Billeder på siden
PDF
ePub

than the form of disease which we call acute melan-administration of food to fasting patients, which apcholy. In some of these cases, however, I have found peared in the last number of our Journal, he alludes occasional seclusion imperatively necessary for the to a feeding apparatus which he has used with much relief of the sufferer. advantage for some years past.

T

The instrument he describes was an invention of the late Dr. Balmanno, who for many years filled the office of visiting physician to the Glasgow Royal Asylum, and was known in Scotland by the name of “Dr. Balmanno's Feeding Apparatus." It was intended to supersede the use of the stomach pump in feeding lunatics; much difficulty being experienced in introducing the tube of the latter from the determined efforts of the patient to keep his mouth closed. The nasal tube was found to answer in every respect, and might with some slight modifications be adapted to the stomach pump apparatus, thereby giving the practitioner a choice of means in so far as the passage to the

I have mentioned above that I frequently employ seclusion in cases where it is not necessary, but only useful. To supply an instance, let me briefly refer to the case of E R a woman who has led a dissolute life, but whose ordinary condition now is that of tranquillity, with loss of mental power. She is a willing and laborious household servant, but about once in three weeks she undergoes an attack of nymphomania. Some years since, when I was in the habit of using a very small amount of seclusion in the treatment of my patients, this woman used to spend one week out of three in a state of excitement, most offensive to all beholders, and most painful to herself. Medical treatment had little influence on the parox-stomach is concerned. ysm, which was prolonged and exaggerated by the demonstrations to which it led.At the present time the paroxysm still comes on, but the patient is left in bed during its continuance. The consequence is, that it lasts, only two, or at most three days, instead of seven or eight, and putting entirely out of consideration the comfort of the ward, the patient does not undergo one-tenth part of the amount of suffering which she did when these paroxysms were treated without seclusion. I could corroborate my opinion with a multitude of cases, but it does not appear needful to do so; since it seems to me that I have proved that of which, when fairly stated, proof ought scarcely be demanded: namely, that in forms of disease of which the principle manifestations are mental excitability and exhaustion, it may sometimes be necessary, and frequently be beneficial, to withdraw all possible sources of excitement, by the temporary removal of the patient from the society of his fellows.

The only objections I have ever known urged against the use of the nasal tube, are that it is sometimes from its small calibre apt to hitch on the epiglottis, and occasionally to enter the trachea. The latter accident has never happened to me, and I have frequently used the instrument, passing it as a general rule with but little difficulty. Sometimes if this tube is too flaccid from warmth it will curve when it touches the back part of the tongue, and pass forwards into the mouth the patient may then grind it with his teeth, and so spoil the tube. This can be avoided by a little care in passing it.

[ocr errors]
[ocr errors]

1

We usually dip the tube into the liquid about to be injected, and when it is sufficiently pliable give it a slight curve with the end pointing somewhat outwards, and it readily finds its way into the pharynx. The constrictor muscles then seize it and carry it downwards to the stomach, frequently without our having to use the slightest force. The length of the tube In concluding this paper I beg to draw attention to passed, and the exit of gas through it, are sufficient inthe utility of a trivial expedient which I have for dications that it has reached the stomach, and the some time adopted. On the door of every dormitory liquid food or medicine may then be injected. A senor single sleeping-room, in which there is a patient sation of choking is experienced by the patient as the detained, or remaining willingly on account of sick-tube reaches the pharynx, and this is sometimes so ness, or for any other reason, I make the attendant marked as to induce the operator to suppose he has suspend a label with the letter S painted on it. This entered the trachea; but a little patience, and withlabel is of sufficient size to be observable from one end drawing the tube slightly is all that is necessary, it of the gallery to the other. It aids me materially in soon passes onwards in the right direction. The tube visiting the sick, since I have not to call the attendant may also be found to pass more readily by the right every time I visit a ward, to enquire in which room a than the left nostril, this has happened to myself, and patient may be.* it will always be well should any difficulty arise in making the first attempt to try the opposite nostril. In the old palmy days of restraint when medical aid was rarely invoked, cases of refusal of food or medicine were very summarily disposed of. The cause of the patient's refusal was deemed of slight importance, and scarcely meriting investigation In no espect is the advancement made in the treatment of the insane more manifest than in the attention now paid to the causes of the varied phenomena which mark thees cases. The refusal of food, perverted appetite, vigilantia, and many other symptoms of disordered physical action are now minutely studied, and and in most cases relieved by appropriate treatment; but what was the course adopted in former times? SIR,-In Mr. Wilkes' paper upon the subject of the The patient would not eat. Unless food is forced into

