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 Homoeopathy 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 treatment 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 Homoeopathic 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.*[North American Journal of Homoeopathy. Feb. 1857.] 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 arc not regarded as a part of the true disease Insanity.

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 Spermatorrhea as also of pretty clearly marked Hepatic disease. The specialists of the Brain, the Liver or the vesiculae 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 symptomatological indications.

Disregarding everything but the mental phenomena, the specialist in this department is many times ignorant of disease 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 confinement 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 occurrence. 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; that clearly belongs to the specialist, and any light which he can throw upon the subject from that point of view, will be appreciated by us all. As yet, it must be confessed, the results have been negative rather than positive.

I regard the cure of disease, as the main duty of the physician, and I believe we have reliable means of accomplishing that result. Nor do we consider it necessary to first settle the many interesting questions of pathology, which with us are only indirectly connected with the treatment of disease.

We should otherwise be upon an unstable and constantly changing foundation. It is evident, that if our treatment were founded upon the supposed pathology, it would constantly vary with the frequent changes in the views of the profession in regard to the nature of disease; but if we rely upon the correspondence between the actual phenomena of the disease, and the known effects of drugs upon the healthy subject, we have a real foundation, capable of indefinite improvement as we perfect our knowledge of the materia medica, but not to be overthrown by any discovery in collateral science.

In regard to the propriety of sending any patient to an asylum, I would remark that there are undoubtedly some cases of insanity exceedingly difficult to be treated at the homes of the patients, on account of the peculiar prejudices which sometimes arise in the minds of the patients, in regard to their friends. But in general, I think, the question whether we shall be compelled to send a patient to an asylum, will be narrowed down to one of money. If the friends have means to provide sufficient capable attendants, and fair accommodations, I am of the opinion that a large proportion of cases can be advantageously treated without change of residence. In neither of the cases now published, had the friends any but quite moderate means. If the friends have not means, and the patient is violently maniacal, and really dangerous, it may be a matter of necessity to consign our patient to a mad-house; but as a curative measure alone, with the much better remedial, measures which we as Homoeopathists possess, I should not send patients to any asylum, under allopathic superintendence.

Mrs. A's case has been partially reported in this REVIEW, under the head of “Intermittent Fever;” I now propose to report as fully as possible the symptoms and progress of her mental disease; a repetition of some facts previously stated, will be necessary to give a connected statement of her case.

She became a patient of mine, Feb., 12th, 1858. Her age was 51 years, she had ceased menstruating about 5 or 6 years previously. For many years, she had been subject to turns of depression of spirits. Two years before my seeing her, she had contracted Intermittent Fever, for which Quinine had been repeatedly given, with the effect of suppressing the external manifestations of the disease for various periods; but the evidences of mental disorder, had during this period become much more decided. She was sleepless at times; was fearful of being poisoned; had refused to take medicine, or even see a physician. Her symptoms had sometimes partaken of a religious character. The case was considered to be so serious, that her family had been strongly recommended to send her to a lunatic asylum. An unfavorable prognosis had been expressed by her former physician. Her own account, given at the time of my first visit, was by no means irrational nor disconnected. She considered herself as insane at times, said she frequently felt confused and excited, and that her memory frequently failed her. She gave as a reason, for not tailing the medicine prescribed by her physician, that she knew from experience that laudanum, which he wished her to take, would injure her. She was said to appear rather better than usual, at the time I happened to see her. Her eyes had a peculiar expression, appeared as though they were fixed but a very short time on one object. It was said that any unusual occurrence or noise affected her unfavorably, although the noise of her children and grand children, about her, did not seem to incommode her. She slept but half an hour or so at a time, starting up as though she were frightened. Had unpleasant dreams. I prescribed Belladonna³⁰ solution every three hours. February 12th. I record:-

