A concise introduction to the range of John M. Galt’s medical interests is provided by Shomer Zwelling: “He experimented with mesmerism (a nineteenth-century version of hypnosis) and phrenology (a diagnostic technique that postulated a correspondence between the shape of the brain and personality tendencies). He administered soothing warm baths for extended periods, applied electric shock, and briefly tried to abolish almost all restraining devices. Without a clear sense of what would prove effective, he read voraciously and inquired of other superintendents concerning their procedures.” (43)
While some of the treatment methods Galt employed were dubious at best, his efforts nonetheless represented a medical approach to insanity that made for a decisive break with attitudes of the past, when insanity was generally perceived as something outside the body and beyond the realm of treatment.
|Under the present improved spirit of managing the insane in asylums, the system is adopted of considering insanity as no longer the mysterious affliction it was once deemed, but as simply entering into the catalogue of diseases which the physician must treat upon the established principles of medicine. Here all changes and improvements in the subject at large of medical knowledge, must bear immediately upon insanity and its treatment. (61; 37)|
Despite his wide-ranging reading and experimentation with various methods of treatment, Galt was alert to the dangers associated with devoting too much attention to new ideas.
|I think, in reality, if a golden mean is to be assiduously sought in any quarter whatever, it is as regards new ideas. In other words, the greatest circumspection should be used, that our attachment to old things should not induce us to oppose new truths, and on the other hand, a reckless adoption of apparently new truths-often, alas! the reverse of what is claimed, and any excessive attraction of the novel should be equally avoided. (61; 38)|
In his book The Treatment of Insanity, Galt collected together his notes on an enormous range of American and European writings on insanity. Much of the advice contained was highly questionable and, in some cases, contradictory. It seems that Galt endeavored to keep an open mind, and encouraged others to do the same. The following extract, from Galt’s note on a French text, gives a sense of some of the various potentially conflicting impulses surrounding care for the insane at the time.
Daquin, La Philosophie de la Folie
Baglivi observes that diseases of the mind should be mildly treated, and that we ought to abstain as much as possible from too many and too strong remedies. Case.—A young girl became insane from the repercussion of smallpox: she began to smile without apparent cause; she sang incessantly, or talked very extravagantly, and was exceedingly gay. Blisters to the neck restored her. Case.—A girl, aged 24 or 25, became insane from a suppressed arthritic humour; she wept incessantly, answered nothing to questions, but upon being pressed, got angry. Vesicatories at the same time to the arms and legs diminished the symptoms, and some mild purgatives, administered two or three times, completed the cure. The cure of insanity is more difficult, more nice, and, at the same time, more discouraging than that of any other disease. Patience and mildness are especially necessary. The physician should endeavour to gain the confidence of the patients, and to discover the moral means which may avail. It is not by a number of remedies that we must hope to cure: regimen, exercise, liberty, and, above all, great mildness in our discourse and manner, form a method of cure much more sure and reasonable. Above all things, we should be very careful not to irritate them by awakening their dominant passion, or suggesting that which has caused the disease, either by conversation or in any other way. (13-14)
A further extract, from later in Galt’s notes on the same book, serves as a reminder of the other aspects of treatment.
|Bleeding is doubtless a great remedy, but it is not useful except in the commencement, and it is decidedly hurtful when the disease is of long standing. If the patient is young, if of sanguineous temperament, if athletic, if in a paroxysm of fury, he gives, at the same time, proofs of uncommon strength—and, above all, if in the commencement of the madness—do not hesitate to draw blood, whose quantity should be proportioned to the symptoms. Bleeding from the foot, through a large opening, often works wonders. We must not be alarmed if the patient faints: it is a favourable sign; and we have often seen a lunatic faint, and then become absolutely reasonable. (14)|
It is impossible to know how many of these ideas Galt tried implementing at his own institution, and to what extent. Examples like the following show that he was open to experimentation with new ideas.
|As respects bathing, we have been accustomed to derive the most marked benefit in subduing nervous irritability and excitement, from what the French have denominated "irrigation," which consists in the warm bath, continued for an hour or two, or longer, consecutively, whilst cold water is simultaneously applied to the head, a slight sprinkle being a judicious mode of so applying it. (59; 28)|
Click here to see a questionnaire that Galt issued to the families of prospective patients. Sample questions include "Is his derangement evinced on one or several subjects" and "Has he had any bodily disease, from suppression of evacuations, sores, injuries, or the like, and what is its history?"
Perhaps unsurprisingly, Galt believed that medical science would reach its full potential only in an asylum where all the treatment received by patients was overseen by a single person: the chief physician or superintendent.
|As Truth is above all things, being, as it were, an adumbration of God himself, so must every science assume a nobler attitude, when stripped of error ... if medicine, then, at any period, or under any circumstances, shall assume an attitude of certainty, it will be in the treatment pursued in an asylum wherein are enforced the true principles of organization; in which the physician, as superintendent, has the control of all that acts upon the patient, whether of physical or moral influence; in his capacity, as a medical man, minutely examining into the exact condition of the patient, and by his power, as superintendent, so ordering every measure, whether referable to the moral or the physical, that it shall exert an action suitable to such condition, thus previously ascertained. Then, more unequivocally than elsewhere, will we be able here to recognize the footsteps of that beneficent progress, before which error flees away, as the night melts and vanishes before the advancing brightness of the sun, in the prime of morn. (61; 56)|
However, this should not finally lead us to conclude that Galt was an egomaniac: in his writings he claimed to be open-minded and alert to the dangers of taking too prescriptive an approach with his patients.
|[W]e may quote Esquirol, as approving a conclusion somewhat different from that usually entertained in this relation. As we treat persons, whether sane or insane, they will generally behave towards us in turn, and moreover will be apt to act accordingly to the character which we attribute to them. (Essays, 36)|
See the Complete Report for 1857.
See the Bibliography.