+

[ocr errors]

སྙན་*,

In asylums where efforts are made to keep the seclusion list as low as possible, patients, especially females, may not unfrequently be seen sitting alone in bed-rooms, at needle-work perhaps, or making artificial flowers, who are not considered to be in seclusion. It may be wrong on my part to think that these are virtually cases of seclusion. Still my plan of conspicuously marking the doors prevents my attendants from secluding a patient on any indirect pretext, and is so satisfactory to myself that I strongly recommend its adoption.

To the Editor of the Asylum Journal.

[ocr errors]

his stomach he will sink. He was therefore to be fed in the old orthodox manner. He was seized by two or three keepers as they were called, his mouth was wrenched open with an iron spoon or blunt chisel, frequently to the damage of several of his teeth, his nose was held tight, and the fluid poured down the throat of the half suffocated patient, who not understanding the necessity for these extreme attentions would only become more alarmed, suspicious, and determined in his opposition.

Even when the stomach pump was used as, it would be when professional aid was sought, the same difficulty existed as to the opening the mouth, and to keep it open a gag was used, which was secured by strings tied behind the head. Usually, however, the feeding process was trusted to the attendants, and it was not an unusual occurrence for patients to leave an asylum minus a few teeth.

+

[merged small][merged small][ocr errors][ocr errors][ocr errors][ocr errors]

The Commissioners generally return imperfect certificates for correction but it seems this is not invariably done but surely the doctrine that the Commissioners are not responsible for the correctness of certificates under which insane persons are confined, [see Commissioners Circular, Feb. 14th, 1855,] and that the responsibility, when they make no objection, still rests with the "Superintendents and others" is unsound. At all events, it is both inconvenient and dangerous.

[ocr errors]
[ocr errors]
[ocr errors]

I remain, dear Sir,
Yours truly,

[ocr errors]
[ocr errors]

A SUPERINTENDENT.

To obviate these barbarities the late Dr. Balmanno invented his nasal apparatus. It was regularly used by him, and his successor Dr. Hutcheson, and has since been adopted in some of the English asylums. I am not certain whether it is used in the general hospitals of this country; but in certain cases of tetanus, and in stricture of the oesophagus it might be useful. Mr. Marshall, the medical superintendent of female patients at Colney Hatch, has found it answer all the purposes it is intended for, and I believe it has been tried at the Northampton General Lunatic Hospital. I have known patients kept alive for weeks, and ultimately saved by means of this instrument, and in one instance a gentleman who had obstinately refused all nourishment and medicine for a protracted time until he was upon the point of sinking, submitted quietly for several days to the introduction of the tube, sitting up in bed voluntarily, and requiring no holding of the hands or head. He had made a vow to starve himself, and kept it rigidly until a few doses of medicine set his brain right, and a short argument, in ad dition to a sharp appetite, convinced him of the folly of his proceedings. As a general rule however, I have found that in cases of refusal of food, where perversity and sullenness of temper are exhibited, the introduction of the tube once or twice is sufficient. The patient finding himself baffled in his determination, at once succumbs, disliking the inconvenience he is putting himself to. In other cases where there are physical causes to account for the anorexia, medicine may be administered by this instrument, for which purpose a small elastic india rubber bag is provided sufficiently capacious to hold a good sized draught. This is supplied in the case, and fits the tubes tightly. Mr. Wilkes' paper reminded me of Dr. Balmanno, and Stafford County Lunatic Asylum.

To the Editor of the Asylum Journal, Dear Sir,-Allow me call the attention of superintendents to an India rubber chamber utensil, which Messrs. Macintosh of Manchester have made at my suggestion, and which I think will be very useful for violent and excited patients, who could not be trusted with those made of metal or earthenware.

[ocr errors]

of his being the physician who first invented and used the nasal apparatus among the insane, and it occurred

1

One of the multifarious uses to which gutta percha has been applied has been the manufacture of these articles, but practically we find, that besides the difficulty of keeping them sweet, from the impossibility of using hot water to them, they are easily broken when made of the ordinary strength, and if made heavier they become serious weapons in the hands of excited patients.

[ocr errors]

The India rubber utensils seem to be calculated to meet all these objections, for while of sufficient strength to resist the ordinary rough usage of an easylum, they are useless as offensive weapons, and boiling water may be employed to cleanse them.

