« ZurückWeiter »
moral agents employed in all well-regulated Asylums for the insane, to divert the deranged mind from its morbid concentration, by giving new direction to thought, and suggesting new sources of contemplation, amusements deservedly hold a high rank; and every appliance which conduces to gratify or create a capacity for enjoyment in the unhappy lunatic, however humble in itself, becomes a valuable adjuvant in the process of restoration. Varied as it may be by periodical diversions and occasional festivals, the hospital residence of ihe insane is necessarily, in a degree, monotonous and insipid. Separated by affliction from the world, with its ties, affections, and pursuits ; excluded by misfortune from the usual sources of rational happiness, much of their life is passed in the gloom of despondency; in inward struggles with their emotions; in revolving cherished delusions; or in groping amid the darkness of fatuity. In removing or mitigating such conditions, mirth and recreation, no longer frivolousor puerile, become dignified as instruments of cure. They not only prove serviceable by presenting temporary enjoyment, but by creating a future in the mind absorbed in gloomy retrospect, or present wretchedness, and by furnishing cheerful attractions to the memory of those who drown all recollections of the past in apprehensions of impending evils. They impel the patient to the exercise of self-control, both by suggesting that propriety of behaviour which will secure participation in such privileges, and by engaging the attention to the exclusion of irrational thoughts. Though by some miserable victims of hopeless despair, all attempts to arouse their cheerfulness are viewed as cruel mockery of their sufferings, to many, such occasions are sources of unalloyed pleasure ; and the aggregate gratification experienced by the insane in any entertainment, is probably but little less than would be manifested by an equal number of their more sane brethren.
With such an estimate of their value, the guardian of the insane seeks to accumulate sources of amusement that he may alleviate confinement and ennui, and at the same time so vary recreation that it may not satiate by its monotony. He thus opens a new world of pleasure to his charge, presenting enjoyments adapted to their mental condition, and their capacity to appreciate them. The character of these amusements is varied by manifold causes. Thus the whole system of recreation of any Asylum, may be influenced or decided by the temperament of its Superintendent; by the social position and former occupation of its inmates; or by the locale of the institution itself ; while numerous minor agencies will affect the details of its operation. As a class, the amusements of the American Asylums rarely differ in a material degree, but a few find both advocates and opponents among the medical officers. Dancing, social parties, permitting the commingling of the sexes, fairs, and attendance on public entertainments, have been successively opposed and defended. When, however, it is remembered that many of the insane are but little separated from the rest of the world in their sense of propriety and correctness of deportment, there seems no reasonable objection, provided the indulgence be limited to this class, to a participation in those amusements which employ so much of the time of the sane world.
In this country, where the utilitarian spirit of the national character exhibits itself, even under the disturbing influences of mental alienation, employment in industrial pursuits, as a moral agent in the treatment of this disease, proves far more efficacious, and in general, more alleviating to the patient than mere recreation. In northern latitudes, however, such occupation is generally confined, by the severity of climate, to a comparatively small portion of each year; and although some branches of industry employ a limited number of patients during the tempestuous season, reliance is mainly placed on those ornamenial arts and intellectual diversions which may be comprised in the terın amusements. But these, of themselves, become agreeable and inviting occupations, arousing the inert, and tranquillizing the irritable. In their nature, they should be such as will engage, without exciting, those to whom they are addressed ; and, while permitting that restrain. ing surveillance which their conditions require, will insure cheerfulness and mirth. Or the numerous source of amusement, combining present gratification and prospective benefit, which are available in an Asylum, none, perhaps, presents more decided advantages than dra. matic representation. All the necessary materiel exists within the precincts of the institution itself, requiring only to be developed and set in operation. Among the throng which fill its halls, move the author and the actor, waiting only to be discovered by the discriminating tact of their guardians. There is the genius to create, and the talent to pourtray scenes of humor, sentiment, and pathos. Froin such convictions, the attempt has been made at the State Lunatic Asylum, during the present winter, to produce the exhibition of theatrical performances by the patients, for the twofold purpose of engaging some who pertinaciously object to all other employment, and offering an agreeable diversion to many others. These efforts have been attended with gratifying success, and the representations have realized the most sanguine hopes of the projectors. Original plays have been produced and enacted solely by the patients, and the approval of competent judges has pronounced the matter and the impersonation to be meritorious. The hope of approbation undoubtedly stimulated some to engage in this project, who might otherwise bave declined; and the presence of the Managers of the Asylum with their families and friends, and, on one occasion, that of the Governor of the State, has gratified the desire, and fairly tested the feasibility of this enterprise. Although the performers consisted entirely, and the spectators mainly of patients, it is believed that an eyewitness of the scene, unconscious of these facts, would have discovered no indication thereof throughout the performance, or would have credited the assurance that the actors before him, and the spectators about him, were isolated from the world as victims of insanity.
