( 7 )
acute to chronic insanity or dementia and in chronic melancholia with delusion to
counter-irritation to the scalp, as recommended by Dr. Buckhill, has been found
useful in a few cases.
In cases of mania attended by much excitement, when the general means
first mentioned either appeared inapplicable, or when tried have not been follow-
ed by decided relief, pouring water on the head from a shower-bath or common
gardening watering-can, or sponging the forehead and face with cold water, have
not infrequently appeared efficacious in removing the excitement. The bromide
of potassium in combination with chloral, preparations of opium, and particularly
morphia and Dover's powders, hyoscyannes and other sedatives, are likewise fre-
quently and successfully resorted to, in some cases of excitement, with the view of
tranquillising the patient and producing sleep without being followed by those
unpleasant symptoms which were formerly thought to arise from their employ-
ment.
In cases of melancholia the warm bath continues to be frequently found of
great service, and when combined with cold effusion to the head has likewise
sometimes been thought of use in tranquillising the patient in some forms of
excitement. The shower-bath, both as a sedative and as a tonic, and either
tepid or cold, has been usefully employed in certain cases of melancholia and in
cases of chronic insanity with the purpose of rousing the patient and giving tone
to the system. In a large proportion of cases, however, the medical treatment
is necessarily limited to the removal of symptoms in other parts of the system
which have only an indirect relation to the cerebral derangement.
With these views, bitters, aperients, diaphoretics, eminmagogues, and other
appropriate remedies are frequently found of service by acting upon, or restoring the
functions of, the stomach, bowels, skin, and uterine organs. There have been
a few cases in which from the first it has been found necessary to invigorate the
tone or support the power of the system by the use of generous diet, quinine,
chalybeates, or other tonics, and even by that of wine, ammonia, and other stimu-
lants or cordials, and in which convalescence has speedily followed.
In a few cases, when patients have absolutely refused their food, the stomach-
pump has been employed.
Statement VII.—The causes of insanity are shown in this, and to repeat what
was stated in the reports of previous years, the causes of derangement assigned
in most of the admissions are misleading: where it is possible to trace out the
antecedents of the patients personal enquiries are instituted in view to arrive at
some definite clue, not only as to the origin but also to surrounding circum-
stances which might have a tendency to guide one to something definite.
To physical causes chiefly are set down—to ganja 1, opium 3, ardent
spirits 2, and fever 1; while among the moral causes 3 were from loss of pro-
perty, 2 from grief, and 4 from domestic difficulties (mostly poverty).
In 11 cases no cause is assignable.
Statement No. VIII shows the statistics of the hospital for the year. The
admissions remaining at the close of 1881 were 9 and those of 1882 69,
making a total of 78, out of which number 57 were discharged and 2 remained
at the close of the period under review. The deaths recorded were 19, being
6 under the total of last year, or, in proportion to admissions, 27.58 per cent.
The mortality was due to the following causes:—
Diarrhœa ... ... ... ... ...
Dysentery ... ... ... ... ...
Anosmia ... ... ... ... ...
Pneumonia ... ... ... ... ...
Ulcers ... ... ... ... ...
Ague ... ... ... ... ...
Broncitis ... ... ... ... ...
Leprosy ... ... ... ... ...
Total ... ... ... ... ...
Cases.
4
4
3
2
2
2
1
1
10