The price charged at present is rather high, but Messrs. Macintosh consider that they shall be enabled to offer them at a lower rate if there is any demand for them.

Yours faithfully,

[ocr errors]

JAMES WILKES.

of his Lunatic Wife.

[ocr errors]

At the Devon Spring Assizes on the 17th ult., before Mr. Justice Crowder, John Rundle was charged with abusing, ill-treating, and wilfully neglecting, Amelia Rundle, his wife, a lunatic.

to me that many who may have employed it were not Trial and Conviction of a Husband for the ill-treatment aware of this fact. Dr. Balmanno did much in his day to improve the condition of the lunatic, and no one had he lived would have taken a warmer interest in the great progress that has since his time been made in this department of medicine than he would have done. I am, Sir, your obedient servant, Mr. Stock stated that the prosecution was instituted THOMAS PRICHARD, M.D. by the Commissioners in Lunacy; and that they were Abington Abbey, Northampton. fully determined to prosecute in all cases of a similar

nature which might come under their notice, in order | safe from the attacks of her husband: she bared her that the helpless lunatic might receive every protection left arm and shoulder, and showed some bruises, and, which the law would afford. He called the following pointing to her husband, said "he did it." Witness witnesses. was of opinion that the bruises were produced by a blunt instrument. He found several bruises on the abdomen and thighs, the hips, the left arm, and the buttocks, the latter he thought might have been inflicted by a kick: a magistrate was present at the time, and a sort of charge was made against the prisoner, upon which he denied it, and took up a brush which he said she might have ran against when he was defending himself from her attacks. Witness was of opinion it was a confirmed case of lunacy.

Ann Hill stated that the prisoner's wife, who was now dead, was her daughter. She had been married to the prisoner eleven years. Some time previous to the 7th of October, the day upon which she was admitted into the lunatic asylum, she met her in Devonport, and she shewed her her arms, which were much scratched. They went together to the prisoner's house in St. Aubyn street, and witness told the prisoner that he ought to be ashamed of himself to ill-treat her, upon which he ordered her out of his house. The prisoner struck his wife with a hearth brush, and said he would make no more of killing her than he would of killing a rabbit. He afterwards removed to Monument street. On one occasion he refused his wife and her (witness) admittance, and they went away. The prisoner's wife had had no rest the previous night, and on returning to the house she fell down through weakness. At that time witness observed that her daughter's mind was disturbed.

Ann King, the wife of deceased lunatic's brother, remembered the period when the prisoner lived in Monument street. She had some conversation with his wife on one occasion, and afterwards took her to her mother's house. A short time afterwards the witness saw the prisoner and asked him where his wife was, when he made use of a disgusting expression, and said he hoped she would rot in prison or be transported. On another occasion when she went to the prisoner's house, the prisoner's wife came down stairs with her stays outside her dress, and looking very wild. She said "Jack" had beaten her, upon which the prisoner laughed. She then showed the bruises on her shoulders and breast, and said to the prisoner "you know you did it :" to which he replied "you were going to throw coals at me." He at first denied having struck her, but he subsequently admitted that he struck her with a brush.

Jane Butcher, a widow, residing in St. Aubynstreet, recollected when the prisoner lived next door to her. On one occasion she heard a violent "screech ing" in the prisoner's house, and she ran in and found his wife crouched down in a corner: she said “the brute has kicked me with his boots." Witness had often heard him talk of the state of his wife's mind, and she remonstrated with him: she told him he ought to have a person to take care of her as she was incapable of doing anything herself, but he replied that it was no more harm to kill her than it was to kill a rabbit. Witness had noticed the alterations in the wife's mind some months previously; sometimes she took things from witness's house which did not belong to her. In reference to these occurrences the prisoner had told witness he could not be responsible for her acts in the state of mind she was in.

Mr. Tripe, surgeon, of Devonport, stated that he had examined the prisoner's wife. He told her she would be taken to a place where her mental and bodily health would be taken care of: she replied that she knew she was not in a sound state of mind, and would be glad to go to a place where she would be

Dr. Bucknill stated that he was the medical superintendent of the Devon County Lunatic Asylum. He examined Amelia Rundle on the 8th of October, the day after her admission, and he observed the bruises which Mr. Tripe had described. He thought that the bruises could not have been self inflicted. The condition of the patient as to her mind was decay of the faculties. In his opinion she had been in a state of unsound mind for a year or more. She had suffered an attack of apoplexy and was paralysed. On the 12th of December she was delivered of a still born child; and on the 12th of January she died. About the end of November the prisoner called at the Asylum, and witness sent for him to his office, and said "Your wife has told me that the injuries from which she suffered when she was brought here were inflicted by your violence. If that was the case, your conduct was brutal and unmanly." Prisoner replied that it was true, and that he was sorry for it.