The plays enacted thus far have been mostly humerous ; caricatures of the follies of the age, burlesques on national characteristics, and ludicrous exhibitions of individual and sectional peculiarities. There can be little doubt, however, that with the assistance of suitable ap: pliances, pieces of higher pretensions, vaudevilles, melodramas, &c., might be successfully attempted.
Some patients have evinced a felicity in the conception and impersonation of the characters assigned them, not unworthy of profes. sed representatives of the histrionic art.
Seventeen patients have assisted in these performances, some of whom have since recovered and left the institution. Others are convalescing, while to a smaller number, the Asylum will probably always prove a better home than the world with its turmoil can offer. Among these were individuals who believed, or had recently believed themselves to be the especial ministers of Divine will; exalled personages, Roman Pontiffs, or Secretaries of State ; that by a wave of their hand they could control the movements of railroad trains, and vessels on the high seas; who had, previous to admission, been confined in chains, as dangerous, from their homicidal propensities ; who insisted on their own idiocy and inability to think,” even while engrossed in the study of their parts; or whose ordinary conversation denied all attempts to trace coherence or point.
No injurious effects have, thus far, been discovered, and none are apprehended from the continuance of these diversions, if proper discrimination in the selection of performers, and admission of spectators, be exercised. On the other hand, undoubted benefits have accrued from the intellectual application, mental discipline, exercise of memory, and self-control of the performers, and from the diffusion of good huinor and hilarity among the observers. The success of this attempt to remove the barrier which has hitherto debarred the insane from enjoyments of this nature, thus assimilating their condition more nearly to that of their sane brethren, is alike gratifying to the philanthropist, interesting to the philosopher, and encouraging to those whose duty and pleasure it is to “minister to minds diseased."—N. Y. Annalist.
Affection of Peyer's Glands in Adynamic Ferer.-At a meeting of the New York Medical and Surgical Society, January 23d, Dr. Swelt stated that he had lately had three cases of Typhus, throwing some light upon the pathology of the diease, especially as to the condition of Peyer's glands. The patients arrived in a vessel in which the disease had been very violent, the captain and all the sailors having sufo fered froin it. In the first patient, no ulcerations were discovered, but some patches of Peyer's glands, near the ileo-cæcal valve, were enlarged and discoloured, being of reddish brown hue. In the second, a girl of 20, who had the ordinary symptoms, the glands of Peyer were very much inflamed and ulcerated. The third case was that of a boy, attacked in a week after landing, who had suffered much privation. At the time of his entrance into the Hospital, he was exceeding prostrated. Stimuli were given at once, and he improved considerably. He lived for a fortnight afterwards, and for the last week seemed constantly dying. A day or two before his death, lived discolorations of a linear form appeared about the upper part of the abdomen, as if from the bursting of small veins. On post-mortem examination, no disease of Peyer's glands, whatever, was discovered, except that some of them were hypertrophied, the results, no doubt, of former disease. In the cæcum, there were about a dozen sloughing ulcers, irregular in shape, the largest of them about the size of a five-cent piece. Taking the three cases together, it appears that the disease, although of common origin, may or may not be attended with ulceration of Peyer's glands. This is in accordance with the opinion of the English, and opposed to that of the French Pathologists.- Ibid.
Professor Dudley's Operation for Stone by Lithotomy.-(Western Lancet, Jan., 1847.) Professor Dudley has recently performed the operation for stone in several instances, and with his usual success. He has now performed the operation on one hundred and eightynine persons, of whom one hundred and eighty-four have recovered. The last case from which we received particular information, recovered in less than a week. Twelve hours after the operation, the urine passed by the wound for the last time, and union by the first intention took place perfectly.
