Madness, Melancholy and Medicine, pt 2

On the Treatment of Nervous Disorders

by Maria Grace

The early 19th century saw an epidemic rise in nervous disorders. Thought to be maladies of affluence and sophistication, doctors, surgeons and apothecaries rushed in to provide relief to a suffering and often monied clientele, so much so that after doctors started taking nervous disorders seriously, everyone seemed to be taking medication for them, outdoing each other with exaggerated symptoms and buying an array of medical equipment to deal with them. How strangely 21st century it all sounds.

Doctors did not agree as to the cause of nervous conditions.  Some, like Tennet, argued the stomach was at core of the disorder. Others, including Buchan believed the causes more complex.  Indolence and other things that relaxed or weakened the body like drinking tea, frequent bleeding or purging could lead to nervous disorders. While those things which hurt digestion could contribute to the problem, unfavorable postures of the body and intense application to study were equally likely to cause difficulties. 

The symptoms of nervous disorders were often thought to begin in the stomach, considered the center of the nervous system. These symptoms might be accompanied by difficulty breathing; violent palpitations of the heart, sudden flushes or a sense of cold in various parts of the body, pains throughout the body, variable pulse, fits of crying and convulsive laughing, poor sleep and night-mares. 

Progression of the disease would bring headaches, body cramps, mental disturbances including terror, sadness, weak memory and failure of judgment. 

Treatments for Nervous conditions

In many ways, the recommended treatments for nervous disorders were quite progressive. They included a multipronged approach that included diet, exercise, and adjustments of daily routine as well as medication. 

Since digestive troubles were considered a large contributor to nervous disorders, careful attention to diet was a major part of treatment.  “Persons afflicted with nervous diseases ought never to fast long. Their food should be solid and nourishing, but of easy digestion. Fat meats, and heavy sauces, are hurtful. All excess should be carefully avoided. …Wine and water is a very proper drink at meals: but if wine sours on the stomach, or the patient is much troubled with wind, brandy and water will answer better…All weak and warm liquors are hurtful, as tea, coffee, punch, &c. People may find a temporary relief in the use of these, but they always increase the malady, as they weaken the stomach and hurt digestion.” (Buchan)

As some doctors argue today, exercise was seen as superior to all medicines. Horseback riding and walking were considered ideal, but simply being quick about one’s business and active in their chores was recommended as well. When these were too much, even riding in a carriage could produce beneficial effect.

“A change of place, and the sight of new objects, by diverting the mind, has a great tendency to remove these complaints. For this reason a long journey, or a voyage, is of much more advantage than riding short journeys near home. Long sea voyages have an excellent effect; and to those who can afford to take them, and have sufficient resolution, we would by all means recommend this course.” (Buchan)

Patients were also advised to avoid great fires and seek cool dry air to brace and invigorate the body, though chills were to be avoided. Regular cold baths as well as frequently rubbing the body with a special brush, or a coarse linen cloth should be incorporated into the patient’s routine. Further, “they ought likewise to be diverted, and to be kept as easy and cheerful as possible. There is not anything which hurts the nervous system, or weakens the digestive powers, more than fear, grief, or anxiety.” (Buchan)

Though not seen as actual cures, a number of medicines might be recommended to render the patient’s life more comfortable. Mild purgatives to relieve constipation were recommended as were elixirs to improve digestion and strength the stomach.

Though laudanum was easily available, doctors cautioned against their overuse as opiates “only palliate the symptoms, and generally afterwards increase the disease (and) habit render them at last absolutely necessary.” 

Multiple forms of nervous conditions were recognized including: melancholy, nightmare, swoons, low spirits, hysteric affections and hypochondriac affections. Practioners recommended a unique approach to treatment for each disorder though they were all considered modifications of the same basic disease.

 OF MELANCHOLY

Melancholy was considered a state of insanity that rendered an individual incapable of enjoying the pleasures or performing normal duties of life and might terminate in absolute madness.