The defendant, in addressing the jury, said his wife was in the habit of falling down the stairs which caused the bruises; and he asked why the case was not brought before the magistrates when she was alive? He admitted striking her on the shoulder: and stated that she had thrown him into great expences, and on one occasion she had put poison into his tea-pot.

A verdict of Guilty having been found, The Judge said that he should reserve the point of law as to whether the prisoner could be deemed, in the words of the statute, to have the care and charge of his wife. For this purpose he sentenced the prisoner to six months' imprisonment with hard labour; and he divided the term, passing sentence for five months and a fortnight for the common assault, and the remaining fortnight for the offence charged under the lunacy statute.

Asylums for Criminal Lunatics.

In the House of Lords on the 9th ultimo, Lord St. Leonards rose to ask, whether Her Majesty's Government had any intention to erect asylums for criminal lunatics? Under the existing system a prison frequently became what it was never intended to be an asylum for lunatics; and he considered, that as it was improper to convert a prison into an asylum, so it was improper to make an asylum a prison, for the rules and regulations of the one and the other were altogether different.

He was aware that he might be met by a statement

of those sums, (expended from the consolidated fund in the building of asylums,) for the advance of which no orders in Council were made, &c.-That it be enacted, &c.

Sec. 1. That Commissioners of General Control and Correspondence, shall report to Clerk of Privy Council, sums expended from consolidated fund in erecting, enlarging, or extending asylums.

on the part of the Government, that at present they did not contemplate the erection of buildings to be used as asylums for criminal lunatics, and under the pressure of the war, perhaps it might be impossible to provide new buildings for the safe custody of such persons; but whenever new asylums were erected, an important question would arise as to the classification of the persons who became inmates of those asylums. He thought, if the Government would consult the Commissioners in Lunacy, and the medical author-order the repayment of such funds by the Counties ities who were at the head of public establishments for lunatics in this country, that, with the advantage of their experience, a plan for the erection and conduct of those asylums might be adopted, and a system of classification might be arranged, which might be introduced whenever asylums for criminal lunatics were built.

Earl Granville stated, in reply to the question, that it was doubtless most desirable that proper accommodation should be provided for the safe custody of criminal lunatics, and that arrangements should be made for their classification.

He was most happy to state, that the subject was under the consideration of the right hon. gentleman, the Secretary for the Home Department, (hear, hear,) though he, Earl Granville, was not able to give a pledge that the Government could immediately carry into effect any plan for affording the requisite accommodation. The question was, indeed, entirely one of

money.

Sec. 2. That Lord Lieutenant and Council may

forming the district for which the asylum is built.

Sec. 3. That the Grand Jury of each County shall make a presentment for such repayment, and that in default of this, the money shall be raised on the order of the Judge of Assize.

Sec. 4. Regulates the repayment between Counties of asylum expences in case of change of district.

Sec. 5. Gives the Lord Lieutenant power to revoke appointments of Commissioners of General Control, and to nominate others.

This Bill was read a second time before the House of Commons on the 9th of March. It received the strong opposition of the Irish members. Lord Palmerston explained that the Bill was not exactly one of indemnity, but that it was intended to set right an irregularity which had been going on a considerable time. The irregularity referred to appears to to have been the building and enlarging the Irish Pauper Lunatic Asylums on monies advanced from the consolidated fund, without the power of obtaining repayment from the county rates.

The other Bill is entitled an Act to explain and LEGISLATION RELATING TO LUNACY.-There are two amend the Lunacy Regulation Act, 1853. It is Lunacy Bills before Parliament; one the "Lunatic a Bill of legal technicality, and explains and amends Asylums Repayment of Advances Act, for Ireland, sec. 129 of the above-named Act, by enabling the states in the preamble, that whereas it is doubtful Lord Chancellor, in matters of lunacy, to empower whether it is competent for the Lord Lieutenant and committees of estates to grant leases binding on issue Privy Council to make orders for the repayment or remaindermen.

