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An Essay on the Use of Narcotics, and Other Remedial Agents Calculated to Produce Sleep, inthe Treatment of Insanity by Joseph WilliamsProvincial Medical and Surgical Journal (1844-1852), Vol. 10, No. 9 (Mar. 4, 1846), pp. 101-102Published by: BMJStable URL: http://www.jstor.org/stable/25499112 .

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THE COLLEGE QP CHEMISTRY. 101

PROVINCIAL

jtlJfica1 & =urgical journal. WEDNESDAY, MARCH 4, 1846.

In these times of vacillation and excitement, when a constant thirst after change, whether for

good or for evil is yet questionable, marks the

feverish state of public affairs, it is refreshing to note the onward progress of institutions of unques. tionable utility. There are some few oases fitted for calm reflection yet left amid the turmoil and

agitation of the vast political desert to which the wearied attention may turn for relief, and where the repose and tranquillity of purely scientific pur. suits have attraction enough to draw off congenial spirits from the keen contests in which the faculties, the powers, and the intellect of the many are so

deeply engaged. The cultivation of science, for its own sake, and

the acquirement of knowledge of various kind., with a view mainly to the benefit of the commu

nity in general, are surely objects worthy of every

support. It is with sincere pleasure, therefore, that we feel ourselves at any time in a condition to

point to such objects, to recommend them as deserv

ing of encouragement and support, and to induce others to aid in their promotion, and to contribute to their success.

Among the many useful institutions of this

description, to which the advance of knowledge, and the requirements of the age, have given birth, there are none of more extended utility, none

likely to prove more practically beneficial, than the new Royal College of Chemistry. The fascinating nature of the science; the beauty and attractive interest of the experimental illustrations which it

offers; the explanation which it gives of many kindred sciences, of the arts and manufactures; the

insight which it affords into the operations of nature and the works of the Creator, are all so

many claims which chemistry has upon him who would be acquainted with the world of animate and inanimate objects by which lie is surrounded, and of which le himself forms a part.

To the lover of knowledge, therefore, such an institution affords valuable means of adding to his

accumulating store; but in an age of ultra-utilita.

rianism, the cui bono is ever forced on the attention, meets us at every turn, echoes its cuckoo note

through the very halls and sanctuaries of literature and science, and is heard even in the inmost

penetralia of the closet or the laboratory. Happy is it for chemistry that she is able well and satis

factorily to respond to the call. It is through the

analytical and experimental processes ot this beautiful science, that the artizan and the manu.

facturer attain much of the excellence which now

distinguishes their varied productions. The agri culturist also, is taught to make two blades of

grass grow where one only grew before; by chemical analysis lie learns in what, and to what

extent, the soil of his lands is deficient, and by chemical experiment where and how to supply the

deficiency. It needs not to pursue the illustration into our own more immediate domains, nor to call upon the physiologist to acknowledge the assistance he derives from chemistry, in understanding the functions of the living organs, the growth, the nutrition and the decay of the animal organism. And for th'e cui bono also, it will suffice to refer to the light thrown upon the investigation and treat

ment of disease by the chemical researches of

Liebig; by the labours of Prout, of Golding Bird, Rees, and others who are following in the same course. It is with sincere gratification, therefore, that we commend to the artizan and

manufacturer, to the agriculturist, to the naturalist and the man of science, to the physiologist and the

physician, an institution expressly established and so well fitted for the cultivation of this branch of

knowledge. From what transpired on the occasion of the

recent visit of his Royal Highness Prince Albert to the College, we learn that the building of labo

ratories is to be immediately commenced. A

special demand must, therefore, be made on the funds at the disposal of the College, to meet this

requirement. That these may prove sufficient for the purpose, without the exercise of such a spu rious economy as shall defeat or injure the intended

object, is greatly to be desired; and we earnestly hope that the munificent example set by his Royal Highness may not be lost upon those whose means enable them to follow it.

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. Post

8vo., pp. 120.

The want of sleep is often among the earliest symp

toms which indicate approaching insanity, and to pro.

cure sleep under such circulmstances-in other words,

to induce that tranquilized state of the system which

admits of sleep, is often to ward off the threatened

attack, or as the author of the Essay before us re

marks, to effect a cure. But the question in such

cases is not as to the indication, but as to the best

mode of fulfilling it so as to meet the peculiar features

of each individual instance. Dr. Williams endeavours

to answer this question, and examines the means at

our disposal for obtaining sound and refreshing sleep, both in the pervigilantia which frequently precedes, and

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102 MrEi.CAL REFORM. that which often accompanies, the attack of insanity.

