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Medical Treatment.—The much extolled new narcotic sulphonal was fre-
quently tried at the General Hospital and at the Asylum during the past 12
months, and I have found that it differs greatly in its effect on different persons.
Thus some may take it regularly for months without its causing any serious
symptoms, while in others I have found the following evil results.
The dose has to be increased frequently, so that whereas 20 grains pro-
duced sleep in the first month, 30 or 40 are required in the second.
After taking the medicine for a few nights a more excited form of sleep-
lessness results if it be discontinued, so that whereas the patient before was
quietly sleepless he is now restless as well as wakeful.
Again in many cases the digestion is impaired and flatulence produced,
and though there be no headache on the following morning (it is stated that it is-
not attended either with nausea or headache), I have frequently found that it
came on associated with restlessness in the evening, and in some cases followed
by nausea and vomiting.
As far as I have seen sulphonal as a hypnotic is most uncertain in its
action. I found it of some use though in the epileptic status, in the furore
of epilepsy, and in some cases of insanity from excess of stimulants (in these
last cases large doses may be required to produce sleep, and at the same time it
has been lately proved elsewhere that large doses are rather dangerous). It is
also useful in some cases of exhaustion following prolonged restlessness, and in
some cases in which the mental symptoms result from other causes that may
be relieved by sleep. 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 re-
covery seemed due to its use; the excitement went on just the same when it was
discontinued and other remedies had to be used.
To sum up I would say that sulphonal is too uncertain in its action ever to
be of much use in the treatment of insanity.
In a few cases, when sleeplessness alone seems the cause of mental break-
down, it is perhaps of some use.
In some cases of excitement, in which chloral-taking or over-stimulation
has caused the nervousness or the insanity, it is probably useful.
In ordinary acute mania, general paralysis, profound melancholia, and
partial or complete dementia it is of no avail.
Cash Account, Statement IX, Finances.—During the year it will be seen that
under the head " Received from paying patients " the sum of Rs. 10,642-10-11
was received. In this sum is included the sum of Rs. 10,393-2-11 received from
the Municipalities; the remainder was received from friends of patients, namely,
Rs. 249.8, or Rs. 99-9-5 more than last year. This increase is due to one paying
patient being admitted during the year.
The Municipalities and townships which have not paid for the support of
their lunatics were Amherst, Tharrawaddy, Thatôn, and Rangoon Cantonment.
There are now in the Asylum 17 lunatics for whom no payment is received.
These lunatics come from Amherst 4, Tharrawaddy 4, Thatôn 2, and Rangoon
Cantonment 7.
The expenditure on account of establishment was Rs. 9,876 against Rs.
9,760, or a difference of Rs. 116. This increase is due to another peon being
engaged on account of increase of population.
The expenditure on account of diet was Rs. 12,180-11-2 against Rs.
10,399-4-10 of last year, or an increase of Rs. 1,781-6-4. This was owing to there
being a larger average number of patients under treatment, namely, 242.53 in
1889 against 230.43 in 1888, and the price of paddy being Rs. 100 per 100
baskets against Rs. 97 per 100 baskets of the previous year.
Rupees 239-7-0 was spent on clothing and bedding against Rs. 771-12-2 of
last year, being a decrease of Rs. 532-5-2. This saving was owing to our having
received a present of damaged blankets from the Commissariat Department.
Bazaar medicines cost Rs. 105-12-6 compared with Rs. 101-13-0 of last year,
or an increase of Rs. 3-15-6. It may be said that this increase is due to there
being an increase of population during the year as compared with 1888.
Contingencies proper amounted to Rs. 900-4-0 against Rs. 687-9-6, or an
increase of Rs. 212-10-6.
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