Slept much better than usual, night before last, but last night had pain and heat in ears, with stiffness of neck. No pain in ear to day, but has stillness in neck and shoulder. Has been subject for live or six years past, to have at times a sharp pain through head, accompanied by vertigo and nausea; also has a “strange feeling” in head accompanied by a sinking at pit of stomach. If she is spoken to quickly, when in this state, it completely overcomes her. The left side of head, is more frequently affected than the right. Is not able to read; as after reading a minute or two, she becomes so confused as not to be able to distinguish the letters apart. Ever since the birth of her first child, has been troubled with “falling of the womb,” wore a supporter, but found it injurious and discarded it. She speaks of a sensation of fullness over left hip; when I pressed upon the affected spot, it seemed to cause a pain in hypogastrium. About 1st of January, had several chills, occurring in afternoon, followed by fever and aggravation of mental trouble. 1 Rhus rad³⁰; then Hell.³⁰, three times a day.

14th. For three nights past, she has had a sensation of coldness in left side of head, at ten o'clock P. M., continuing an hour; afterwards, heat and fulness in same region, and in ear, lasting two or three hours, after which she has rested pretty well. Aching in small of back, when she is chilly. In the morning has a dull aching in forehead, and pain on moving eyes. Has felt better, most of the time than she did. Bry.¹² solution every four hours.

16th. Thinks she is gaining. Last night the cold stage consisted only of a sensation as if a hair were raised up. Finds that she can stand much more excitement than she formerly could. Continued Bry¹².

18th. Rather better. Slight sore throat today with dryness in throat; cough.-Sleeps pretty well. Lach³⁰.

21st, Sleeps well. Complains of a stiffness in lumber region on stooping Excoriation in sternum. Lyc³⁰ solution every four hours.

24th. Went over to the extreme eastern part of the city, yesterday. She resided on the extreme western side. (She had not been out before, for a long time). Had slight difficulty in going to sleep last night. The stiffness in back is relieved, but has today pain in head on movement. Puls ³⁰, every three hours.

27th. Has been pretty well. No headache, except when throwing head backward and bringing it forward again; then has also momentary blindness. Appetite very poor. Nux³⁰, three times a day.

March 4th. Improving. Went to church on Sunday (28th ult.), walked and rode some distance. Less pain or vertigo. Appetite fair. Continued Nux ³⁰

11th Has been quite well, until within a day or two past; she has had pain in lumbar region. Lyc.³⁰ three times a day.

16th. Says she is quite well, except that she has a slight pain over left ilium, increased by raising arm. Lach³⁰. solution, a dose at night.

20th. Pain in loins: more on rising after sitting. Rhus.³⁰, three times a day.

22d. Pulse, 90. Attacked suddenly with general aching, chilliness, and sore throat. Two small ulcers in fauces. Feels quite unwell. Merc. viv ³ solution; a dose every three hours.

[Several other members of the family had ulcerated sore throat about this time.]

24th. Throat much better. Merc¹²., three times a day.
30th Pain in sacrum, worse on moving limbs. Nux³⁰. April 10th. Pain in hip. Rhus³⁰

May 3d. In consequence of the excitement of moving, and perhaps also of religious excitement; she has not slept so well of late. Has some headache. Nux ⁶, three times a day.

31st. On the 26th, 28th and 30th, had chills, coldness commenced in feet, and extending to knees, accompanied by severe pains in head, so that she expressed an “apprehension of going distracted;” afterward heat of face; perspiration during chill and following heat. No thirst. Quite excited after fever. On lying down, vertigo and nausea Puls⁶. every three hours.

She came to my office and gave me the preceding account. I prescribed for her once subsequently for the same attack of Intermittent Fever; but omitted to make a record. I think she had one or two more paroxysms, and, that I continued the same prescription. She has had no return of the fever, and has entirely recovered from her mental difficulties. Her general health is also better than formerly. I have had occasion to prescribe for her a few times for trifling ailments. She attends to her household duties, and goes about precisely like other people. Some of her friends did tell me in July, that they thought she acted somewhat strange at times; but this is a suspicion, which all who are known to have been insane are liable to, during the remainder of their lives.

