Observations on Maniacal Disorders
William Pargeter
(Doctor and Chaplain)
1792 AD

1. In 1792 AD, William Pargeter, Doctor and Chaplain, cured the insane by "catching the eye" of the patient. This was not hypnotism, but simple good, caring bedside manner. "He should be well acquainted with the pathology of the disease - should possess great acumen - a discerning and penetrating eye - much humanity and courtesy - an even disposition, and command of temper." He gives several successfully cured cases using this method that utilizes the element of surprise: "the physician's first visit should be by surprise". Pargeter criticized the torture and drugs that was taking place at the other mad houses like Bedlam. He gives this example: "The maniac was locked in a room, raving and exceedingly turbulent. ... I then suddenly unlocked the door - rushed into the room and caught his eye in an instant. The business was then done - he became peaceable in a moment." Of course this proves that insanity is not some chemical imbalance in the brain where a person is unable to control themselves. Rather, the "madness" can be turned on and turned off at the will of the "madman". Benjamin Rush would adopt "catching the eye" as a treatment in 1812. (Observations on Maniacal Disorders, William Pargeter, 1792 AD)
2. "During the second half of the eighteenth century following the wider experience of the insane afforded by the increasing number of private mad-houses as well as public 'lunatic hospitals' which opened at that time, it was gradually learnt that as Battie (1758) wrote 'management did much more than medicine' in the `cure of madness'. 'Management' meant humane treatment and reflected the spirit of philanthropy and awakened social conscience of the period which sponsored not only more and better hospitals, but was concerned also with the welfare of the poor, prison reforms, abolition of the slave trade etc. Whereas authors who owned private madhouses like Perfect were largely concerned to demonstrate their cures, Pargeter who had no such vested interest and in fact inveighed heavily against the misconduct of madhouse keepers, was the first to give an account of how much could be achieved by 'management' and the physician's influence. He did not think that classification, that is diagnosis, mattered much in this approach. 'It is thought necessary, by some writers', he wrote in his preface probably with Cullen and Arnold in mind, `that the strictest attention be paid to systematic order and method . . . but on a subject so . . . intricate as the present, it is impossible to adhere to rules, even if I were inclined to subscribe to the above opinions'. For this reason he omitted describing 'all the genera of the disease, according to the . . . classification of nosologists, because there are several I never met with in practice'. Instead he wrote a short and unambitious practical book which, viewed historically, gives it its value. He showed how the physician's manner could not only soothe and check developing excitement and render the furious madman tranquil, but even halt incipient madness. His aim was to make immediate contact with patients and this he achieved without words simply by catching their eye. Having established rapport or as he put it gained the patient's 'good opinion; a circumstance I always value as a very great point', such further measures as were necessary could be undertaken without resistance. Catching the patient's eye and influencing him by countenance was a method also used by Francis Willis senior for subduing refractory patients. Although he never wrote about it himself, an anonymous visitor to his establishment in Lincolnshire in late 1795 or early 1796 described it as follows : 'His usually friendly and smiling expression changed its character when he first met a patient. He suddenly became a different figure commanding the respect even of maniacs. His piercing eye seemed to read their hearts and divine their thoughts as they formed. In this way he gained control over them which he used as a means of cure' (translated from Details sur l'etablissment du docteur Willis, pour la guerison des Alienes. In: Bibhotheque Britannique, Littórature, 1796. Geneva). In line with Pargeter's human approach to patients was his humane attitude to their treatment. He denounced the harsh measures to which they were still subjected in private madhouses, especially the use of 'chains and cords' and `stripes and blows', and the practice of giving them 'large doses of stupifying liquor' to 'drown their faculties'." (300 years of Psychiatry, Richard Hunter, 1963, p 506)
3. This preliminary measure being taken, the first object of a physician, when he enters the cell, or chamber, of his deranged patient, should be, to catch his EYE, and look him out of countenance. The dread of the eye was early imposed upon every beast of the field. The tiger, the mad bull, and the enraged dog, all fly from it : now a man deprived of his reason partakes so much of the nature of those animals, that he is for the most part easily terrified, or composed, by the eye of a man who possesses his reason. I know this dominion of the eye over mad people is denied by Mr. Halsam, from his supposing that it consists simply in imparting to the eye a stern or ferocious look. This may sometimes be necessary ; but a much greater effect is produced, by looking the patient out of countenance with a mild and steady eye, and varying its aspect from the highest degree of sternness, down to the mildest degree of benignity ; for there are keys in the eye, if I may be allowed the expression, which should be suited to the state of the patient's mind, with the same exactness that musical tones should he suit-ed to the depression of spirits in hypochondriasis. Mr. Halsam again asks, " Where is the man that would trust himself alone with a madman, with no other means of subduing him than by his eye?" This may be, and yet the efficacy of the eye as a calming remedy not be called in question. It is but one of several other remedies that are proper to tranquilize him ; and, when used alone, may not be sufficient for that purpose. Who will deny the efficacy of bleeding for the cure of mad-ness ? and yet who would rely upon it exclusively, without the aid of other remedies ? In favour of the power of the eye, in conjunction with other means, in composing mad people, I can speak from the experience of many years. It has been witnessed by several hundred students of medicine in our hospital, and once by several of the managers of the hospital, in the case of a man recently brought into their room, and whose con-duct for a considerable time resisted its efficacy. (Medical Inquiries and Observations Upon the Diseases of the Mind, Benjamin Rush 1812 AD)

