tient's talents, memory, and capability for the purposes of business or aniusement; while at other times they shall excite the feelings of terror, anger, and disgust, in those who are new to the nature of this variable disease. But as to distinguish betwixt what is generally termed brain fever, or inflammation of the brain, and insanity, no certain dependence can be placed on the symptoms present, the medical attendant should be careful to learn the whole history of the complaint; and if he finds it has been some time in its progress, or the patient had ever been previously afflicted in the same way, or it had been preceded by unusual eccentricity of conduct or language, or that the delirium has been of several days' continuance without change, or that insanity is hereditary in the family, or if the patient is extremely rude, vindictive, or capable as before described, he may safely refer the mental affection to what is generally called insanity, but would more appropriately be called nervous fever, while in its recent and incipient state. For the treatment of inflammation of the brain, I have no instruction to give; it would be presumption in me to attempt it; for I never saw but three cases, and they all died within forty-eight hours from the first attack: but I must suppose that the measures should be as prompt and decisive as possible, or life is gone. I should think that active depletion and topical applications were not only justifiable, but proper. But if the disease is insanity, the treatment cannot be too mild; and the more violent the symptoms, the more necessary it is to attend to this caution; particularly would I deprecate all violent topical applications, and excessive phlebotomy. It would be too much to assert, that no cases of real insanity recover under violent depletion; but this I can say with confidence, that none recover under it, who might not have recovered under the mildest treatment; and that great numbers have not recovered under it, who would have recovered under the mildest treatment possible. Medical attendants are often flattered by the first paroxysm subsiding under depletion, but the first paroxysm will generally subside without any medical efforts whatever. Some years ago I met a gentleman several times upon business, who I thought had the almost certain symptoms of approaching insanity; some time after, I was told that he was dead; and in answer to my inquiry as to the cause of his death, I was told he died of brain fever. And pray, I said to my informant, can you tell me how he was treated? "O yes, that I can, for I was with him all the time of his illness," was the reply. "In the first place, he had his head shaved, and bled violently, and blistered; he was bled too in the arm a great deal; he was violently vomited, and purged; he was kept almost without food, and bound down in bed till he died raging mad.” Now, had this unfortunate gentleman been put under my care, and that I am sure he would have been, if his own free will had been consulted; however mad he had been, the whole of what I should have done, would have been as follows:—I might have given him a single emetic; but that is uncertain, depending upon the symptoms. I should have acted smartly upon his bowels at the first, and afterwards more gently, so long as the mental disease had continued. I should have administered mild tonics, have forbidden any thing strong to drink, and any food hard of digestion, but I should have given him plenty of light nourishing food; indeed, I should have been anxious for him to have plenty of food, to counteract the exhaustion occasioned by the violence. I should have used embrocations of warm water and vinegar to his head, and lavements of warm water to his feet. I might have used the warm bath; that is uncertain. I should not have suffered him to be bound down at all; and however bad he had been, I should have frequently had him out in the open air. And, with my previous knowledge of the case, I would have ventured fifty to one upon his safe and speedy recovery; and yet I have a very high opinion of his medical attendant, both for his generalmedical skill and care,—but unfortunately he took it for a case of inflammation of the brain, and I should have known it to be a case of nervous fever. There is not a single thing in the practice of depletion for mental derangement, which has not been forbidden by one or more of our medical writers upon the subject, and yet they not unfrequently, and most unfortunately, meet altogether in the treatment of the same case; to this is often added the use of sedatives, and, in confirmed cases of insanity, these are as improper as violent depletion. If a medical attendant is in doubts as to the real nature of the disease he is called to, he may act wrong, without meriting an imputation upon his practice; but if he is under the impression that the complaint is insanity in its confirmed state, and he proceeds to shaving the head, has recourse to the cupping-glasses or leeches, and blistering the head, it may safely be concluded that he does not understand the proper treatment of the disease; and he will consult his own honour by resigning it into more experienced hands. It cannot do him any discredit to say, that insanity is a complaint which he does not undertake to treat, but he will discredit himself if he aggravates the disease by improper practice, which is too frequently the case. It is astonishing how many instances I have come to the knowledge of since I began these letters, and one most deplorable since I began this I am now writing. Taking it for granted that insanity, commonly so called, arises in all cases from nervous disorder, all that I can safely recommend as medical treatment is, gently to reduce the morbid excitement of the nervous system, by first promoting, and then keeping up, a healthy tone of the digestive organs, and a gently increased and healthy action of the secretions. The medical attendant will have quite enough upon his hands to do this, and to do it judiciously, so as to avoid excess, and unless he do this, he does nothing of any use; and if he does this successfully, he may rest satisfied, as I think, with having accomplished every thing in medical practice which can be of real utility, the rest being a moral work. And the leading principle of moral treatment should be, to treat the patients as much as possible as rational beings, that is, as much so as the necessary management will permit; with one important exception, which is, never to argue with, or attempt to set them right upon what is their particular hallucination, but to avoid it as much as possible. If my patient tells me he is a king, it would be equally wrong in me to say he is a king, as that he is not a king; for either would do injury, by