send the patient to an Asylum. I wish in this connection to say a few words in regard to Asylums, and the circumstances. which in my opinion would make it proper for us as Homeopathic practitioners to make use of them. Such Institutions are in this country exclusively under the control of Old school physicians. Strictly medical treatment for the cure of Insanity is scarcely thought of, specific remedies they do not profess to have, and even the general treatment of the Old school is not much used at the present day in Asylums. The almost exclusive reliance is upon coercive and moral means. A few years since I happened to meet with the medical superintendent of one of the most extensive Asylums, he remarked that he had heard I had published some cases of Insanity, treated by homoeopathic medicine.* As he seemed to take some interest in the matter, I thought it a favorable opportunity to urge him to try the experiment of giving similar remedies to his patients; he replied that he "never would believe that medicine could cure mental disease."

Such is no doubt the general opinion of the medical gentlemen to whom this unfortunate class of patients is intrusted. Instead of regarding mental peculiarities as a part of a more or less general derangement of the system they seem to look upon them as phenomena connected only with the immaterial part of man-the mind or at the most with the organ through which the soul communicates with the external world-the brain. Symptoms of other functions or organs are regarded simply as complications, but are not regarded as a part of the true disease Insanity.

*North American Journal of Homoeopathy, Feb.. 1857.

I believe that Insanity seldom shows itself simply as a mental affection, but that it is much more frequently preceded and accompanied by symptoms indicative of functional or organic lesions in other organs than the brain. I may instance the uterine function in women, the genital in the male, the digestive in both sexes. As an illustration I will briefly relate the following case:

A young man came into my office one day and said to me: "Sir, I have the strongest desire to cut my throat whenever I see a razor, I have been for some time suffering from extreme depression of spirits." On enquiry I ascertained that he was the subject of Spermatorhea as also of pretty clearly marked Hepatic disease. The specialists of the Brain, the Liver or the vesiculæ seminales would either in their own opinion have found a patient in their particular department from this case. Such was very nearly the fact in this instance, for being pretty impatient, as this class of patients are apt to be, he disappeared for some months, and then came back and related his medical experience: he had been taking medicine to act upon the liver from a physician, and had had instruments introduced into the urethra by a surgeon, he had fortunately escaped the mental specialist, or he might have found himself in an Asylum. He is now under my care, and I may perhaps report his case more fully at some future time. He has improved greatly under the influence of Nux, Sulph, and other remedies given according to the symptomalogical indications.

Disregarding everything bat the mental phenomena, the specialist in this department is many times ignorant of diseases · which perhaps have much to do with the mental and physical condition of his patient. I will relate a case in which I think this was the fact.

In certain legal proceedings which were instituted in this city, within a few years past, to obtain the liberation of a lady, who had been confined in an asylum for many years, the medical officer was asked if his patient had any disease other than insanity, he said he was not aware that she had; he was particularly asked, if she had any uterine affection,

he said not that he was aware of, he had never made an inquiry or examination. By the testimony of a highly educated physician, who had had charge of her for some years previous to her confine nent in the asylum, it was proved, that she had been the subject of Hypertrophy of the Uterus, which he considered to be the cause of her nervousness; he did not think it amounted to Insanity. This is believed to be only an ordinary occurence. The specialist is so intent. upon his own particular department, that he is apt to loose sight of everything else.

The case cited, illustrates another point to which allusion ought to be made. As is well known, the term Insanity is given at the present day, to a much more extensive class of diseases, than was formerly the case; so that it is now rather more difficult to say, what mental state cannot be brought under this designation, than those which can. I do not propose to find fault at present, so much with the theory of this, as with the practice. By the latter, many persons perfectly harmless, in most respects correct in judgement and deportment, are placed on nearly the same level in treatment and reputation, with violent maniacs and persons whose intellects are completely upset. The case cited shows that a person by whose regular physician she was considered to be nervous from uterine disease, was considered as a lunatic by a physician who knew nothing of her previous history or diseases.

In anything that I have written, I do not intend to assert that the mental condition of certain cases absolutely depends upon the condition of certain organs, as the uterine or digestive, but only to intimate that an exceedingly close relation exists between the morbid conditions of the digestive, uterine, generative, and mental functions; and that we should be very careful in the treatment of Insanity, to take into consideration any symptoms which may occur, whether they seem to be directly connected with the mental phenomena or not. I am not proposing to investigate the pathology of the disease; tha! clearly belongs to the specialist, and any light which he can throw upon the subject from that point of view, will be