William Pargeter (1760-1810)

B A Oxon, MD Aberdeen, physician of Oxford and London, specialist in insanity; subsequently naval chaplain

Observations on maniacal disorders,1792 Reading, for the author (pp. viii +140) pp. 49-53, 57-61, 126, 129-30

MANAGEMENT OF MANIACS

The chief reliance in the cure of insanity must be rather on management than medicine. The government of maniacs is an art, not to be acquired without long experience, and frequent and attentive observation. Although it has been of late years much advanced, it is still capable of improvement. As maniacs are extremely subdolous [cunning], the physician's first visit should be by surprise. He must employ every moment of his time by mildness or menaces, as circumstances direct, to gain an ascendancy over them, and to obtain their favour and prepossession. If this opportunity be lost, it will be difficult, if not impossible, to effect it afterwards; and more especially, if he should betray any signs of timidity. He should be well acquainted with the pathology of the disease - should possess great acumen - a discerning and penetrating eye - much humanity and courtesy - an even disposition, and command of temper. He may be obliged at one moment, according to the exigency of the case, to be placid and accommodating in his manners, and the next, angry and absolute. I shall subjoin three or four cases, in which management seemed to be attended with the most desirable effects.

Case I. When I was a pupil at St. Bartholomew's Hospital, as my attention was much employed on the subject of Insanity, I was requested by one of the sisters of the house, to visit a poor man, an acquaintance of her's, who was disordered in his mind. I went immediately to the house, and found the neighbourhood in an uproar. The maniac was locked in a room, raving and exceedingly turbulent. I took two men with me, and learning that he had no offensive weapons, I planted them at the door, with directions to be silent, and to keep out of sight, unless I should want their assistance. I then suddenly unlocked the door - rushed into the room and caught his eye in an instant. The business was then done - he became peacable in a moment - trembled with fear, and was as governable as it was possible for a furious madman to be.

Case II. A young lady, who resided at a village near the metropolis, had been for some weeks on a visit to a friend, at a distance from home. In a few days after her return, her natural spirits and vivacity gradually forsook her; she became pensive - morose - fond of being in her own room and alone - she would take no nourishment, unless to avoid importunities. After I had informed myself particularly respecting the family - occasional visitors in her late excursion, &c. I was introduced to her room, and found her in a thoughtful posture, her elbow on the table, and resting her cheek upon her hand. She did not, for some time, seem to know that any body was in the room; at length she looked up, and the moment I caught her eye, for, till then I had been silent, I told her I was perfectly acquainted with the cause of her complaint, and conversed with her on those topics, I thought most suitable to her case, and at last persuaded her to come down to dinner with the rest of the family, and to drink two or three glasses of wine, and to join in the conversation of the table. I recommended an immediate change of residence - gave directions respecting diet - excercise - amusements - reading - conversation - and had soon the pleasing satisfaction to be informed of the lady's perfect recovery.