To ameliorate melancholy, a patient’s diet should consist of cooling and opening foods. This meant primarily a fruit and vegetable diet, avoiding animal proteins, including fish and shell fish. Onions and garlic were to be avoided as they ‘generate thick blood.’ Melancholic patients should avoid strong liquors of every kind, coffee and tea, instead drinking water, whey or small beer.

Open air exercises of all kinds were recommended to “dissolve the viscid humours, … remove obstructions, promote the perspiration, and all the other secretions.”  (Buchan) In contrast, confinement to a closed room would be the very worst thing for the patient.

A patient’s companions could play a key role in his or her improvement by providing the melancholic with a variety of amusements, entertaining stories, pastimes and music. Music in particular was considered highly efficacious.

Since suppression of ‘customary evacuations’, hard digestion or dryness of the brain were physical factors that contributed to a case of melancholy, medical interventions focused on keeping the body open and evacuating.  Bleeding was often employed as a means of evacuation.

Purging medicines as well as those which increased urine or perspiration were often prescribed for days, weeks or even months at a time. External applications such as blistering ointments and warm baths might also be used.

Of Low Spirits

Physicians of the era believed that those with weak nerves were likely to experience some degree of low spirits, a disturbance much like melancholy, but less severe. Symptoms could include sleeplessness, headaches, indigestion and loss of appetite. These would be exacerbated by solitude and gloomy thoughts.

Treatment for low spirits depended on the suspected cause.  Generous diets, cold baths, exercise, cheerful company and good amusements were thought to be the best medicine overall.  When the stomach or bowels were involved, infusions of Peruvian bark with cinnamon or nutmeg, or purges might be used.  When suppression of menstrual or of the hemorrhoidal flux was suspected, bleeding, blistering or other similar approach was called for.

Those with low spirits were cautioned against the use of too much alcohol, “as the unfortunate and melancholy often fly to strong liquors for relief, by which means they never fail to precipitate their own destruction.” (Buchan) 

Of Hypochondriac Affections

Those of melancholy temperament were the most susceptible to hypochondriac attacks in which “the worst consequences imagined from any unusual feeling even of the slightest kind; and in respect to such apprehensions and feelings, there is always the most obstinate believe and persuasion.” (Perkins) Physical symptoms tended to cluster around digestive upsets, and vague physical discomforts.

The hypochondriac patient should enjoy a solid and nourishing diet, avoiding windy vegetables. Flesh meats were highly recommended, the claret or madeira to wash them down. Every kind of exercise and cold bathing were considered beneficial as were long travels to warmer climates.

Medicines for this disease focused on strengthening the alimentary canal and promoting secretions. Thus the recommendation for “gentle opening medicine, [such] as pills composed of equal parts of aloes, rhubarb, and asafœtida, with as much of the elixir proprietatis as is necessary to form the ingredients into pills. Two, three, or four of these may be taken as often as it shall be found needful, to keep the body gently open. Such as cannot bear the asafœtida may substitute Spanish soap in its place.” (Buchan) 

Of Hysteric Affections

Women, who were considered particularly delicate, were thought to be most susceptible to hysterical complaints. These included fits or laughter or crying, fainting, convulsions, low spirits, anxiety, heart palpations and cramps throughout the body.

Treatment of this disease sought first to shorten the fit, then to prevent their return. Strong patients might be bled during a fit.  Weaker ones required more gentle methods to end the spell. 

Strong smells, hot bricks to the bottoms of the feet, placing the feet and legs into hot water or strong rubbing on the legs, arms or belly might be used to bring a patient back from a paroxysm.

Practioners recommended a milk and vegetable diet, with water to drink, supplemented by a small quantity of spirits, to help cure an individual of their fits.  Additionally cold bathing and everything ‘bracing’ and that kept the mind easy and cheerful was encouraged.

Family and friends were cautioned not to offer too much sympathy for these spells lest they inadvertently excite further episodes. Young ladies who experienced hysterical fits were advised to avoid boarding schools when the disease may be caught by imitation.

Medicines to strengthen the alimentary canal, as described above, were considered appropriate for hysterical affections as well. Vomits and opening medicines were sometimes recommended. Interestingly, opium was prescribed in this case, orally, applied externally or even given in clysters.

