Subduing Insanity with Narcotic Induced Sleep: Mental Illness Treatments in 1845

JF Ptak Science Books Post 153
This book review on the use of narcotics in treating the insane appeared in the New York Journal of Medicine for 1846.  The book, “An Essay on the Use of Narcotics, and other remedial Agents calculated to produce Sleep in the Treatment of Insanity….”, by Joseph Williams, M.D., and published in London in 1845.  The theory behind the sleep treatment was that the basic mechanism of insanity was “cerebral inflammation” or “excessive vascular action” in the brain—inducing deep sleep, evidently, was a good way to combat the over-active brain.

The article itself comes at an odd time in the history of the treatment of the insane.  It came almost 40 years after the establishment of  McLean Hospital (first known as the "Asylum for the Insane," a division of the Massachusetts General Hospital), which opened on Oct. 1, 1818, and was the first hospital dedicated to the treatment of the insane in the U.S.  It came 70 years after the great advances of Benjamin Rush, who elevated the “Mental Patient” from chains on the floor to the status of medical or nervous illness or disease.  The use of narcotics over this period seems to have surged and waned.  In 1879, in an article in the New York Times, the reputation of the Asylum for the Insane on Ward’s Island in NYC was considered—and one of the high points was that it had (largely) discontinued the use of narcotics. (There were still problems, of course, what with the asylum being overcrowded, housing 1100 in an institution meant to house 700, and where the chores and even nursing positions were staffed by the inmates, who were feed on 32 cents a day.)  As late as 1921, though, Jacob Alter Goldberg notes in his Social Aspects of the Treatment of the Insane, that there was a new, sharp increase in “toxic narcotic” treatments of the insane.  Of course, I guess one could replace “narcotic” with some sort of other misplaced treatment, like shock therapy, or Freudian mélanges, or something.  Each age must necessarily have their entry in the encyclopedia of embarrassments
. 

In this article we find sleep assaulted by the use of the following:  purgatives (“to subdue vascular action when the propriety of bleeding is doubtful’), emetics, opium (to be used “in cases of high nervous excitability and in puerperal mania”), morphia (“the most valuable remedy for calming excitement”), hyosciamus (“to produce sleep, tranquilizing the irritability of the insane”).  It is weird to see that the last sentence in the description of hyosciamus reads “some fatal cases have occurred from exhibiting henbane as an enema”.  A narcotic enema?  Still to come in the review is conium (“I have used it frequently and in large doses…it is chiefly valuable as a deobstruent and alternative”, followed by camphor, Belladonna, hydrocyanic acid, colchirum, stramonium aconite, and others.  “Warm baths’ makes an appearance (“90 degrees may be considered to be the best temperature for a warm bath for the insane”), as do cold baths, and the applications of ice caps. 

I’m not so sure about what to make of it all, the sleep treatment of insanity I mean—after all, Joseph Lister only makes his epochal pronouncements on cleanliness in the operating theatre 15 or so years after this paper, which seems today to be the most rudimentary thing that one could do in treatment in the surgical room, so treating extra blood in the brain through drug-induced sleep doesn’t seem all that far away from the realm of possibility back there in early Victorian England.

I don’t think I’ll forget the toxic narcotic enema any time soon, though.  Or the word “deobstruent”. 

Comments

[Rick]

John--I think you mentioned a significant clue as to the motivation of some of the medical community in treating the disturbed or insane with narcotics: 1100 patients in a hospital designed for 700.

It would be vital in such an overcrowded situation to calm those who would incite the emotions of others if not prevented from doing so. It becomes about patient control then, not treatment.

I'm sure there were plenty who sought to deliver treatment through the use of narcotically induced sleep because they found it helpful--but the pure motivations weren't the only ones. The folks in charge of large populations of the mentally ill had competing priorities. And, in some cases even today, still do.