Case III. I was desired to visit a young man. Before I was introduced to the patient, I made some enquiry about him; and was told, that he had been for several days and nights on the bed with his cloaths on, nor would he be prevailed upon to take them off — that he was peevish — obstinate — refused all sustenance — was silent, and his face very red. From this representation, I was fearful that his complaint was making a rapid progress towards Mania furibunda [raging madness]. After some deliberation, I desired to see the patient alone — that no one was to come into the room till I stamped with my foot, and then two women were immediately to come up, and to place themselves one on each side the bed, and to begin to undress him without saying a word. I entered the chamber, and planted myself in a direction that I might catch his eye. This was not easy to be done; I, therefore, as I saw occasion, changed my position, at which he seemed greatly embarrassed, though not a word passed on either side : being at length obliged to look up, I set him in an instant. Finding that we perfectly understood each other, I made the signal, the women appeared, and executed their orders without the least obstruction. Thus was accomplished in a few minutes what could not be effected for several days and nights. Before I left him, he quietly drank a bacon of tea, and eat some toast and butter; he was then bled, and took some cooling physic, which unlocked the secretory organs, and I had the pleasure, a few days afterwards, to congratulate him on his compleat restoration. This was a strong case, and I am convinced, that if violent means had been used, the disease would have appeared in all its fury.

Case IV. A lady became insane, in consequence of having had an unfortunate parturition. In a few days, from her derangement, I was desired to visit her, and was much pleased to be informed, that she was not apprized of my coming. Before I was introduced, I understood she had, from her first seizure, been so exceedingly turbulent, as to require coertion. After some further enquiries, I begged to see her alone : I went suddenly into the room, and had her eye in a moment. She persisted in the same romantic way of talking, as before I saw her; but we did not lose sight of each other the whole time, neither had I as yet uttered a syllable : a signal which was previously agreed on, being given, the attendants entered, observing a profound silence, according to my orders, and began to release her, which they soon effected without the least resistance, and immediately withdrew. Being convinced that she was afraid of me, I offered her my hand, which she accepted, and after an hearty shake, as a token of amity and peace, I drew a chair, and in some measure relaxing the severity of my aspect and demeanour, I endeavoured to draw her into a more rational conversation; but I could not accomplish this by any artisice whatever. However, I could plainly perceive that I possessed, in a considerable degree, her good opinion; a circumstance I always value as a very great point, and therefore determined to seize every possible advantage by it. I accordingly prescribed some aperient physic, which her habit of body rendered her much in need of, and gave it her myself, and she took it very peacably. I left her in this state for the present, nor could I for several days gain any advancement in the cure, till the process of lactation (the suppression of which caused her indisposition) commenced, and then she recovered as rapidly as that process was completed. I have to observe in this case, that by management, Mania furibunda was evidently and happily reduced to Mania tranquilla. Before I saw hers she had not only beat, and otherwise ill-treated the servants, but rejected; with fury and disdain, both medicine and food; by which refractory conduct, her friends were obliged to impose on her the abovementioned restraint : but after my first introduction, she took whatever was offered her, without betraying the least opposition. And I am thoroughly convinced, that management principally contributed in restoring a very valuable woman to the enjoyment of her family and friends.

Notwithstanding the recent regulations, there are many private mad, houses in the neighbourhood of the metropolis, which demand a very serious enquiry. The masters of these receptacles of misery, on the days that they expect their visitors, get their sane patients out of the way; or, if that cannot be done, give them large doses of stupifying liquor, or narcotic draughts, that drown their faculties, and render them incapable of giving a coherent answer. A very strict eye should be kept on these gaoleri of the mind; for if they do not find a patient mad, their oppressive tyranny soon makes him so . . . I must add, that beating was a practice formerly, much in use in treating the insane; and I am sorry, and surprized to not that some authors, of very late date, have countenanced such unnatur, and brutish violence. But I will boldly and positively venture to declare that such usage is on no occasion necessary, self-defence only excepted for if maniacs are not to be subdued by management, or by the operation of fear, or both — beating will never esfect it : but instead of that, by rendering them more irritable, the fury will be increased, and consequently the disease less likely to be overcome : and therefore, I at once condemn this practice, as altogether erroneous, and not to be justified upon any. principles or pretences whatsoever.

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