keeping up that train of the ideas which caused the illusion. It would be my duty to take no notice of the expression, except with a view to change the idea, and lead to something else, upon which he would be rational, and by the exercise of the reasoning powers weaken the power of the illusive habit. I have a lady now in the house, who is extremely visionary; she can, however, at times converse rationally upon other subjects, and occasionally knits, and sews, and plays music correctly: when she begins upon the subject of her hallucination, we endeavour to divert her thoughts to something else; if we cannot succeed, but she will go on, her maid is called to attend her to her room, and she is told that the other ladies are not to be annoyed by her folly. After some time she will request to come down again, and she is immediately permitted, well knowing that she will for a time be quite correct. As I finished the last sentence, the dinner-bell rang, and on going into the dining-room I found the lady above alluded to in her usual place; and during dinner, and for some time after, she was quite correct, and behaved as if entirely free from a mental disease. This is the great point in moral treatment, to give full effect to the lucid intervals, and to elicit them as much as possible by proper management, and strongly diverting the thoughts, losing sight of the mental affection whenever it is practical. We are upon a certainty, as far as moral treatment goes, in all curable cases; for that which produces lucid intervals must have a tendency to produce recovery, where that is attainable,-sanity itself being no more than such a series of successions of lucid intervals, that the mental absences and aberrations which intervene shall not be perceived; all being subject to absence and aberrations of thought, in a greater or less degree. THOS. BAKEWELL. Spring-Vale, near Stone, Feb. 7, 1824. This article, extending farther than was expected, has been found too long for the present number ; the concluding part is, therefore, unavoidably postponed until the next. POETRY. LINES TO A SISTER, ON THE FIRST DAY OF THE NEW YEAR, 1824. TIME rolls his chariot swiftly on, Strange that poor mortals tremble so Resign'd, tho' careless of its doom, A willing victim to the tomb. But who are they whose noble forms, Who turns the darkest night to day? Tho' pale disease and sickness reign, Should Heaven's pale messenger appear But he who summer has within, May brave the seasons altogether; He lives above the clouds of sin, And has perpetual July weather. Like one upon a mountain peak Of greatest attitude-his eye Sees clouds and storms beneath him break; But all above is cloudless sky. Then cease to blame our humid isle, The cause is in thyself alone; They greatly err, they miss the mark, Who think that bliss more southward lies, Then tempt the waves, and climb the bark, To dwell beneath Ausonia's skies. "Tis not in seasons fair or foul; The mind is its own parallel: He has Madeira in his soul, Who learns the art of living well! Bliss never had a native spot, Since man was out of Eden driv'n; It shuns the palace, villa, cot, To live with him who lives for heav'n! The pious man no autumn fears; The guilty soul has nothing vernal; Yea, smile within a body crazy. Who lives beneath the hill of Zion; Tho' skies be dark, and suns be dim, The Goat is pleasant as the Lion! Newark. J. MARSDEN. WINTER. HOAR winter, with his gloomy train, And ev'ry prospect round is drear. For silenc'd are their little throats. The insect tribe-ah! where are they, O'er mossy bank, or lucid stream? And where gay Flora's num'rous race, With glowing tints of lovely hue? The infant morn with zephyrs bland, Would all their balmy sweets inhale, And breathe rich odours o'er the land? But 'tis enough-I'll ask no more, The moaning blast your requiem sings; While the loud tempest's angry roar Proclaims another scene of things. Lo! desolation marks the way To leafless woods, and barren hills; To swelling streams that madly stray, Or snow-clad plains and frozen rills. But tho' awhile we must endure The piercing cold, the biting blast, The raging storm, and pelting show'r, The troublous scene will soon be past. While we behold the circling sun, And, flush'd with hope, our joys arise; Anticipation leads us on To milder days and calmer skies. Tho' now, with a resistless sway, Stern winter holds bis sullen reign; Near Kingsbridge, Devon, shore, To join the wasting remnant of their power: But all in vain-corruption's deadly pow'r Yet, e'en in this last refuge from the foe, Wilson their drooping legions rous'd, and gave the parting blow. Dread Sovereigns! arbiters of Europe's fate! Could deeds like his deserve your mighty hate? Ye did not hate him when the thundering sound Of Gallia's vengeance shook your thrones around. Mean are your honours in a soldier's eyes, What though their bright insignia oft have graced Old Southwark's triumphs,t on thy bosom placed, 'Twas not alone the glittering baubles' blaze That rais'd their plaudits, or deserv'd their praise, 'Twas the far nobler gem within thy breast, The patriot's heart-outvalued all the restAnd while that heart to liberty beats true, The Man we'll love, the Hero praise, and give the Patriot's due. Bermondsey. LINES J. W. SUGGESTED UPON READING THE ACCOUNT OF HONEST RIEGO, faithful to the last, And ye, vile authors of a deed so base, In history's page your future fame shall blot, Till kings, and priests, and monks, are all forgot. But his fair name, to liberty so dear, While men love truth or justice-while a patriot can be found. To panish deeds like his, proud France decreed That Spain should suffer, and her patriots bleed: To fix more firm the Bourbon's tottering throne, *After the action at Villers-en-Couche, the Emperor of Austria presented him with a gold medal and ribbon of Maria Theresa, accompanied with a gold chain. + In allusion to the circumstance of Sir Robert wearing them in one of the processions celebrating his return as a member for the Borough.. They hear they answer-proud the victor stood Sarely his gods and patron saints delight in human blood! Onward, proud chieftain, in thy path to fame, Riego, fettered, in his prison cell, Could not a touch of sympathy impart A patriot's, soldier's, or a hero's name, than thou. And as for thee, mere shade of regal pow'r, And lick the dust before their conqueror's feet: THE DESIRE. OH! could I rise with those who rise And taste by faith a Saviour's love, Join with angelic hosts to tell J. W. The work which brought him from above! Oh! could I feel my soul expand, Catching the pure seraphic flame, Which angels and archangels feel, Who sing the glories of the Lamb. Oh! could I leave my cares awhile, And feel my soul to him ascend, And leave my burdens in his haud. I. C. H. |