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In most lingering diseases the secretion of gastric juice ceases before death, and no post-mortem digestion of the coats of the stomach takes place; but in phthisis it often happens that, through untimely secretion of gastric acid, or in consequence of fermentative processes within it, the stomach at the time of death contains a digesting acid, and its coats after death become dissolved from within outward to a degree which depends on the energy of this digestive fluid, and the temperature at which the body has been kept.
When great fatty enlargement of the liver occurs, as it not unfrequently does in women, there may be, as I have already stated, another cause of disturbance: the pyloric end of the stomach may be compressed; the stomach may, in consequence, become enlarged; and then, superadded to the other forms of indigestion, are those which result from an impediment to the ready and complete emptying of the stomach through the pyloric opening.
There are three classes of remedies available in the treatment of these stomach disorders; namely, sedatives, alkalies, and astringents. Where the cough is hard, and, as often happens at first, vomiting occurs only after hard fits of cough, the most effectual remedies are sedatives. Three or four minims of dilute hydrocyanic acid, or a twelfth of a grain of the muriate or acetate of morphia, three times a day, or these two medicines in combination, will often lessen the violence of the cough, and arrest the vomiting that depends upon it.
If there be excessive secretion of gastric acid, or excessive acidity of the stomach from other conditions, hydrocyanic acid often fails to quiet the stomach, sometimes even renders the vomiting more frequent, and the vomiting may be checked for a time by alkalies—by fifteen minims of liquor potasse, or by fifteen grains of the bicarbonate of potash or soda twice a day, an hour before meals.
But, generally, where there is untimely and excessive secretion in the stomach, the most effectual remedies are astringents. Five grains of the trisnitrate of bismuth may be given three times a day, a quarter of an hour before meals, or Ziss of infusion of logwood, or some other vegetable astriugent.
The vegetable astringents check excessive secretion in the stomach as they do in the bowels, and allay vomiting that depends on excessive secretion as they allay diarrhæa.
Medicines of these different classes may often be given in combination with better effect than either may be given singly. Ilydrocyanic acid, for example, may be given with advantage in combination with soda, or potash, or bismuth, when it cannot be given alone.
Lime-water, which is at once alkaline and astringent, is often of much efficacy in these and similar cases.
When vomiting occurs soon after meals, or when food, especially solid food, excites pain—when there is reason to believe that an inflammatory state of the stomach exists—the most effectual remedy is a light and easily digestible diet.
A disposition to vomiting is always much increased by a costive state of the bowels, and it is therefore essential to obviate this by the
occasional use, if need be, of some aperient that does not fret the stomach.
I need hardly add that recovery from these stomach disorders is promoted by whatever lessens the irritation in the lung on which they primarily depend.
CONOLLY ON THE MORAL TREATMENT OF INSANITY. HAVING alluded in our last number to the labors of Dr. Conolly in the promotion of the benignant treatment of insanity, we have thought it not misplaced to give our readers some specimens of his peculiarly genial and graceful eloquence of style. They are extracts from his work on the “ Moral Management of the Insane," quoted in Rankin's Abstract for 1857, and it is difficult to say whether they bespeak more clearly the scholar, the sound physician, or the philanthropist.
In the opening chapter he well observes, “When the close of active professional exertion is felt to be approaching, and the pressure of that period, aut jam urgentis aut certe adventantis senectutis, becomes perceptible, a natural wish arises in the mind of any man who has been specially engaged in what he regards as a good and useful work, to leave the work, if not finished, yet secure; or, if not yet secure, at least advanced by his labors, and as little incomplete as the shortness of his life and the limitation of his opportunities permit. The accordance of such a privilege must have imposed obligations which his imperfect powers never can have fulfilled satisfactorily; and consolation under consciousness of deficient performance can only arise from a trust in that Higher Power which allows men to be the instruments in any kind of good. Influenced by some feelings of this kind, I am anxious, in these pages, to explain, as distinctly as I am able, the nature, as well as the rise and progress, of that method of treating the insane which is called the Non-restraint System; so as to contribute to its preservation and further improvement, and perhaps to its wider adoption; or, at least, to prevent its being abandoned or imperfectly acted upon, or misrepresented, when those by whom it has been steadily maintained in its early days of trial and difficulty can no longer describe or defend it.”
