Case CLVI

A lady, hallucinated after her confinement, imagined that she saw a large figure in white which accompanied her everywhere. Her medical attendant recommended the application of leeches on the neck and the use of baths. But the patient became more violent, and it was feared would throw herself from the window.

Her physician then recommended her being placed in my establishment. I had her immediately placed in the bath. For two hours the water flowed on her head. On my entering, "Sir!" she exclaimed, "pray let me out of this place; the water that falls on my head is insufferable; I know it is done because I was mad; but, thank God, I am so no longer; do not leave me here."

Before yielding to her wishes, I asked what had become of the great white figure. "I see it no more; it was an illusion."

This lady having given rational replies to all my questions, was conducted to her room; and in eight days returned to her family quite cured.

Such, however, are not always the happy results; we have frequently seen the false ideas return after having momentarily ceased. In other circumstances, again, the false sensation has disappeared, but insanity has remained.

We have found so much benefit in irrigation, that we have employed it in all cases in which it has appeared to us practicable, and the cures that we have effected by associating it with prolonged baths, have been so numerous and so rapid, that we believe we have rendered essential service to the therapeutics of mental maladies in pointing out the circumstances under which these means ought to be employed.

The cases which we have described can leave no doubt of the efficacy of physical agents. How do they act? In the greater number of cases, in calming the symptoms of excitation. It is because sufficient attention has not been paid to this period of the malady, that contrary opinions have been held. When the excitement is relieved, either by the remedies used, or from the effect of time, great advantages may be obtained by moral treatment.

But before entering on this part of the subject, it will be well to say a few words on the medication proposed some years since by Dr. Moreau, of Tours, physician to the insane in Bicetre. This mode of treatment, which has some affinity to homoeopathy, since it is founded on the property which the datura possesses to cause hallucinations and illusions, was employed on those, who, if they could not be declared incurable, were yet in conditions more or less deplorable. Seven were cured, three experienced only a transient amelioration. The cures were obtained in four, seven days, and one month, with moderate doses of extract of clarified sugar of stramonium, one decigramme night and morning; for five, eight, or fifteen days, by increased doses, 3 decigrammes in a potion, taking a spoonful every hour; in twenty-four hours, for very powerful doses, 1 decigramme of extract, administered hourly, until physiological effects were observed.

According to the author, they generally appear after the administration of 3 decigrammes. The use of datura in a large dose requires extreme caution. The patient must not be lost sight of for a moment, in order that the effect of the remedy may be watched and the symptoms combated, if they threaten to overpass normal limits.*

From the precautions required, it is evident that such a medicament cannot be used without great circumspection. There is, moreover, a serious objection to it, which is, that it has not realized the same fortunate results in the practice of other physicians which it did in that of M. Moreau. In this case, the suspension of hallucinations appears to us to depend also on the action of the medicament. In experiencing the more or less varied symptoms which it causes on the economy, the hallucinated person feels himself drawn into another train of ideas; the tingling in the ears, the buzzings, the nausea, the vertigoes and faintings, occasioned by the datura, surprise, astonish, and oblige him to reflect, and for a moment the false sensation is forgotten.

The selection of cases which we make is of no minor importance; for if, in the example we are about to give, the medicament had been hastily administered, a cure would have been attributed to it, due only to the efforts of nature.