 Of the Night-mare

Nightmares were thought to result from indigestion. Some recommended a dram of brandy before bed which was thought to prevent the problem.  Others thought it a poor custom and that foods easy to digest, cheerfulness, exercise and a light supper, early in the evening were better interventions.

If something more was needed, a glass of peppermint-water was recommended in place of the brandy.  And for young people ‘full of blood’, frequent purging could be particularly useful.


References

Buchan, William. Domestic Medicine: Or, A Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, 11th ed., (1790)
Parissien, Steven. Regency Style. Phaidon Press Limited (2000)
Perkins, John. Every Woman Her Own House-keeper; Or, the Ladies’ Library. James Ridgeway: London (1790)
Sales, Roger. Jane Austen and Representations of Regency England. Routledge (1994)
Shoemaker, Robert B. Gender in English Society 1650-1850 Pearson Education Limited (1998)
Tennet, John . Every Man his own Doctor: or, The Poor Planter's Physician, Williamsburg, VA, (1736).
The Home Book of Health and Medicine. Philadelphia: Key and Biddle. (1834)
Wilson, Ben. The Making of Victorian Values, Decency & Dissent in Britain: 1789-1837 The Penguin Press (2007)
Wiltshire, John - Contrib. to Jane Austen in Context. Cambridge University Press (2005)

~~~~~~~~~~~~

 Maria Grace is the author of Darcy's Decision,  The Future Mrs. Darcy, All the Appearance of Goodness, and Twelfth Night at Longbourn and Remember the Past.  Click here to find her books on Amazon. For more on her writing and other Random Bits of Fascination, visit her website. You can also like her on Facebook, follow on Twitter or email her.

From Madhouse to Asylum: The Evolution of the Treatment of Mental Illness

by Debra Brown

My previous post, A Brief History of Mental Illness and its "Cures", discussed how while in some parts of the earth advances were made in the understanding and treatment of mental illnesses, in Europe superstition and religious edicts and misinformation combined to increase the suffering of the sick and the fears of the rest of the population. The mentally ill were thought to be demon-possessed, witches or subhuman. 

"Solutions" included driving the madman out of the city gates at night to fend for himself, shipping him off to distant towns and arresting oddly-behaved women as witches and obtaining their confessions by torture. Many of these were cruelly put to death.

Families sought help for their insane loved ones; some protectively hid their relatives and sought treatment as best they could find from priests, physicians and healers. Exorcism, purging, application of holy relics or herbal therapies might be tried.

As time went on hospitals developed, originally from religous houses, to house the mentally ill--more for the protection and peace of mind of the sane than for treatment of the sick. A far cry from healing their ailments, they were subjected to miserable living conditions, some even caged and fed like animals and put on display to the public for a profit.

As time went on, more attention began to be paid to the possibility of mad behavior being caused by poor health of the mind. 

In the mid-17th century Richard Morton treated an eighteen-year-old girl who refused to eat until she looked like "a skeleton clad with skin". Morton appled plasters to her stomach to draw out the bad humors. He forced her to inhale ammonia fumes to subdue her violent passions, and tried to build up her strength with medicines containing iron. She died within a few months, and likely would have without this treatment, but at least he was trying to help.

As European doctors learned more about the brain, they gave up the concept of the four humors and ascribed emotional disturbances to problems of the nervous system. Women were considered prone to "nervous complaints"--at least wealthy women, while  poor women in the same condition were "mad". 

The cause of the illness? Some doctors returned to an ancient Greek notion that the womb wandered throughout the body in search of children, causing hysteria (thus the hysterectomy connection). Privileged women were warned to avoid study or hard work which might overtax their delicate nervous systems. Their menfolk tried to prevent excitement which might bring on an attack of "the vapors".

In 1728 Daniel Defoe, the author of Robinson Crusoe, protested the horrors of the madhouse system. He wrote an outraged expose about husbands  