He is thus led to examine in succession the effects of

various agents in the treattant of cases of insanity,

bleeding, purgatives, emetics, opium, morphia, digitalis,

hyoscyamus, hydrocyanic acid, and others of the nar

cotic and sedative classes; stimulants; baths of various

descriptions; exercise, employment, amusements, and

the means in use for the general management of the

insane. On most of these subjects the reader will

find judicious remarks and much useful information,

and hCat adds to their value, comprised within a

reasonable compass. The following cautior.s in the

employment of narcotic remedies in insanity should

always be kept in view:

" When inflammation of the brain or of its membranes

actually exists, opiates must not be given, or the

symptoms will be aggravated and even coma may le

produced: indeed wherever there is considerable arterial

action with a hard full pulse, antiphlogistic measures

must be resorted to before giving narcotics. Broussais never gave a narcotic until the antiphlogistic treatment

had been carried as far as the powers of the patient would permit. It is most important to ascertain what

are the complications with insanity, whether the

brain, membranes, heart, lungs, liver, kidneys, &q., are involved; opium being peculiarly contra-indicated

where the abdominal viscera are at fault.

' If, in doubt, the mildest narcotics should be pre scribed, such as henbane and camphor, or in some cases

digitalis, or calomel and antimony, or James's powder

may be combined with opiumn, or digitalis with opium or colchicum; but generally, the safer practice, when in

doubt, would be to order the hydrochlorate of morphia,

remembering that, in most cases, it will first be neces

sary to purge, At the same time it must not be for

gotten, that tepid, warm, or cold baths, refrigerating the head, with the use of the pediluvium, may some

times be very beneficial, when the employment of any narcotics would be positively injurious.

" It is well known that absolute repose, and quiet, are

very essential in the treatment of incipient cases of

mania; and whenever it is necessary to administer a

narcotic, it is important that the room be kept very

quiet, generally dark; and usually it will be advisable

to keep the body warm, and the head cool."

MEDICAL REFORM.

TO THE EDITOR OF TIlE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL.

SIR, .

The subject of Medical Reform seems to be one of those questions that are destined to undergo a periodi cal revolution of commotion and quiescence; for since

it has passed through its fervent perigee of 1845, and

now, out of the attraction of the central focus, it appears, in its orbitual progress of 1846, to be retreating to ios

former apogee of cold neglect in the wide and disturbed

regions of uncontrolled repulsions and of nebular con

fusion.

But to forego metaphor, it is much to be regretted that nothing on the. legislative reform of the medical

profession is promised by Government this session. It

was confidently hoped by many of our fellow mIembers, that tlie case would have been otherwise, seeing that so

much had been accomplished last year, and how

generally and amply the sentiments of all branches of

the profession on tie important subject had been

ascertained ; nnd laid in cunmulo, as it were, on the

table of the Home Secretary. No reason has been

assigned for the abandonment of this measure, and it

would be, perhaps, difficult to render one that would be

satisfactory, or even justifiable, beyond the unwilling ness to resume a task which has hitherto been unplea sant, if not vexatious. But in this quietus of legislation, it is easy to see that the profession is left in a worse

condition than if the question had never been agitated. The fabric, insecure before, has thereby received a

general concussion. Disorder and irregularity did

more or less prevail; but then some respect to pre

scriptive rights and enacted law, with fear of its viola

tion, remained. But now the opinions and declarations

of men in power, and of others out of power, but of

influence and of aa aggressive spirit, have unsettled

and confounded the rights and privileges of the

several sections of the profession. In short, every

member is left to do what pleases his own eyes, and

to pursue, quocumque modo, what seemeth to each

either safe or expedient. It is not altogether to be regretted that the bills of

last year are lost. They were all little honourable to

the profession, the members of which were looLed upon

by their tenor as a body rather to be placed under

police regulations, than as one consisting of devoted pur suers of science and practisers of a Divine art, that

called for encouragement, improvement, and protec tion. The bills were, moreover, loaded with too much

machinery; too much was left dependent on the dicta

and the patronage of the powers that be, and too little

consigned to the collective wisdom and regulation of

the profession within itself. Professional divisions and

distinctions were also too much recognized and pro vided for; instead of endeavouring to diminish the

number and prominency of these invidious insignia, in a profession, which, obeying the spirit and wants of

the age, is, practically, tending to a requblic in attain

ments and honours.

However little reason there is to lament the syncopal

condition, if not the absolute asphyxia, of the bills on

the above accounts, yet we must acknowledge they

embraced many highly useful and necessary provi

sions-.-such as the equalization of medical education,

and equal priviliges and rights to practice every where

in her Majesty's dominions, along with tle registration of all qualified practitioners.

These three highly important objects should ever

form the triple foundation of the professiql ; and until

they are sanctioned and secured by statute, there can

be little solid peace or well-being in our ranks through the three kingdoms. These simple but important points are all which the profession essentially wants ; the

rest of the superstructure must be completed and orna

mented by the zeal, study, talents, stand the moral and

religious lives of the members themselves. It is, there

fore, worthy ot consideration how these deeply desirable

points are to be obtained, and that in the least com

plex and most practicable manner.

For this purpose, it appears to me, that all uni

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