Case CLVIII

A student of Berlin having always enjoyed good health, returned home one night in great alarm, and, with pallid countenance and bewildered looks, announced that he was to die in thirty-six hours. He went to bed, sent for a minister, and wrote his will. Symptoms, apparently so serious, alarmed his comrades; Hufeland was called in; his reasonings were unavailing. This celebrated physician prescribed a powerful dose of opium, which threw the youth into a profound sleep, lasting far beyond the fatal term. On awaking, the date of the day and hour being proved to the student, be found that he had been the dupe of his imagination; his mind became calmed, his fears dissipated, and he returned to his usual gayety. The young man then related to his friends that, having walked out in the twilight, he saw a death's head, and heard a voice say to him: "Thou shalt die in thirty-six hours."*

* M. Estre, Observations recueillees dans le service de M. Aubanel, Journal l'Esculape, 1842.

The principal physical agents employed in the treatment of hallucinations, are sanguine emissions made at stated periods, prolonged baths, either alone or with the douche, irrigation, and purgatives; under some circumstances emetics, narcotics, and antispasmodics, and, finally, external revulsives, such as blister-ings, moxa, and setons. Many other remedies have been extolled; we think it unnecessary to give the list. One, however, the hot-water treatment, shall be mentioned on account of its author's name.† Manual labor is often a powerful auxiliary. It sometimes happens that patients are brought into the hospitals, whose insanity appears to proceed from an insufficiency of food. If hallucinations arise from this cause, good nourishment should be prescribed. And, lastly, we recommend a care-fid notification of the condition of all the organs, and the manner in which the functions act.

Section second. - Moral Treatment. - When the excitement is calmed, moral means, which essentially consist in producing novel impressions, in rousing the affections, and fixing the attention on foreign objects, may be of the greatest service. The choice of these must necessarily vary according to the education, mental acquirement, and the character of the delirium of the hallucinated. The means that would be successful with a distinguished man, would have no effect on one of mediocrity. The artisan would not understand the language of the savant. A woman would be accessible to consolations that could not be lavished on the other sex. The use of moral means requires sagacity, a knowledge of men, pliability of temper, and great perseverance. In this, as in everything, we agree in the maxim of La Fontaine: -

"Patience et longueur du temps Font plus que force ni que rage,"‡ as conducting to the most certain results.

* Darwin, Zoonomia, t. i. p. 289.

† Du Traiteraent des Hallucinations par l'eau chaude. Broussais, Annal. de Med.-Physiol. Janvier, 1828.

Time and patience do more than force or anger.

If we take into consideration the immense part that ideas occupy in the production of hallucinations, we shall readily understand that to them we must have recourse for the cure of the false sensation which is the torment of the hallucinated.

Shall we be contented to give diet, drinks, purgatives, and medicaments to this man, who imagines himself a teapot; or to that other one, who thinks his head has been turned round? Could we conquer by a bath, or a sanguine emission, the conviction of that hallucinated man, who asserts, in gloomy despair, that he is everywhere followed by his Double, who plays him the most treacherous tricks, ruins, dishonors, and will infallibly lead him to the tomb? What remedy would be sufficiently energetic to chase away the phantom which an unhappy being has ever before him, especially if the hallucination is caused by remorse of conscience? Will the douche always succeed in conquering the obstinacy of that melancholy man, who would die of hunger, rather than eat the food he fancies to be poisoned, or who is destroyed by pestilential odors?

Facts exist to show that if, in some cases, the remedy disperses these strange ideas, it more generally only combats the symptoms of excitation, and leaves the chimeras in all their force.

A lady whom we attended, endeavored to destroy herself in order to escape the pursuit of an imaginary enemy, who quitted her neither night nor day. We conjectured that the periods were irregular, and bled her in the foot. On the following morning, she was quite an altered being; all the distressing symptoms had ceased; and she spoke of the falsity of the sensations she had experienced. In a few days she was restored to her family.

But by the side of this case we must place that of the physician mentioned by Esquirol, and, unfortunately, such are the most numerous. After a judicious therapeutic medication, calm is re-established, and the patient conforms to the customs of the house; the hallucination has not changed, but he speaks less of it. It is then that the physician must use all the resources of his mind to attack the idea, to weaken and eradicate it, now by direct, now by indirect methods, but always by ja happy mixture of kindness and firmness.

These precepts we will now apply to particular cases.