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stress on bodily exercise. Esquirol recommends gardening, horseexercise, the gymnasium, swimming, fencing, &c. Some of these M. Delasiauve considers objectionable. M. Ferrus, on whose opinion our author evidently places great reliance, depends much on the utility of out-door work, such as agriculture and gardening. While acting as the principal physician at the Bicêtre, M. Ferrus tried this plan of treatment somewhat extensively, both with the insane and with epileptic patients. Both classes were benefited, but the latter most so. The utility of gardening is equally discoverable in private life. Of this we have in the essay before us an illustration, in the case of a gentleman subject to epileptic fits, for which medical aid was powerless, but which were entirely arrested by a journey to Switzerland, and garden-work, carried on by the patient for a series of years. Other cases are also alluded to, in which a similar result followed the having recourse to garden employment.
Horse exercise, swimming, and fencing, which, as previously mentioned, are recommended by Esquirol, are stated by M. Delasiauve to be dangerous, as are also all exertions which require too large an expenditure of strength, or a stooping posture, or in which the body is exposed to a very intense heat or light.
Variety of occupation, intermingled with amusing relaxations, will prove serviceable in cases of epilepsy. Intellectual employment requiring deep thought is injurious. Reading, drawing, music, light compositions, and the elements of chemistry, botany, physics, &c., afford great satisfaction, and sustain the moral powers, instead of exhausting them.
In his concluding remarks, M. Delasiauve recommends the establishment of institutions for the reception of epileptic patients, in order that an hygienic as well as a medical plan of treatment may be carried out, as is practised at the Bicêtre. He considers them to be absolutely indispensable.
With respect to the treatment during the fit, it resolves itself almost entirely to the prevention of bodily danger by falls or otherwise. The patient should generally be placed on his back in bed, all tight articles of clothing removed, the head a little raised by pillows, in order to diminish the determination of blood to the head, and the body placed a little on one side, in order to favour the discharge of saliva, which collects in quantity in the mouth, and might otherwise prevent the passage of air into the lungs. Some patients, when attacked during the night, have an unfortunate tendency to turn on the face, and unless carefully watched, and their position changed, may die asphyxiated. Another accident, which occurs in some instances, is the laceration, or even the amputation, of the tongue during the fit. To prevent this, a piece of wood, or a linen roll, may be placed between the teeth when the fit is coming on.
The symptoms consecutive to the attack occasionally require the attention of the medical practitioner. Generally speaking, the patient complains simply of a little fatigue, heaviness, and headach, which may be removed by rest, or by a slightly sedative or cordial infusion, with sinapised pediluvia. In the more severe cases, where the symptoms indicate congestion of the brain or lungs, the indication of practice is the abstraction of blood by large general bleedings, assisted by cupping and the application of leeches. The loss of blood is readily borne under such circumstances. Warm baths, external revulsives, sinapisms, flying blisters, &c., may also be had recourse to. The utility of refrigerant applications appears to M. Delasiauve to be problematical.-Annales Medico-Psychologiques.
LUNATIC Asylum, NANTES.—Patients are placed in the lunatic asylum at Nantes, either by their friends or by order of the authorities. The former is entitled placements volontaires, a term that does not indicate that the patient has entered of his own free will, although such examples occasionally occur, but that his friends have placed him there on the authority of a medical certificate, which should indicate his mental condition, the symptoms of his disease, and the necessity of treating his case in an asylum, and of keeping him in one. One of the persons thus admitted was a patient there for the second time. His insanity consisted, not in a delirium of words, but of actions ; such as sensual appetites, a desire for continual motion, and the purchase of all sorts of articles without utility. M. Verdon, the physician to the asylum, certified that he was insane- that the disease affected the will and the character, rather than the ideas and the judgment, although the reason could not be said to be sound—that the insanity was characterized by a tendency to excesses of all kinds, to extravagant expenditure, and romantic and ridiculous eccentricities. M. Foville, of the Charenton, fully agreed with M. Verdon, that the patient was a fit person to be admitted into the asylum ; but notwithstanding, on the perusal of their certificates, and the reading of a letter written by the person, he was set at liberty by the authorities. The reporter observes on this case, that justice is always unwilling to consider a man insane who can write a reasonable letter, and sustain a long conversation without any wandering in his ideas. Extraordinary actions, excesses, extravagant expenditure, and romantic and ridiculous eccentricities, it refers to a bad education and pernicious habits.
The difficulty of this limitation, however, says M. Bouchet, the reporter, which equally exists for the disease of the intellectual faculties, ought not to prevent our acknowledging this species of insanity, which, without affecting the intellect, acts more especially on the moral principles. Psychologists have distinguished three distinct groups of the faculties of the soul-sensibility, intellect, and the will : sensibility, which comprises the pleasures and the pains, the appetites, the desires, and the more or less reflective tendencies, that is, the sentiments; the intellect, that is, the ideas, the notions, the thoughts; and the will, which comprises the determinations and the resolutions, in a word, action. This latter faculty is the result of the coöperation of the other two, or of one of the two. Sensibility, intellect, and the will decompose in the psychological as in the material order, and act together, or are separated more or less completely in the pathological order. In order that man may be in the full possession of reason, there must be a simultaneous action of these three faculties in their regular or habitual course ; but if, under certain organic dispositions produced by disease, the equilibrium is lost between these different forces, the mental faculties, which comprise the moral as well as the intellectual feelings, are changed in their manifestations, and mental alienation is the result. The conscience itself can no longer prevent the wanderings of the faculties; influenced by internal sensations, it seeks its impressions in the deposed notions and recollections of the intellect, as well as in the deposed feelings of sensibility. With these elements it judges actions; thus it justifies murder with Brutus and Charlotte Corday, suicide with Cato, and persecution with Philip the Second and Robespierre. The lunatic who has a knowledge of the morality of his actions, without the power of controlling them, or preventing their wanderings, judges and thinks rightly, but he feels wrongly; and this perverted feeling, superexcited by disease, commands the will, which directs the action in spite of his judgment, the healthy state of which has rendered it powerless.
