Practical Observations on the Causes and Cure of Insanity
See also: History of Psychiatry homepage
In 1818 AD, William Saunders Hallaran, Doctor, described the use of the swing in the Lunatic Asylum of Cork, England as "a safe and very effectual remedy for the description of maniacs". He fully credits Joseph Mason Cox, 1811 AD with the invention which induced the vomiting without (emetics). Remember that John Monro raved about vomits as a cure for insanity. "The circulating swing erected in our asylum, appears to be improvement on the model suggested by Doctor Cox. It is worked by a windlass, and capable of being revolved a hundred times in a minute" ... "from repeated trials, I can confidently declare, that its efficacy, to the extent alleged by Doctor Cox, appears to be incontrovertibly ascertained" ... "This method of subduing furious maniacs, has succeeded in an admirable manner". Hallaran was the primary doctor for a major asylum and testified boldly that the swing cured the insane to his surprise! "The advantages to be derived from the swing, in the intermitting form of insanity, cannot be too highly estimated. Several proofs of its superior efficacy have come within my observation, where, immediately on the approach of the paroxysm, the symptoms had nearly subsided on the first effort." The key was to bring those who are out of control, into submission: "I have generally found patients to become at once so subservient to my wishes, as willingly to take any medicine prescribed." ... "inflexible maniacs already referred to; on whom no influence can be exerted sufficient to effect a medical purpose ... I have generally found patients to become at once so subservient to my wishes, as willingly to take any medicine prescribed." The common practice of torture in mad houses of the 18-19th centuries included the swing, bloodletting, vomits, isolation and chains. These methods indeed cured the insane in the same way a spanking fixes the bad behaviour of a two year old. The chair was the new treatment of choice because it induced vomits without drugs. And it worked, proving that mental illness is not a bodily disease, but a moral choice of the madman within his power to control and change. Incurables were those who did not respond to any known treatment, yet the chair cured them! "In several cases of continued insanity of long standing, where the swing had been employed as a last resource, I have been most agreeably surprised at the unexpected alteration which was effected after a few trials. In some who, from their disposition to violence, and who, from necessity, were closely confined to solitary apartments, it had so far succeeded, as not only to render them easy of access, but also to induce kind and gentle manners; effecting in the end, the most willing service in the daily occupations of cleansing, and attendance on the sick." The insane have always been in full control of their own actions and the chair is an effective method of aversion therapy that works! Later, Sir Alexander Morison, 1828 AD, would also adopt the swing which induced motion sickness and brought about compliance from the insane. (Practical Observations on the Causes and Cure of Insanity, William Saunders Hallaran, 1818 AD)
Practical Observations on the Causes and Cure of Insanity, William Saunders Hallaran, 1818 AD
Causes and Cure of Insanity, William Hallaran, 1818 AD
Fortunately for practitioners, a safe and very effectual remedy for the description of maniacs last adverted to, has been communicated to the public by Doctor Cox, in his practical work on insanity; who, though he modestly ascribes the invention to the late Doctor Darwin, was the first to apply the circulating swing to practical utility, for the relief of the insane.
From having repeatedly experienced the want of some subduing power, in cases which had resisted every ordinary expedient; and from being often placed under apprehensions for the safety of patients, by whom the usual mode of treatment had been utterly opposed, I was not slow in availing myself of the observations of Doctor Cox, on this subject. Accordingly, I set about erecting the necessary machinery for a circulating swing, on the principle recommended in the first edition of his very valuable work. Having completed it to my satisfaction, I was enabled in a most ample manner to put fairly to the test the degree of utility which may be attributed to this invention. Where I feel myself called upon, from a sense of duty, to report upon a matter of so much importance, I will not hesitate to acknowledge the debt due to Doctor Cox, by the public at large, for the general excellence of his labours ; and especially for his appropriate application of the circulating swing, as "a moral and medical mean" in cases of insanity.
The advantages immediately arising in the medical treatment of maniacal patients, through the medium of the swing, are, as far as I am capable of judging, of the first consideration ; and though I cannot undertake to say, that it is in any case to be, exclusively, relied on, yet, from repeated trials, I can confidently declare, that its efficacy, to the extent alleged by Doctor Cox, appears to be incontrovertibly ascertained.
I have been in the habit of using the swing with evident success, for those who were recently attacked, and who, previous to its application, were sufficiently evacuated by purgative medicines; also with others, who after repeated attacks at short intervals, were subjected to its influence Immediately on the accession of a paroxysm.— There are others, besides, for whom it was found particularly useful, and to whom Doctor Cox has strongly alluded : I mean those inflexible maniacs already referred to; on whom no influence can be exerted sufficient to effect a medical purpose, or even to maintain the common energies of life. Where the object may be to affect the patient by full evacuations, the intention seldom fails, in such obstinate cases, to be produced by the swing, on increasing its velocity to the degree required, gradually, rather than by giving it rapidity at the beginning. By attending to this, I have in most cases succeeded in exciting the sudden action of the stomach, bowels, and urinary passages, in quick succession ; particularly by reversing the motion of the swing every six or eight minutes, pausing occasionally, and stopping its circulation as suddenly as possible. It often happens that the action of the stomach only is excited, notwithstanding the continued rotation for some time after. In this case, however, I have generally found patients to become at once so subservient to my wishes, as willingly to take any medicine prescribed. I therefore availed myself of the opportunity, by giving the calomel purge at bed-time; and when necessary, the purgative solution on the morning following. The discharges which succeeded have surprised me, as much by their extraordinary magnitude as by their density and fetor.
