Tag Archives: calomel

Mania and Medicine

Woman Forced Into Cold Shower, from Elizabeth Packard's Book Modern Persecution, or Asylums Revealed

Woman Forced Into Cold Shower, from Elizabeth Packard’s Book Modern Persecution, or Asylums Revealed

Doctors in the asylum era were breaking ground in a new field, and unfortunately, had few scientific studies to reference when it came to treating patients. Most treatments progressed from fairly benign standards like warm or cold baths, enemas, frequent meals, and so on, to more extreme forms of the treatments (baths that lasted hours or days, force feeding, etc.), and then to medicines. Most physicians were quite comfortable–and felt assured of the safety–of medicines that today we know are quite dangerous. Calomel (see last post) is just one example of a favored medicine with dreadful side effects.

Excited patients–particularly epileptics–might be given bromides to calm them. It worked, but at least one doctor (Chicago physician Dr. J. S. Jewell, writing in an 1881 issue of the New York-based journal The Medical Record) noted that the use of bromides in the treatment of epilepsy actually led to “maniacal furor,” a condition that made the person appear insane.

Skin Eruptions Were Another Side Effect of Bromide Use and Resembled Smallpox, from Materia Medica, 1918

Skin Eruptions Were Another Side Effect of Bromide Use and Resembled Smallpox, from Materia Medica, 1918

Genetian (which could affect blood pressure and ulcers) was used to stimulate patients’ appetites; hyoscyamia (found in plants like henbane and having an action similar to atropine and belladonna) was used to help patients remain calm or sleep; and ergot ( a fungus which includes a chemical that can cause people eating food contaminated with it to go berserk) was used for “persistent congestion of the brain and cord.”

Painting by Matthias Grunewald of Patient Suffering From Advanced Ergot Poisoning, circa 1512

Painting by Matthias Grunewald of Patient Suffering From Advanced Ergot Poisoning, circa 1512

Of course, many medicines used today would be poisonous if they weren’t compounded properly and given in the proper doses. Doctors must also watch for adverse side effects in sensitive individuals and interactions with other drugs patients might be taking. Unfortunately, in the era under discussion, it is unlikely that doctors were skilled at avoiding these potential problems.

Asylum Patients Under a Doctor’s Care

Indiana Hospital for the Insane

Indiana Hospital for the Insane

In 1884 Dr. Joseph G. Rogers, superintendent at the Asylum for the Insane in Indianapolis, wrote in an article (see last post) that nothing remarkable in either the treatment of insanity or recovery of patients had occurred recently. His suggestions for the primary care of acute (recent) mania were rest and nutrition, with the addition of soothing baths and perhaps a dose of medicine to help the patient sleep. These treatments could just as easily be done at home if a family wanted to–so why would they send their loved one to an asylum?

If patients didn’t immediately recover their sanity, of course stronger measures would be necessary. That’s when medical professionals took on more than most families could comfortably embrace.

William Green, a Patient With Acute Mania, Bethlem Hospital

William Green, a Patient With Acute Mania, Bethlem Royal Hospital

Rogers, and most other alienists of the time, believed that patients almost always needed their bowels cleared by a good enema, and he suggested using gallon portions if necessary. The enema should be repeated until deemed successful by seeing proof of the “evacuation of the entire canal.” He called this dramatic enema “hydraulic mining so to speak” and what it would have been like for family members to administer can only be imagined. To aid in the complete cleansing of the patient, Rogers also suggested an active purgative of ten grains of calomel with three of gamboge.

Calomel is a mercury compound which could have devastating side effects and actually kill patients who consumed too much of it over time. Gamboge is a strong laxative (that can also expel worms) with side effects that include vomiting, stomach pain, and loss of potassium–which can damage the heart.

Union Soldier Carlton Burgan, Whose Upper Mouth, Palate, Right Cheek, and Right Eye Were Effected by Calomel Poisoning, courtesy National Museum of Medicine and Health

Union Soldier Carlton Burgan, Whose Upper Mouth, Palate, Right Cheek, and Right Eye Were Affected by Calomel Poisoning, courtesy National Museum of Medicine and Health

Though laypeople of the time probably wouldn’t have known about these side effects, they might still have felt uneasy giving these stronger kinds of medicines to their relatives. And, if patients needed these stronger interventions, it would be because they were becoming increasing difficult to manage–another reason to send them to an asylum.

Though asylums took much of the care-taking burden off families’ shoulders, they may not have actually given the patient better care. In my next post, I will discuss some of the medicines available to doctors caring for the insane.