THE LAST DAYS OF THE OLD METHOD OF TREATMENT.—Dr. Conolly concludes his historical sketch of the past treatment of the insane with the following well-advised remarks: “What the old system of treatment by restraint really was, ought, therefore, not to be forgotten, nor should palliations of it be unreflectingly admitted. Its evils were not imaginary, but real and dreadful. In the clean, quiet, orderly galleries of wellmanaged asylums, the visitor now sees nothing indicative of the condition to which the apologists of restraints look back as scarcely objectionable. In the gloomy mansions in which hands and feet were daily bound with straps or chains, and wherein chains of restraint and baths of sur
prise, and even whirling chains were blended, all was constantly bad. The patients were a defenceless flock, at the mercy of men and women who were habitually severe, often cruel, sometimes brutal. The evidence of this stands on record, and can neither be denied nor explained away. Cold apartments, beds of straw, meagre diet, scanty clothing, scanty bedding, darkness, pestilent air, sickness and suffering, and medical neglect—all these were common; and they must remain common, however disguised, wherever the system of restraint remains the subject of eulogy. Before the appointment of commissioners, armed with power to inspect these receptacles of madness, there was so much security and concealment, that the aggravation of loathsome dirt, of swarming vermin, and of the keeper's lash, were safely added. Nó mercy, no pity, no decent regard for affliction, for age, or for sex, existed! Old and young, men and women, the frantic and the melancholy, were treated worse, and more neglected, than the beasts of the field! The cells of an asylum resembled the dens of a squalid menagerie. The straw was raked out, and the food was thrown in through the bars; and exhibitions of madness were witnessed which are no longer to be found, because they were not the simple product of malady, but of malady aggravated by mismanagement."
THE FIRST DAYS OF THE NEW OR NON-RESTRAINT SYSTEM.—Dr. Conolly here gives a graphic description of the first influences of a wellconducted asylum on a newly admitted patient, and points out with great clearness the remedial value of seclusion, and of the padded room, and then enters into many interesting details of the non-restraint system as fully carried out. Thus, he observes, “In the greater number of recent cases of mental malady the patient is unable to sleep: the days are tolerably tranquil, but in the night restless distraction comes. Whoever has known the affliction of a restless night must know that his affliction would have received no abatement from his being tied down to his bed ; and that fresh air, cold water, sitting up a while, and diversion of mind, are the things to which he would resort for relief. The poor lunatic, equally restless, equally sleepless, and with a brain more excited, should not be deprived of these alleviations, all of which form a part of the true non-restraint system ; but none of which are regarded where restraints are employed, which are indeed utterly incompatible with them. The attendant, who has fastened down his troublesome and sleepless patients in bed, retires with a satisfied mind to his supper and his rest. The patients may suffer from heat and thirst, and may shout and yell in their despair—he heeds them not; or, if he does, it is only to visit them in an angry mood, and to punish them as he chooses. The attendant, where restraints are not used, cannot leave his patients so neglected, or punish them at will. If a patient cannot lie down without distress, he is not compelled to lie down, but allowed to walk about; being supplied with soft warm shoes, and other clothing, to prevent his suffering from being out of bed. If he knocks at the door of his room, the reason of his doing so is inquired into; if he is thirsty, he has water given to him; if he has been restless, and his bed is discomposed, the bed is made comfortable again; the patient's face and hands are cooled with water; per
haps a cup of tea or coffee, or beef-tea, or arrowroot-kept in readiness by the night-attendants-is given to him, or sometimes a little tobacco; and thus the patient is refreshed in body and soothed in mind, blesses his visitors, bids them good-night, and falls asleep; and thus the cries and howls which disturbed the wards so often are heard no more.
“ The old system placed all violent or troublesome patients in the position of dangerous animals. The new system regards them as afflicted persons, whose brain and nerves are diseased, and who are to be restored to health and comfort and reason. This simple difference of view it is which influences every particular in the arrangement of every part of an asylum for the insane."
