Duboisine sulphate, by the mouth, and also hypodermically in doses of V„, to l/„ grain, used in all cases of excitement; in acute mania its use was not followed by any beneficial results; single doses produced quiet for a time, but this was followed by more excitement. In de lusional mania it was only used for out bursts of excitement, and was entirely satisfactory. In general paralysis the drug was used both occasionally and continuously, with satisfactory results. In melancholia bad results were seen; in no case was there any relief, and in some cases the excitement was increased, and there was a tendency to syncope, with hallucinations of sight and hearing. Used occasionally in dementia it gave satisfactory results, with rest at night. The danger of the drug is from cardiac failure, if given continuously. It should be used only in physically-healthy per sons. On the whole, the drug is prefer able to hyoscine or hyoscyarnine, as the quiescent state induced is of longer dura tion, and there is less prostration. Skeen (Journal of Mental Science, July, '97).
In hypodermic doses of l/„„ to grain scopolamine proved a good hyp notic in paroxysmal excitement, but not in habitual insomnia. It is especially
useful in acute mania. Tomasini (Brit. Med. Jour.; Epitome, Dec. 4, '97).
Hydrobromide of hyoscine preferred to the hydrochloride. It is given in doses of '/, to grain. In cases of mental excitement with delirium and destruct ive tendencies, especially in periodic mania, it is of great value, also in the delirium of alcoholics. In melancholia agitata as well as in other cases of sleeplessness, hyoscine often produces quietude when all other means fail. On the other hand, it is not adapted for all cases of an hysterical nature, and espe cially in affections which require a con stant use of sedatives. Marked valvular trouble and fatty heart contra-indicate it. Doerner (Therap. Monats., June, '9S).
After the acute stage has passed the physical strength returns, and the brain begins to return to its normal activity, great care is necessary to prevent relapses. All sources of irritation should be kept from the patient, visits of friends should not be allowed too soon or too frequently, and he should be kept under close obser vation until the normal mental stability is re-established.