Observations on Maniacal Disorders
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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
Observations on Maniacal Disorders, William Pargeter, 1792 AD
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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