"sending their wives to madhouses at every whim and dislike, that they may be more secure and undisturbed in their debaucheries ... This is the height of barbarity and injustice in a Christian country. ...If they are not mad when they go into these cursed houses, they are soon made so by the barbarous usage they there suffer ... Is it not enough to make anyone mad, to be suddenly clapped up, stripped, whipped, ill-fed, and worse use? To have no reason assigned for such treatment, no crime alleged or accusers to confront, and what is worse, no soul to appeal to but merciless creatures who answer but in laughter, surliness, contradictions, and, too often, stripes [lashes with the whip]?"

After a series of similar protests, the British Parliament investigated private madhouses in London and found that sane persons were indeed incarcerated against their wills. In 1774 Parliament passed a law requiring a medical certificate before any non-pauper [!] could be locked away as insane. Medical certificates, however, were all too easy to obtain, even for persons of means. 

Somehow, this well-intentioned effort of Parliament did not do much good for even the beloved King George III, who apparently had a physical disorder, porphyria, which caused severe psychiatric symptoms. Agitated, irritable and incoherent, he received the full horrors of eighteenth century treatment. The Countess Harcourt said, "The unhappy patient ... was no longer treated as a human being. His body was immediately encased in a machine which left it no liberty of motion. He was sometimes chained to a stake. He was frequently beaten and starved, and at best he was kept in subjection by menacing and violent language." He was purged, bled and given emetic drugs. His madness, however, helped to stir Parliament's interest in the treatment of the mentally ill.

In 1793,in an era called the Age of Enlightenment, Philippe Pinel was appointed director of a notorious Paris madhouse, Bicetre. The bloody French Revolution promised equality, liberty and brotherhood. Yet Pinel found many of the patients locked in filthy cells or chained to the walls. He hoped to treat these patients humanely and bring forth their inborn humanity as he had seen accomplished in Spain and other places. He was deeply impressed by the wife of a hospital official, Madame Poussin, who treated the patients with kindness and used her imagination successfully to reach into the private realm of the sick.

Pinel determined to unchain the madmen of Bicetre. Many Parisians were alarmed. As he predicted, however, the patients were grateful for their freedom and did not attack him or other members of the staff. Evidence of humanity!

Also in the 1790s, William Tuke led an investigation of English madhouses. At York Hospital he discovered a tiny room, eight feet square (six square meters), where thirteen women slept on filthy straw. Like Pinel, he was convinced that mad persons should be treated with kindness rather than cruelty. He determined to create "a place in which the unhappy might obtain refuge--a quiet haven in which the shattered bark may find a means of reparation or safety." His York Retreat opened in 1796. It heralded in a new era in the treatment of the mentally ill, the age of the asylum.

William A. F. Browne, superintendent of the Montrose Asylum in Edinburgh, Scotland wrote:

"The inmates ... all are busy, and delighted by being so ... You meet the gardener, the common agriculturalist, the mower, the weeder ... The bakehouse, the laundry, the kitchen, are all well supplied with indefatigable workers ... There is in this community no compulsion, no chains, no corporal chastisement, simply because these are proved to be less effectual means of carrying any point than persuasion, emulation, and the desire of obtaining gratification ... You will pass those who are fond of reading, drawing, music, scattered through handsome suites of rooms, furnished chastely but beautifully ... In short, all are so busy as to overlook, or are all so contented as to forget, their misery. Such is a faithful picture of what may be seen in many institutions, and of what might be seen in all, were asylums conducted as they ought to be."

Was this the end of the terrible treatment of the mentally ill? Could they now begin to heal in peace and plenty? Surely some were greatly benefitted in the improved conditions, and their gratitude would have moved them to cooperate as best they could. In my next post, however, we will look at more of what lay ahead in the treatment of the mentally ill.

Snake Pits, Talking Cures, & Magic Bullets: A History of Mental Illness by Deborah Kent

~~~~~~~~~~~~~

Debra Brown is the author of The Companion of Lady Holmeshire.

Her current work is on a novel, For the Skylark, about an emotionally disturbed woman, based on Charles Dickens' Miss Havisham, and her adult twins.