STE

TEWARD & CLERK. Wanted, at the DEVON COUNTY LUNATIC ASYLUM, a person to to fill the situation of Steward and Clerk. He must be thoroughly conversant with accounts, and understand Stores and Storekeeping. The salary is proposed to be £100 a year, with a residence in the Asylum, and rations. If allowed to reside out of the Asylum, the salary will be from £125 to £150 a year, without rations-as the Visitors may determine.

The person appointed will be expected to give security, himself in £200, and two securities, jointly and severally, in £200.

Applications, with testimonials, are to be sent to me, on or before the 28th day of APRIL next 13th March, 1855. T. E. DRAKE, Exeter, Clerk to the Visitors

LUNATIC CLOTHING AND BEDDING.

CHARLES ROOPE & SON, 144 SLOANE STREET, LONDON, Have always on hand a great variety of Material, specially adapted for the above purposes; and invite the attention of the Medical Superintendents and Governors of Asylums thereto. Tenders given from a single item to the furnishing of an Establishment throughout.

Reference kindly permitted to the Hanwell and Colney Hatch Asylums, Which they have supplied since their foundation. Private Asylums treated with on favourable terms.

THE ASYLUM BUCKLE.

This neat substitute for the Screw Locks, used to keep on the boots and clothing of the Insane Patients who strip themselves, can be supplied by PEARSE RROTHERS, Ironmongers, 93, Fore-Street, Exeter. Price 10s. 6d., per dozen.

All Communications for the forthcoming Number should | Published by SAMUEL HIGHLEY, of 32, Fleet Street, be addressed to the Editor, DR. BUCKNILL, Devon County Lunatic Asylum, near Exeter, before the 1st day of May next.

in the Parish of Saint Dunstan-in-the-West, in the City of London, at No. 32, Fleet Street aforesaid; and Printed by WILLIAM AND HENRY POLLARD, of No. 86, North Street, ir, the Parish of Saint Kerrian, in the City of Exeter. Monday, April 2, 1855.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][ocr errors][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small]

The Accumulation of Chronic Lunatics in Asylums.
Question of further Accommodation.

That pleasant moralist of the Garden Sect, Alphonse Kerr, writes: "Je suis de l'avis de ce philosophe qui prétendait avoir découvert la véritable raison pour laquelle dans toutes les grandes villes il y a un Hôpital pour les Insensés; c'est qui, en y enferment quelques pauvres diables sous le nom de Fous, on fait croire aux étrangers que ceux qui sont hors de cet Hôpital ne le sont pas."

Commissioners in Lunacy to the Clerks of Visiting
Justices, on this subject.

That "in many instances existing asylums are overcrowded or full," and that “Pauper Lunatics in considerable numbers have been refused admission," is certainly "a state of things generally regretted by all who have authority, or take an interest in the care and treatment of the insane poor."

That the magnificent and costly institutions for the care and treatment of the insane poor, with which the enlightened philanthropy of the age has provided nearly all the counties of England, should have rapidly filled up with incurable and hopeless cases, is indeed truly to be regretted.

If this quaint reason be accepted to account for the immense asylums, which within a few years have grown up around London, the elaborate care and cost with which the Londoners have attempted to prove The most remarkable evidence of the manner in their sanity, would naturally tend to excite a sus- which chronic patients have accumulated, as accompicion of the contrary, for " qui s' excuse s' accuse." modation has been extended, is afforded by the votes Another philosopher, who was also a patient at Han- for asylum buildings passed at the Middlesex Quarter well, once told us that the reason why he and others Sessions. On the 5th of May, 1829, the first of were the inmates of asylums was, that they differed in these votes was p passed, authorising a committee "to some matters of opinion from the people out of doors, enter into a contract not exceeding £50,000, for the and the latter exercised the powers if not the rights of erection of an asylum for 300 patients." The comthe majority by shutting them up. He was in hopes mittee reported to the July Quarter Sessions, 1831, that he should live to see the tables turned and the that the asylum at Hanwell was ready for 300 patients majority on the other side. the number intended to be received;" "but upon But in all seriousness, whatever may be the cause, carefully examining the establishment, it is found the rapid growth of asylums both in number and size that 200 more patients, making in the whole 500, is a fact sufficiently serious to alarm the sanest of can be accommodated with great comfort." To build men, especially if he pays poor and county rate. by mistake for 500 patients, instead of for 300, may

We append a circular issued this year by the be taken as proof that the first Hanwell com

« ForrigeFortsæt »