Case CLXII

A man named Vincent believed himself to be so tall that it was impossible for him to pass through the door of his room. His physician ordered that he should be taken through by force. The order was executed, but the consequences were fatal; for, in passing through, Vincent cried out that they were crushing him, and breaking his bones, and the impression was so terrible that he died in a few days, reproaching his keepers for being his murderers. ‡

Science has now admitted the conclusion that hallucinations may be successfully treated. In this point we agree with Leuret, but we differ as to the mode of execution. Whilst he insists on his mode of treatment for the generality of cases, which he calls moral revulsion (revulsion morale), we only think it applicable to a certain number of cases, determined by the social condition of the patients, their character, and the quality of their delirium. Far from reducing the treatment of hallucinations to moral means only, we think it necessary sometimes to have recourse to physical agents, sometimes to moral influence, and sometimes to a union of the two methods. By means of this mixed treatment, in connection with the etiology and symptomatology of hallucinations, numerous and durable success will be obtained, which, without presenting the brilliant cures referable to the method of Leuret, will, amongst practitioners, offer the immense advantage of not encountering those nume-

* Bulletin de l'Academie Royale de Medecioe, Paris, 1639, t. ir. p. 63. Report of M. Pariset on the Memoir of Dr. Blanche, entitled: "Do danger des rigueors corporelles dans le traitement de la Folie, Paris, 1839." - See, in the biographical notice which we have devoted to M. Leuret, Annal Med. Psych., t iii. pp. 512 and 520, 1851, our appreciation of his method.

† Leoret, op. cit. p. 207.

‡ Marcos Donates, Hist Med. Var. lib. ii. cap. i rous asperities with which our poor humanity is beset As to the choice of moral agencies, the physician must be guided by the individuality, the particular disease, and certain indications, which, notwithstanding they have been ridiculed under the name of medical tact, are, nevertheless, often the luminous beacons which guide us in difficult cases.

Contradiction and firmness are certainly useful, but we are better satisfied not to attack hallucinations openly, but to take them by stratagem, and fight them after the manner of the Partisans. Hallucinated monomaniacs differ from other men only by holding some peculiar notions; in other respects they are similar. Mild methods, by which so many enterprises are conducted, are equally applicable to them; therefore, we do not hesitate to give to these the preference in most oases.

During our study of hallucinations, we have established several positions. It is evident that the therapeutic just mentioned is only useful in some instances; that in others it cannot be employed; that in short, various cases present various symptoms; it is by the examination of these divers circumstances that we will close our chapter on treatment.

Hallucinations compatible with reason may be habitually manifested without any derangement of the intellect; in such cases, therapeutic agents would be useless; but there arc other cases in which these phenomena are distressing, and disturb all peace and tranquillity; then physical remedies may speedily promote a cure. An individual hears incessantly the voice of a woman; although placing no faith on the error of the senses, he seeks medical relief. In consequence of some symptoms, M. Bottex applies leeches behind the ears, mustard to the calves of the legs, mustard foot-baths every night, the use of new milk and orgeat syrup, with two of Anderson's pills for several days. To these remedies manual labor is added, and in the course of one month the patient is entirely cured. It was by bleeding that we cured Madame---------of her visions.

In hallucinations of this nature, the cause must be carefully sought out. Thus, the treatment would vary according to whether they resulted from an afflux of the blood, or an accumulation of bile in the stomach. The same would be the case if they were caused by a powerful concentration of thought, or by the weakness of convalescence. Hallucinations created by darkness, terror, and imprisonment, cease with the exciting causes.

The treatment required in simple hallucinations, and in those which are complicated with insanity being the express objects of this book, we will observe that, when mental alienation preponderates, against that must therapeutic means be employed. It is only when the hallucination forms the striking characteristic of monomania, that it may be successfully treated. In mania and dementia, hallucinations only require physical treatment when the physical health of the patient is deranged. Sometimes, however, mania is increased by hallucinations or illusions. In this event, it should be discovered if light or noise does not induce them. Should this be the case, the patient should be placed in the dark, and care taken that no noise should be around him. Anodynes are clearly indicated. Under other circumstances, the patient must, on the contrary, be placed in the light. Bleeding may be found necessary, and relief will be the result.

Delirium tremens is often accompanied by hallucinations, frequently of a very importunate character; solitude, baths, and opium, remedies employed against mental diseases, equally triumph over hallucinations. This kind of delirium offers a practical fact, which should be generally known, namely, that certain individuals accustomed to the use of fermented liquor cannot be deprived of it suddenly without distressing symptoms; they should be allowed a moderate quantity of wine or brandy.

Drunkenness may occasion very strange hallucinations; they are commonly dispelled when the effects caused by fermented liquors cease; if they persist, bleeding, a purgative, an emetic, or an opiate, will usually free the individual from their presence.