This remarkable success has not been attained by a selection of cases; on the contrary, we have the best authority for the declaration that he has operated on nearly every case that has been presented. He performs the lateral operation, and always employs the gorget.-Southern Journal of Medicine and Pharmacy.
A Case of Idiopathic Tetanus, treated successfully by Strychnine. By EDWARD VANDERPOOL, M. D. (New York Jour. of Med. Jan., 1847.-Was requested to see Mr. B., aged 58 years, segar merchan:. Just one month ago he thought he took cold from sitting in front of his store in the evenings, from a chilliness creeping up the sides of his face, which continued for several days. This was followed by a sore feeling of the face, near the ears, and inability to extend the jaws, with a difficulty of swallowing. About this time, he commenced to fall backwards when walking, which he would do every few days from a sudden spasmodic opisthotonos attack. Two days ago he fell suddenly, in the same way, through the lower half of a window, breaking out both the sash and the glass, but without injury to himself.
I found him with tetanic expression of countenance, permanent rigidity of the masseter and temporal muscles, jaws nearly closedcould only show the edge of the tongue at its tip, which was much bitten, by being caught between his teeth whilst dozing--is frequently drawn, or, if standing, thrown backwards by spasmodic action of the muscles of the back. Bowels soluble. Pulse eighty, and soft. Has taken several catharlic doses of calomel since he felt unwell, and "a number of sweats.” Prescribed strychnine in solution, the sixteenth of a grain every two hours.
14th October.-Doctor Fell happening to call on me, I invited him
to see the patient. 10 o'clock, A. M.–Took only three doses yes terday and one this morning. Found him with a handkerchief tied around his waist from bad feeling in the region of the diaphragmproduced, as he supposed, by a fall an hour before-rigidity of the jaws about the same ; his teeth are worn off, to appearance one-eighth of an inch-thus allowing for the distance he can open his mouth. Spasms more frequent; takes fluid nourishment well. Bowels have moved. R. Stryc., one-fourteenth of a grain every two hours. 7 o'clock, P. M.-Jaws have yielded a little, but spasms have been very frequent. B. Stryc., one-twelfth of a grain every two hours.
(This treatment was continued with a gradual abatement of the symptoms until the 20th, when the patient was convalescent. He was discharged cured on the 22d.)
Within the last two years, two other cases have occurred in my practice. The lamented young S. Fox, aged 19 years, from an injury whilst bathing, died the fifth day; having been treated with tart ant., assafæt., laudanum and brandy. The other, a coloured woman, two months subsequent to young Fox, recovered. Both were traumatic tetanus. The woman had the opisthotonos form, permanent rigidity, with occasional spasmodic aggravations-especially of the diaphragm-which caused excruciating suffering. The fifth day, her jaws having become firmly closed, I concluded to take the responsibility and bleed her to the extent of a large wash-basin full, when her jaws yielded a little-say ģths of an inch-and this state of things I endeavored to maintain by tart, ant. She took 4 grs. in solution every hour and every other hour for two days without producing emesis, when, for fear of inflammation of the stomach, I suspended its use.
Her convalescence was very slow, but her health has been good since.
N. Y., Oct. 10th, 1846.
P.S. Strychnine will not dissolve in water or alcohol. A good way is to add 3j. acetic acid to Zvij. aq., which will make a clear solution.-Ibid.
Fælus, with left Arm partly amputated by the Funis coiled round it. (Dub. Quart. Jour. of Med. Scien., Nov., 1846.)-Dr. Beatty exhibited to the Pathological Society of Dublin, a preparation of a fætus, of between the fifth and sixth months of utero-gestation, which he adduced in confirmation of the fact several years ago described by Dr. Montgomery, the spontaneous amputation of the limbs before birth. This specimen illustrates that process, and may help to explain why the fætus is so often found maimed before it arrives at its full period. The left arm in this instance had been enveloped in a coil of the umbilical cord, which had so tightly constricted it as to cause the absorption of all the tissues with which it was in contact ; this had occurred about the middle of the humerus, and, the soft part being removed, only the bone preserved the continuity of the limb.Ibid.