( 7 )
Statement No. V.—This shows the ages of the inmates who entered the asylum
during the year. Of these the extreme ages were reached and are as follows :—
Under 20 years ... ... ... ...
From 20 to 40 years ... ... ...
From 40 to 60 years ... ... ...
Above 60 years ... ... ... ...
1
41
13
1
Statement No. VI.—The types of insanity are shown herein. Of those treated,
namely, 245, 97 were suffering from acute mania, 6 from chronic mania, 53 from
melancholia, 39 from acute dementia, 2 from chronic dementia, 2 from paralysis
of the insane, 8 from idiocy, 19 from imbecility, 2 from monomania, and 17
were not insane.
The difference in the classes of insane cases has not materially differed from
those of other periods.
Medical treatment.—Of the 56 new cases admitted, there have been 20 males
and 1 female in a state of raving madness, attended with excessive violence,
in all of which during the continuance of the maniacal paroxysms I administered
a liberal diet in the form of beef-tea, broths, milk, and other convenient kinds of
nourishments; tonic medicines were employed for some, but the resistance offered
frequently does more harm than the remedies do good, which does not so much
happen when nutriment of an enticing description is presented to the patient.
No case has occurred in which antiphlogistic medicines save aperients have been
used. Inflammatory action in the brain seems to be a disease of very rare occur-
rence in acute mania as admitted here. Nature is slow either to set up or sustain
inflammation of the brain or of its membranes, whilst the physical powers are so
intently engaged in maintaining the peculiar violence of madness. The indica-
tion therefore is to support and to succour the constitution and thereby to fortify
it against the debilitating influence of long-continued raving; an opposite plan
of treatment renders the heart irritable by deranging the digestive organs, pro-
longs the paroxysms, delays repose, checks and postpones recovery if the results
are not fatal nor end in confirmed dementia. Examinations after death show
a want of blood in the brain, a deficiency of firmness in its substance, frequently
too much water in the ventricles, and some at the base. I am speaking particu-
larly of the post-mortem appearances after acute mania and do not refer to its
complication with other diseases to which the insanes are liable. The warm
bath continues to be very serviceable in cutting short paroxysms in cases of
acute mania and in producing sleep in cases of melancholia. Many cases of
melancholia have also been benefited by a combination of tonics and sedatives.
Hemiplegia and paraplegia have been treated with strychnia, but I cannot say
that it has done more than improve the general health; the paralysis remains.
Preparations of opium, and particularly morphia and Dover's powders, are
constantly given; hyoscyamus and other sedatives are frequently and successfully
resorted to. I have not used chloral so largely during the year under review as
I was wont to in former years.
The bromide of potassium has been used in all cases of epilepsy, but I can-
not call to mind that it has cured any cases; the fits come on just the same and
the patients are but very slightly relieved.
Restraint.—Articles of restraint have been put on three patients in the year.
In the first case a man wore gloves or bags fastened at the wrist on the hand
for a few days to keep on the applications to and otherwise to protect a scrofu-
lous open sore on both sides of the neck which had followed abscesses.
In the second case a similar contrivance was used for several days to prevent
the patient from tearing an ulcer he suffered from. Both patients were reckless
of pain and evil consequences from want of care when the glove suggested
itself as a sine quâ non to success in the treatment. Both affections presented
a very unpromising aspect. As the result the sores healed rapidly.
The third instance of restraining is to me of more importance as the neces-
sity in this particular case has, for the first time, driven me to overstep a boun-
dary line of principle which I had felt confident never to cross.
The subject of this restraint was a Burman. The restraint itself consisted
of a strap, or armlet, round each arm above the elbow, the two armlets being