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until they become troublesome and too violent to be looked after are steps taken
to have them detained in the asylum. Early removal from home is important in
most cases, but there are some that require it more certainly than others. Those
whose attacks depend on some definite physical state, if early treated, are invari-
ably cured in a very short time.
To treat the insane it is important to know what we want to do, and what
is possible, and every case has to be considered apart, and the knowledge of the
cause of the insanity is of the utmost importance in the treatment; in fact, the
cause is of much greater importance than the form of the disease, hence the
necessity for a full history of cases when admitted. The cases, however, are seldom
carefully got up, the cause is seldom given, and the whole history is most defec-
tive in the information required. The first thing done after admission of a patient
is to determine the condition of health he is in, and if pale and anæmic, and
with feeble pulse, tonics are given, and to get the bodily functions into working
order, easily digested food in the shape of nourishing soups is administered early;
for all the functions are so dependent on healthy nerve-supply that permanent
return to health precedes return to sanity.
Amongst the simplest of general remedies is bathing; cold baths in the
majority of cases in the hot months, and warm baths to patients suffering from
melancholia, and in some cases of acute mania. Many cases of acute mania pass
from the excited state to one of greater or less depression or dementia, and in these
cases baths are of the most signal service; patients seem to improve from the
first and steadily progress under their use.
In some cases of acute mania occurring in young persons who are in fair
general health, many of whom are noisy and destructive, shower baths are of the
greatest service in checking the destructive tendencies, and the patients seem to
be quiet and sleep better after them.
In some cases of melancholia having periodic fits of depression attended with
insomnia, morphia is given at intervals with great benefit.
Chloral hydrate, in my opinion, is rarely of permanent benefit, except in epi-
leptic cases. In states of maniacal excitement I have given the medicine, in doses
beginning with 20 grains, three or four times a day, and have produced more or
less quiet, but I cannot record a single case in which recovery seemed due to its
use.
In ordinary cases of sleeplessness and melancholia doses of from 20 to 40
grains were given at night. In recurrent mania I have given it in one dram doses
three times daily and continued it for several days, and was only discontinued
because the digestion began to suffer.
In some puerperal and in sleeplessness of senile cases chloral is of service
in preventing rapid exhaustion.
Chloral combined with camphor is now recommended, as it is said that the
prolonged use of chloral produces loss of appetite and of flesh, and that the addition
of camphor obviates it. This combination as a rule produces more or less mark-
ed quiet, though this quiet is generally but temporary. I have not had sufficient
experience of its effect in checking the deleterious effects of chloral.
I have not used either conium or hyoscyamus during the year.
Purgatives are not given with the idea that we shall cure by these means ;
but in all cases of acute insanity we begin with a purge, and cases have been met
of violent maniacs whose bowels were confined becoming quiet for days after free
purgation.
Stimulants are rarely given except in cases accompanied by great debility ;
in these they are of the utmost importance ; and in many anæmic cases quiet and
sleep result from the glass of spirits given at night.
Statement No. VII.—The table of causes must always be faulty and unrelia-
ble, as very often the only information to be obtained concerning the patient is
got from the lunatic himself, and in the majority of cases an Inspector of Police
writes up the document furnished with the patient.
It would undoubtedly be of greater value if supplied by the Civil Surgeon
who signs the certificate ; this, however, is not always practicable as these indivi-
duals often wander away from their own villages, and are sometimes taken up
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