It is not therefore necessary that a patient should wander in his ideas, judgment, reasoning, and language, in order that he be declared insane; it is enough that he shows it by eccentric and abandoned actions, caused by a diseased imagination, which the judgment is incapable of controlling. If, in the sequestration of the insane, a separation should be made between those whose insanity was indicated by their words, and those who evinced it by their actions, there would be but little room for hesitation. The latter ought to be submitted to sequestration rather than the others, because perversions of the sensibility cause more injury in social life than the perversions of the intellect.
In dementia, the manifestations of insanity are less evident, because all the faculties are merely weakened, (affaiblis.) The disorder often ceases, as regards words and actions, but the patient speaks and does little; he replies at greater length than he questions, and his actions are more routine than voluntary. The manifestations of delirium take place only under some excitement influencing the intellect or the sensi
bility, which gradually become weaker, so as, at last, not to be influenced by any excitant. One can do as one will with these patients, except induce them to reason. They have lost the power of combination. When excited by more or less vivid impressions, the disorder returns, and its manifestations are often dangerous. Of this kind, two or three examples are given in the report. In one of these, the patient, a lawyer, having left an asylum apparently convalescent, while travelling in Switzerland, mixed with society, and also bathed in the sea. The result was, that in a few days, mental delirium was displayed in the form of all kinds of eccentricities, so that he was again placed in an asylum, labouring under insanity and general paralysis, and died, some months afterwards, at Charenton.
The next case exhibits, in a painful manner, the consequences of setting at liberty a man labouring under dementia. The patient was an old advocate; his complaint was demency, with general paralysis; his idea, the extent of his riches. He was placed in the asylum, and an interdiction obtained with respect to his property. Becoming apparently better, he was removed; relapsing, he was admitted into another asylum, whence he was withdrawn, on again improving. He then obtained the withdrawal of the interdiction, and at once plunged into a wild career of speculation, making also ridiculous purchases, until he had ruined his own fortune, and that of his children, when the disease carried him off.
With respect to the sequestration of the insane in asyla, it appears that in France a law passed in 1838, (article 8,) requires the medical man to state in his certificate, not merely the facts of the insanity, but also that the patient's sequestration is necessary, otherwise he cannot be received, unless the insanity be of a character to interfere with the public welfare, or to endanger the lives of individuals. M. Bouchet dwells somewhat on the difficulty of indicating precisely the characters of insanity which render a patient dangerous, and require him to be sequestered. He considers those persons who, in their insanity, offend against public order by wild cries, gesticulations, and menaces, and by causing alarm, — the religious, sombre enthusiast, who fancies he does God service by committing murder,—and, again, the man who fancies himself pursued and persecuted by imaginary enemies, to be among those who require sequestration; but the patient labouring under dementia, and the quiet idiot, may be, he thinks, kept under the control of their respective families. Occasionally, he admits, they may revive from their apathy, and cause some annoyance to society, but this, he says, is but momentary, and not of a nature to necessitate ration.
The withdrawal of patients from the asylum is effected, first, in conse
quence of a cure; secondly, by the desire of the friends; thirdly, by order of the prefect; fourthly, by order of the tribunal; fifthly, by escape; and sixthly, by death.
In some cases, the indications of the cure are readily perceptible, but in those instances in which the disease consists of an exaggeration to delirium of an habitual state of intellect and sensibility, disordered by nature or a bad education, the signs are less perceptible, and the patient requires to be watched after he has left the asylum. This precautionary measure is recommended in all cases. In some cases of insanity the lucid intervals are so well-marked that the patients, although not cured, may yet enjoy their liberty. In other, but very rare instances, the dismissal of the patient before a cure has been effected becomes a necessity, in order not to cause by a further sequestration an aggravation of the disease. This was exemplified in the case of a young woman, whose mind was impressed with the belief that her family were all in the asylum. Her dismissal took place, and in a short time she was convalescent.
The second mode by which patients are withdrawn from the asylum, is by the interference of the friends against the wish of the physician. Of the injurious effects of this proceeding two instances are narrated : the second is the more painful of the two. A lady, forty years of age, labouring under incurable dementia, was withdrawn by her mother and brother, in spite of the earnest opposition of the physician, who yielded only on the promise of the brother that she should be under his surveillance. This promise, however, was broken, and the old lady was left alone with her insane daughter. The consequence was, that the latter murdered her mother, by separating her head from her body, and was then taken back to the asylum, which she ought never to have left.
The patients who are dismissed by order of the prefect are those whose mental state is such as, under certain conditions, is compatible with the arrangements of social life.
The fourth mode of withdrawal of a patient, by order of the tribunal, is a legal process, and one not unattended with bad consequences.
The fifth is by evasion. This is partly attributed by M. Bouchet to the insufficiency of the keepers, who, in consequence of the paucity of the pay, are generally persons whose capacity unfits them for other employment. He mentions an interesting fact, that in consequence of a new superintendent (surveillant du personnel) having been appointed, ten escapes took place, he not having had time to make himself acquainted with the persons under his charge. Another cause which leads to escape is the insufficiency of the buildings where the lunatics are confined, more especially in the places where they work. As in the latter