It is not to be inferred, that on all occasions of mania, this powerful remedy is to be employed ; even where the violence of the symptoms might seem to justify the expedient. I have never used it, where the introduction of other remedies had been sufficiently in my power; or, unless they had failed of the desired effect. It will, however, sometimes happen, that though insane persons may be induced to take medicines with the . utmost alacrity, and though these will tend in the general sense to a diminution of the most urgent symptoms, still the great desideratum, sleep, cannot be obtained, at any fair price; and of course, the disease continues to advance in a more determined form. Here then is the point to which the swing may be directed with a never-failing benefit. Under such circumstances, I have had the satisfaction, in numerous instances, to perceive the much wished for influence of sleep for many hours in continuance, with very little inconvenience to the patient.
On the occasions where sleep was the primary object, I have constantly adopted the plan of continuing the patient an unusual length of time under the slow action of the swing, if possible without affecting the stomach to the extent of vomiting. This method has frequently succeeded, so as to detach him from his aberrations through fatigue; and finally, by the protracted circulation, to induce the most perfect repose. Sleep, induced by such means, is sure to be accompanied by a gentle diaphoresis, which seldom fails to bring about some consciousness and tranquillity, sufficient to establish the merits of this remedy in an eminent degree. Subsequent circumstances will of course determine when it may with propriety be repeated ; the dread it excites very soon predominates, and is generally sufficient to prevent the recurrence of violence, as well as to invite a disposition to sleep, whenever particulary desirable.
The advantages to be derived from the swing, in the intermitting form of insanity, cannot be too highly estimated. Several proofs of its superior efficacy have come within my observation, where, immediately on the approach of the paroxysm, the symptoms had nearly subsided on the first effort. I have, however, a strong objection to its use in all cases where an inordinate determination of blood to the vessels of the head may be present; especially in young plethoric habits, in whom every sudden emotion, either of mind or body, should be carefully avoided.
Speaking of the swing, merely as a medical mean, the following additional practical observations respecting it, have repeatedly occurred, and they appear to merit attention. Its uses do not seem applicable to the cure of insanity, in any form, at the commencement, or until the violence of the paroxysm has subsided;— or previously to the patient having undergone such evacuations as shall be sufficient to provide against its immediate consequences, which, in the first instance, tend materially to aggravate the morbid determination to the head, already existing.— The horizontal position seems less liable to objection than the erect, on the first effort, and should be preferred as long as the desired effect can be obtained by its continuance. When this cannot be accomplished, great care should be taken, especially with tall persons, when placed in the erect posture, to prevent the hanging over of the head; otherwise a suffusion of countenance will take place, which frequently leaves an ecchymosis, giving the appearance of unnecessary severity.
The application of the swing, will be regulated according to the urgencies of evacuation or sleep. For the first, I have satisfied myself that the erect posture is preferable. Where sleep may be more immediately required, the horizontal position, continued in a steady uniform manner, will, in a majority of instances, produce the effect; and so happily, as to supersede the necessity of other expedients, more uncertain and hazardous in their operation-.
The remarkable prostration of strength, which so suddenly succeeds to the full effect of the swing, in all cases where benefit is to be attained, and which, to a person not aware of its direct consequences, may create alarm, would necessarily suggest the propriety of careful superintendence, whenever this remedy is called for. Its immediate influence in lowering the circulation, and the general temperature of the body [shock], has occasionally caused uneasiness as to the result; which, though of short duration, has taught me to believe, that if such cases had been committed to less cautious hands, mischief must inevitably have followed, from too bold a confidence in the strength of the patient.
The swing, considered as an anti-maniacal remedy, has, as well as others of repute, in some instances entirely failed ; even where it appeared to be judiciously applied, and sufficient in its sensible operation. In such cases, I cannot advise too frequent recourse to it, or to exact more than it can yield by two or three well directed efforts. It is capable, by indiscretion, of producing the most painful apprehensions on the part of the patient, and of removing at a greater distance the benefits already in possession.
The circulating swing erected in our asylum, appears to be improvement on the model suggested by Doctor Cox. It is worked by a windlass, and capable of being revolved a hundred times in a minute; but can with ease be regulated to the degree best suited to the intent. It is now adapted for one person only, instead of four, as had been at first contrived ; the same movement being seldom admissible for more than one patient. To the body of the machine is affixed the apparatus for the horizontal position, which, when necessary, may at a moment be accommodated to the purpose.
