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Thursday, July 11, 2013

Treatment of the insane used to be nasty

The nurses in the critical care unit were complaining the other day, and rightfully so, that the patint rights' movement has gone too far.  No longer can hospital staff freely apply restraints on people, even people who are a danger to themselves and staff, at their own descretion.  It can be done, yet not without frequent checks and frequent orders.  It's easier not to do it at all. 

We have patients come in who are insane and generally out of their minds, and we have to continue to treat them with dignity and respect.  Nurses in psych wards used to be able to keep a taser gun on hand to use for those emergent situations when a crazy person goes out of control, thus posing a danger to himself and staff.  Taser guns are no longer allowed.

If you think the insane have it good today, well, they do.  Yet all we have to do is go back to the 18th century and we will see a completely different picture.  Historian Fielding Hudson Garrison explains that the insane were often "chained or caged when housed, or, if harmless, were allowd to run at large.  In ancient Vienna and Bedlam, the public was allowed to view the insane, like animals, in a menagerie, on payment or small fee."

Likewise, "a sentitive, self conscious patient was confined in a cold, damp, gloomy, mephitic cell, fed on perpetual hard break, and otherwise treated as a criminal." The diet of the insane usually involved soup, warm beer, and a few vegetables and salads, mainly because this was the cheapest food and drink. 

Probably the worse part of being in an insane assylum was that the conditions were very poor, vermin probably roamed freely, and their was very poor ventilation.  This means that if a new prisoner arrived with a disease, then that sicknes swould spread quick, causing much morbidity and mortality. 

There were various institutions built for the insane, with the following being the only reasons a person would be admitted or committed:
  1. Suicidal
  2. Dangerous
  3. Unmanageable
Symptoms back then were regarded as causes, such as the following:
  1. Exaggerated self esteem
  2. Jealousy
  3. Envy
  4. Sloth
  5. Self abuse
  6. Etc.
These causes resulted in an imbalance of the bodily humors yellow or black bile.  The remedy would be to do something to recreate a balance of the humors, which included:
  1. Malancholia (depression) treated with opium
  2. Excited states treated with camphor or pruritis by diaphorisis (sweating)
  3. Belladonna (bronchodilator, hallucinogenic) believed to have mysterious power: when it failed, everything failed.
  4. Purgatives (made you puke)
  5. Clysters (enema to make you poop)
  6. Venesection (cut open a vein and make you bleed out)
  7. If purgatives and emetics failed to work, the patient went into a special room "for many hard knocks with a regime of bolts and chains to inspire fear."
  8. Sometimes open air treatment was used, putting patinet to mend geese, harvest land, or something like that
  9. Some patients were ordered to take mineral baths (this might have been nice)
  10. Marriage was also recommended as a cure.  Why?  No reason is given, although I'd imagine a good woman could probably straighten any man out.  What?  You don't think so?  Come on, I'm just speculating here.
There was an unconditional belief in the efficacy of these remedies.  When drugs failed to work for a particular patient, such cases were regarded as hopeless.  Could you imagine if we, in this day and age of political correctness, decided that one of our patients was hopeless? 

  1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1913, 1st edition, Philadelphia and London, W.B. Saunders and Company, page 419

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