Opinions of MM. Esquirol, Lelut, and Calmeil - Opinion of Lenret - Sequestration - Two divisions: 1st Physical treatment - Use of datura stramonium - Hallucinations sometimes suddenly cured - Electricity - 2d. Moral treatment - Author's method - Leuret's method - Objections - Treatment of hallucinations in the diseases which they characterize - Recapitulation.

It is only of late that the treatment of hallucinations in France has attracted much of the attention of practitioners. This was the natural result of an opinion, universally admitted, that they were only a symptom of insanity, † The subject had, however, been the substance of several works; and we are surprised at not finding any chapter relative to their treatment in the important works of Ferriar, Hibbert, Esquirol, and Jacobi.‡ The French author declares that they do not require any particular treatment; he nevertheless adds that they should be especially considered in the intellectual and moral management of the alienated, and in the therapeutic views that might be proposed. The two English physicians have not been more explicit, and the German philosopher, although the cases he relates are interesting, does not propose any new plan for their treatment.

M. Lelut reports several cases of sensorial insanity treated by physical agency, where reasonings and moral impressions were likely to prove, and, in fact, had proved entirely useless. All the experiments were unsuccessful.

* It must not be lost sight of, that hallucination being generally united to some one of the forms of alienation, what we may say of the treatment will frequently apply to both maladies; the distinction will be particularly recognized in the means employed against false ideas (idees fausses).

† We regret that we have not been able to procure the lectures of Gall, on hallucinations. They were published in the Gazette de France, in 1807, 1808, or 1809.

‡ Jacobi, Bemerkungen uber das studium der mit irrseyn Verbundenen Krankheiten, in seinem beobachtungen uber die pathol. und therap. der mit irrseyn Verbundenen Krankheiten, 1 Bd. pp. 1-24, Elberfeld, 1830.

M. Calmeil, in concluding his excellent work on hallucinations, thus expresses himself: "We will return to this subject, the treatment of which, above all, enters into that of hypochondria and the different kinds of monomania." Now, in his article Hypochondrie, it is in nowise mentioned; and in his article Monomanie, he says, speaking of sensorial monomania: "It is especially in this species of insanity, in monomania with hallucinations, that patients have been instantaneously cured, by skilfully throwing a snake, frog, or slug into the basin destined to receive their dejections, at the moment when they were preparing to eject, either by the mouth or otherwise, the imagined animals which they insisted were living within them." We are far, however, says the author, from anticipating habitual success in the employment of similar stratagems, which are, happily, of easy accomplishment. In general, physical lesions, which give rise to partial delirium, do not yield with so much facility to external impressions, and a physician, whose practice is amongst monomaniacs, soon learns the use that must be made of a multitude of remedies from which an enthusiastic mind presages much success.

Such was the state of science, when a man of ingenious mind and remarkable sagacity, sweeping away all that had been previously effected, announced that hallucinations, hitherto abandoned to the sole efforts of nature, were susceptible of treatment and cure, and that this desirable end could be accomplished by attacking them boldly, harassing them incessantly, and forcing them to acknowledge themselves beaten. This scientific opinion met with much opposition. But when the excitement was somewhat calmed, Lelut's book was acknowledged to exhibit a powerful will, numberless mental resources, and happy applications of a new method of therapeutics.

Experience has verified the worth of this method. It was proved to be not of such universal application as its author imagined, who had experimented on the hospital patients. It was manifest that in private establishments, especially destined for those in whom education and the position of fortune had developed the exercise of the will, and, by consequence, the passion of pride, the origin of much insanity, it was needful that the treatment of the physician of Bicetre should be considerably modified.

With this reservation, we are amongst the first to say that this method is destined to be of signal service, and that we shall have recourse to it whenever we consider it available.

In studying the causes of hallucinations, it was easy to perceive that they demanded more attention, and more active means, than had hitherto been applied.

The treatment of the symptom must not be disdained, and there are few diseases in which it is not often the sole resource of the practitioner.

The treatment of hallucinations is not, however, so entirely negative as Leuret has endeavored to maintain in his work. Certainly, there exist neither rules, systems, nor doctrine; but, in carefully looking over works on mental alienation, we find many cases of hallucinations to have been cured by physical and moral means. These facts, confirmed by practice, the study of causes and of symptoms, lead us, without farther preamble, to propose two divisions of treatment, the first comprising physical, the second moral means.

Before we enter on the developments belonging to the subject, we must speak of the place in which the treatment should be pursued. Must the hallucinated be isolated? Can they be treated at their own homes? By Leuret's method sequestration is evidently necessary. In order to oblige a patient to acknowledge himself wrong, it is indispensable for him to understand that some one has authority over him, and that he is not master of his will; without these conditions, obedience is impossible. The species of hallucination, its long standing, and its complications also establish important differences. Is the necessity of isolation always indicated? This is the first question, to which we will reply by examples.