Powerful as this contrivance has hitherto proved, still, in some cases, where its influence was much sought for, it has had but trivial effect, though put in motion to its full extent. The idiots of the establishment have been permitted to use it for amusement, without any inconvenience; and the strictly insane, also, during their intervals, with equal satisfaction: the latter, however, on the return of the paroxysms, were found incapable of resisting its most gentle rotations for five minutes in continuance.
In several cases of continued insanity of long standing, where the swing had been employed as a last resource, I have been most agreeably surprised at the unexpected alteration which was effected after a few trials. In some who, from their disposition to violence, and who, from necessity, were closely confined to solitary apartments, it had so far succeeded, as not only to render them easy of access, but also to induce kind and gentle manners; effecting in the end, the most willing service in the daily occupations of cleansing, and attendance on the sick. It may be proper to remark, that those persons, previously to any such amendment, were invariably affected from the disturbance occasioned by the swing, with a smart fever of eight or ten days duration; and from which the favourable occurrence, here alluded to, seemed to have arisen. I cannot undertake to say, that where the disease had assumed the chronic and uninterrupted form, any one instance of complete recovery has as yet followed from its use ; yet, as it has thus far established its utility, it is to be presumed, that no well regulated institution intended for the relief of the insane, will be unprovided with a swing of a proper construction, as a curative expedient, eminently adapted to the purposes for which it is so particularly recommended.
* See Doctor Cox'* work on Intimity, page 175,—third
In a few cases in private practice, where the swing was not at hand, as well as in public, in which it could not be repeated, I have contrived to confine my patients in close hammocks, slung by two parallel ropes from the ceiling, and supported at the angles by cords, with eyes hooked to the upright ropes. A gentle oscillatory motion , is thus readily obtained, which is applicable, particularly after the effects of the swing, where the continuance of sleep is of importance. If nausea or vomiting be desirable in the first instance, the oscillatory motion should be held in reserve; and by twisting the parallel ropes to their full extent, so as to let them return by retexation, to their former position, the action of the stomach is powerfully excited. This, from its vertiginous effects, having produced surprise and some share of tranquillity, is followed by refreshing sleep: the attendant, on continuing the rocking motion of the hammock, in a darkened room, has contributed to prolong it, for eight or ten hours without intermission.
This method of subduing furious maniacs, has succeeded in an admirable manner. It deprives them of all power to resist, and prevents the possibility of injury to themselves, by beating against a wall or bed-post. They, by this contrivance, are completely enveloped, and kept sufficiently warm; and where the attendants will obey the injunction of silence, the disposition to a return of violence may again be restrained by the repetition of such gentle expedients. To avoid the necessity of the attendant being constantly in the room on those occasions, a string attached to the side of the hammock, and passed through an aperture in the door of the apartment, will give the ready means of renewing the oscillatory motion from without, or of maintaining it as long as circumstances may demand; it never fails to overawe, without exciting painful and unnecessary irritation and to produce a cessation of those strong emotions, which are enemies to tranquillity and repose.
In the incipient stages of mania, where the more active and determinate symptoms are to be opposed by remedies tending to depletion, the physician can seldom be at a loss to meet the indication; provided he can be so fortunate as to have his prescriptions duly administered: they, in this case, will frequently answer the object of his solicitude and he occasionally has to congratulate himself on the successful result of this treatment of the disease. It will also happen, after haying accomplished as much as a prudent practitioner would venture on, even with evident diminution of symptoms, that still, in the essential points, no permanent good is accomplished : he yet has to contend with the continued form of insanity, to view it in its progress with, perplexity and doubt. The usual routine of medicine may have been tried, and proved inefficient; particularly to the important purpose of repose, which with all appliances and means to boot," is often unattainable."
Objections to the circulating swing, have been very erroneously entertained, on the supposition of its severity, and the distress which it is capable of causing; and its application has been occasionally interdicted, to the: manifest injury of patients or whom it was decidedly suitable. I cannot undertake to set aside mere idle prejudices, by any argument,—but I feel justified in remarking, that all- measures of importance connected with the profession of medicine, are capable of being, perverted and abused, when injudiciously employed. The circulating swing, however, should not be considered as an expedient attended with severity, when used for the purpose of relieving the man any more than sea-sickness, when resorted to for the benefit of delicate people, in the last stage of pulmonary consumption. Besides, the circulating swing is commonly used in places of public resort, as a source of recreation and pastime, by men, women and children who do not complain of its extraordinary inconvenience. I have known it if special advantage, where banaptysh had taken place of mania, and where it succeeded in 'topping the hemorrhage. It is therefore a question with me, if, by a due management of its power, it may not with material benefit.
By Steve Rudd:Contact the author for comments, input or corrections.
Send us your story about your experience with modern Psychiatry
Go To Start: WWW.BIBLE.CA