Tue Old SYSTEM IN PRIVATE ASYLUMS. – Dr. Conolly gives the following graphic account of the private asylums as they were under the old régime—as we ourselves have seen them—as, indeed, the extracts we made in a former section from the Commissioners' last Report, show that they still are. “Such houses were generally distinguishable from all the houses in the neighborhood by their dismal appearance; their exterior was as gloomy as their interior was dirty. Heavy gates, a neglected shrubbery, windows heavily barred, doors clumsily locked, prepared the visitor for rooms which, though rooms of reception, had an air of cold discomfort and shabby finery; and, whilst the friends of the patient were shown into them, the patient himself, ushered by men of repulsive aspect, disappeared into long passages, closed to the curiosity of those who brought him there, in the hope that change of scene and specific skill and kindness would promote his speedy recovery.
“From that time, and commonly for a long period, the visits of all his friends were jealously interdicted ; although the patient often grieved no less than they did at each absolute and prolonged denial of what might have been a consolation to both. If the patient had previously been violent, or had on any occasion acted in a manner to excite a suspicion of a suicidal tendency, it was not unusual to resort to restraint at. once, and he passed his first dreadful night in the asylum fast bound in a strait-waistcoat. In the morning he awoke to find himself in a strange apartment, watched, rather than waited upon, by rude, ungentle keepers, all the details of his dressing disregarded, and his morning meal brought to him with little care. An ill-furnished, ill-cleaned room; a half darkened window, looking into a wretched yard; and a scanty fire, rendered less efficient for warmth by a heavy fire-guard advancing far into the room, were the characteristics of the apartment in which he was to pass the day, either in solitude, or with some other patients more or less afflicted than himself. If he went out for exercise, it was into a dolorous space of ground; the grass-plots and borders of walks half trodden into the clay, unadorned by flowers, and disfigured, rather than ornamented, by torn and withering shrubs and trees. The hour of dinner brought no comfortable meal; and no social or rational conversation, and no amusements of any kind, diversified the evening. Beyond the boundaries of the lofty walls, no exercise was allowed ; and within them there was no variety and no companionship, nor any thing calculated to cheer the mind or soothe the feelings; so that, by degrees, even the hope of change and
liberation became faint, and almost died away. Such I know—from observation made when the access of visitors to such establishments was difficult, and my own visits were only permitted because an official appointment qualified me to demand it-was the general condition of insane persons in the old asylums; in which the doctrine of non-restraint was years afterward received with derision and defiance, and made the groundwork of every kind of misrepresentation; and into which the full principle of non-restraint can scarcely yet be said to have found a willing admission."
As a contrast, we subjoin the following description of a private asylum conducted on the non-restraint principle, gladly bearing testimony to our acquaintance with many such, both near London and in the provinces :
The outward appearance of such houses is indicative of comfort ; highly cultivated grounds and gardens surround them, and nothing is suggestive of a place of confinement. The patient is received as a visitor, proper refreshment is placed before him, friendly words are addressed to him, and he retires at night to a bed-room where cleanliness and all arrangements fitting his station in life reconcile him to being its occupant. If his case requires that an attendant should be near him in the night, or even in the same room with him, it is represented to him that this is done for his own safety, or for his comfort in a strange bou..."In the morning he is persuaded to get up, without threats and rough words, and his dressing is attended to as carefully as if he were in his own house. On coming down stairs, he finds a cheerful breakfast prepared for him, either with a few other patients or with one of the proprietors or officers of the establishment. lle can read the morning paper, or walk out in the grounds, or look over the new books from the library, or adjourn to the billiard-room, or join one of the walking-parties or carriage-parties. On returning, he is allowed, within limits of prudence and of rules necessary for the preservation of health, to choose what luncheon he will take-a small privilege, but productive of a feeling of liberty not to be undervalued. The remainder of the morning is passed much according to his own inclination. The visits of friends to himself or the other patients, or to the proprietors, and from conversation with whom he is not debarred, diversifies much of the time, and serves to iutroduce new ideas without any formality of device; and at dinner-time he sits down with the proprietor or the resident physician, and perhaps a lady acting as matron, and with several of the patients, who are gentlemen of his own station, and whose neatness of dress reminds him of the propriety of his making some alteration in his own before that meal. A table well appointed, an excellent and varied dinner, wine in moderation, a dessert, and agrecable conversation, make him almost unmindful of being the innate of an asylum; and in the evening a party in the drawing-room, and music, and chess, and backgammon, and cards, make the hours pass agreeably until it is time to retire.
“Such, then, is the non-restraint system; by which it is found to be no less practicable, and safe, and advantagcous, to control and govern, and in many cases to contribute to the cure, and in all to the improve