The general indications in the treat ment of delirium are, first, to secure sleep; second, to overcome motor unrest; third, to prop up and maintain the pa tient's vitality by contributing to his nutrition; and, fourth, to discover and remove the cause upon which the de lirium is dependent. Collins Med.
News, Feb. 20, '98).
There is no necessity to wait until some unfortunate accident or crime necessitates the tardily written certifi cate. Treatment is thus available much earlier than usual—a point the impor tance of which to the patient, to his friends, and to the can scarcely be overestimated. It places "border-land" and early cases under the same therapeutic conditions that have been found efficacious against the kindred hysteria, cerehrasthenia, and bodily disease generally. and it gives the patient greater opportunities of having frequent co-existing or causative bodily disease properly attended to. It does away with the false distinction between mental and bodily disease and it alto gether avoids the stigma and disgrace attaching to "lunatic" and "asylum." There is no signing of certificates, with its, at times, serious sevehe to both patients and medical men, and natural convalescing ground, the home, is much earlier and more readily avail able. J. W. Springthorpe (Lancet, June 14, 1902).
Careful attention must be paid to the bodily functions. A useful preliminary is a large rectal lavement, to remove fTcal accumulations and prevent soiling of the bed. Feeding with nutritious food is of the first importance. Maniacs usually eat ravenously anything offered them. Care should be taken to prevent overloading the stomach with indigest ible food. In cases where the pulse is weak and rapid, the addition of a moder ate quantity of alcohol is often useful. Milk and eggs, with beef-juice, or partly predigested beef-powder, and some of the starchy invalid foods are perhaps the best form in which to introduce nourish ment.
In eases of very active mania, a warm bath, with effusion of cold water, some times has such a calmative effect that. patients who before refused food then took it freely. Binswang,er (Centralb. f. Nervenh., Mar., '91).
Sleep must be secured. If it does not
follow the measures here recommended within a reasonable time, some hypnotic must be given. Among the hypnotics least likely to disturb digestion or de press the appetite are bromide of potas sium, chloral, hyoscinc, sulphonal,' and trional. Clouston highly recommends chloral, 30 grains, with 10 minims of the tincture of cannabis Indica. A combina tion of bromide of sodium and chloral, of each, 15 grains, with 15 minims of tincture of hyoscyamus is also an excel lent calmative. In cases of great weak ness and rapidity of the heart's action, digitalis, strophanthus, or strychnine may be added to the bromide-and-chloral mixture. Paraldehyde is a valuable hyp notic in cases with depression. It is given in doses of drachm to 1 drachm in V., ounce of whisky, diluted with a little water. It usually produces sleep within an hour. A bottle of ale or beer is often an excellent hypnotic.
Opium, which is so useful in melan cholia is generally contra-indicated in mania. The brain-hypertemia is simply increased by the drug, and the symptoms heightened. In the late stages, however, where there is brain-exhaustion and the descent into dementia seems imminent, opium sometimes pulls the patient to gether and enables him to recover.
Opium or morphine recommended in the acute stages of mania. The heart should be sustained by digitalis. In cases of hyperaemia nothing is better than ergotine. In obtaining sleep and inducing bodily quiet, warm and pro longed baths, also hyoscine. Krafft Ebing (Inter. Min. Rundschau, May 25, June 1, 8, 25, 29, '90).
"Chlorobrom," a mixture of bromide of potassium and chloralamid, is also a satisfactory hypnotic in mania. It does not produce depression or derange di gestion.
In mania, chloralose, in doses of from 1 to 15 '/, grains; preferably given in solution in boiling water. Sedative effect in from fifteen to twenty minutes after taking the drug. Ilaskovec (Revue Neurol., Oct., '94).
Neutral duboisine sulphate an excellent sedative in all psychical and motor agita tion. Sleep produced similar to physio logical slumber. Dose varies from 'AN to grain. Loicano and Masuro (Med. Standard, May, '95).