The other case I purpose reporting at this time, was a domestic by occupation, and was living at service when attacked. I first saw her, February 2d, 1859, at the residence of her own family-persons in quite moderate circumstances, and having necessarily somewhat limited accommodations. As I have mentioned previously, these are matters of some importance in the treatment of such cases. The first warning they had of the patient's state of mind, was that her sister met her early one morning, at a church, near her parents residence, but a considerable distance from the patient's home. The sister soon perceived that her mind was affected, as she told her many things inconsistent with each other, and opposed to known facts. Her manner was unnatural. She was taken to the home of her parents, and two days after, I was sent for. As she was then a stranger to me, her general appearance presented nothing very remarkable, although her face was some what flushed; but when she commenced to speak, I could see that her manner was excited, and her statements were so extraordinary, that there was no difficulty in perceiving that her mind was disordered. She told me that about the 11th of January, a man called upon her, and blew down her bosom, and in this way inflicted a terrible injury upon her, and that several times since, she had seen him. She had come to the conclusion that it was a dead man personating one of her friends, who committed the above assault. She had been much troubled by needles jumping from the floor and dancing about her. She made many other remarkable statements, and seemed disposed to continue the narration as long as any one would listen to her. The person whom she thought was personated by the dead man, was a man who had paid her considerable attention, and to whom she was much attached against the wishes of her parents. It was known that she had heard of his paying attention to some other girls, and this was supposed to be one cause of her present state. She said to me that she “liked him, and he knew it.” She had not slept at all, during the two nights she had spent at her present home, but had been very restless and troublesome, constantly expressing fears that some one was attempting to kill one of the family. Every noise in the house seemed to confirm her suspicion of a plot against her friends. At the time I saw her, her mind was so to speak, in a double state, at one moment stating that she fancied these improbable things, and then speaking as though they were realities, and expressing fears in regard to her own safety. She seemed to have lost the power of discerning between the effects of her own imagination and facts, and was yet aware that a part at least of the remarkable things she related, had no real existence.

I prescribed, Puls⁶ solution, every four hours

5th. Saw her again.-No better. No sleep at night; sleeps for a short time during day, and starts up as if frightened. Endeavored to conceal a hatchet, but it was discovered and taken away from her. Thinks some one is going to kill her brother. Pulse varied from 82 to 94 during my visit. Bell ¹² solution, every three hours was prescribed.

7th. Has been quite troublesome; sleepless at night; face flushed at times. Refused to take her medicine this morning. Constipation. Nux⁶, every three hours.

9th. Has slept a portion of each night. Had an evacuation yesterday. Is quite troublesome, attempted to jump out of the window (fourth story), and tried to throw a fork at her mother. Says herself, that she fancies she is going to be burned, and that she feels frightened, also that she fancies some one is coming after her. Pulse 94.-Prescribed two Sulph³⁰, then Sach Lact.

11th. Slept some, night before last, but scarcely any, last night. This morning has appeared more rational than at any time. No evacuation since. Tongue coated quite thickly brown, with red edges. 2 Nux⁶, and Sach Lact.

14th. Much better.-Nearly rational ever since; says she does not “fancy” things as she used to. Last night felt somewhat anxious about her brother who was out. Sach Lact.

19th. Quite well. I was struck by the change in her general appearance. She takes a perfectly rational view of everything, appreciates what her condition was, although she has scarcely any recollection of anything that has happened during her sickness.

I have seen her a few times since. She remains perfectly well.

The above report, which is simply copied from my daily records, does not give a complete idea of the real difficulties of the case. The patient's family were respectable persons, but were dependant upon their daily labor for their subsistence. Their residence consisted of a suit of rooms, three or four in number, in a tenament house. The nurses of the patient were her mother, quite an old woman, and her sister a far gone consumptive. Her father and brothers were out during the day, at their work. She was so troublesome at night, that the brothers threatened to leave the house, and board elsewhere if she were not sent away. It was only by my expressing what was my strong conviction, that she would recover better where she was, that induced them to retain her at home. The family had not sufficient means to employ suitable nurses to assist them, and they were almost worn out by their exertions. If the disease had continued much longer, they might have been compelled to consign her to an asylum, although it would have been with very great reluctance, that I should have consented to such a measure.