ANNUAL REPORT ON LUNATIC ASYLUMS.
17
With regard to the causes of deaths, they were as follow :—
General
debility.
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Atrophy
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Diarrhœa
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Dysentery
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Ulceration of bowels
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Apoplexy
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Phthisis pulmonalis ... ... ... ... ... ...
Cerebral hæmorrhage
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Hepatic abscess ... ... ... ... ... ...
Pneumonic phthisis ... ... ... ... ... ...
Exhaustion (within six days of admission)
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14
10
8
2
5
1
3
1
1
1
1
9. It is usual to divide the treatment of insanity into moral, hygienic,
medicinal, and so forth; but in most cases these require to be blended, that it is
impossible to point to any one remedy as effectual in a cure ; it is to the combined
effects of various measures tending to improve the general health, give repose to
the irritated nerves, and sooth the excited brain, or stimulate the exhausted mind,
that we must look for ultimate recovery. Brain disease also shows as many
varieties of type as bodily disease. In mania we have a condition of violent febrile
excitement and exaltation opposed in melancholia by the utmost depression of
the powers of mind and body, whilst in dementia faculties and powers are
alike reduced to the lowest ebb ; in idiocy mental powers have never existed, the
mind is undeveloped, has in most cases no power to develop. It will therefore be
seen that the treatment must be as varied as the range of the disease. Again,
while observing the great diversity in the forms of insanity, we are also surprised
by a striking uniformity in some phases of the disease. Thus it has been remarked
by so noteworthy an observer as G. H. Lewis that patients belonging to very
different classes of society and to different nations, have precisely similar hallucina-
tions. " Not only does the fact of cerebral congestion determine hallucination in
the Englishman as in the German, but determines the precise form which that
hallucination will take. This identity of conception rests on identity of cerebral
congestion. Remove the congestion and the hallucination vanishes." Therefore in
the treatment of insanity our attention must be simultaneously directed to improving
the bodily health. Since on the healthy condition and regulated supply of blood to
the brain proper performance of its functions depends, to soothing the nervous
system where over-excited or stimulating it where torpid or inactive, and here
anodynes, sedatives, tonics, or counter-irritants respectively become of value to
actual relief of brain disease where that may be possible as in cases of congestion
where counter-irritation may remove it. Last, and not least, the mind may be acted
on by external objects and associations, by the removal from scenes with which
painful thoughts are connected, and the substitution of new and cheerful surround-
ings, by the salutary influence of a firm will over a weak one, by order and
discipline reacting on a mind a prey to disorder and misrule by kindness influ-
encing ill-regulated passions and subduing them ; while in the acute stage, much
may be done by these means, if used promptly, and before actual degeneration of
the brain tissue has taken place ; but once the substance of the brain is affected, the
source of the disease is too deep-seated and obscure to be reached by the means
and appliances now known to us, and even where the degree of mental aberration
indicates extensive disease, the changes in the brain substance are frequently
imperceptible to microscopic examination after death, and the post mortem discloses
nothing on which to base a course of treatment. Of the medical remedies from
which most valuable aid is derived, morphia used hypodermically and hydrate
of chloral are found to afford relief and obtain sleep, and may be regarded as
the most effective of hypnotics and sedatives.
Tartar emetic is usually found too depressing, although it has proved of value
in cases of powerful Europeans in conditions of great excitement. Bromide of
potassium has a specific effect in epilepsy, unsurpassed by any other remedy,
lessening the frequency and violence of the attacks, and even, effecting a lasting
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