Treatment.—One of the first questions usually asked the physician who is con sulted in a case of mental disturbance is: can the patient be treated at home, or is removal to an institution necessary? In cases of melancholia home treatment is often practicable, if an attendant with tact and firmness is secured. Even under these favorable circumstances, however, treatment in an institution should be advised. Refusal of food and medicine must be met with positiveness, and in case of resistance forcible feeding must be practiced. It is rarely necessary to resort to the nasal or oesophageal tube, and, in those cases in which it must be employed, a few trials are usually suffi cient and the patient will thereafter take his meals with a little coaxing. It is not sufficient to know that the patient eats; the physician must assure himself that the quantity of food is sufficient to main tain the standard of .normal nutrition.
As refusal of food is sometimes due to gastric or intestinal disorders, the patient should always be carefully examined to determine whether the gastrointestinal canal is in normal condition. Catarrhal conditions demand appropriate treat ment, and want of digestive power may, at times, be relieved by tonics, stimulants, and digestives. I" or brief periods, con centrated or partially digested foods, such as beef-juice, clam-juice, peptones, etc., may be employed with benefit.
Nux vomica or strychnine, quinine, phosphorus, or codliver-oil will often be found of use.
The systematic use of stomach-wash ing also promises good results in these cases.
There is usually constipation in melan cholia. This should be counteracted by the nightly administration of compound licorice powder, cascara sagrada, or one of the usual anticonstipation pills. A mercurial followed by a saline purgative is good initiatory treatment, and a weekly repetition of the mercurial will be found beneficial.
Perhaps the most important remedy in acute melancholia is rest in bed. The depressed state of nutrition is a strong indication for bed-rest. It will be found that the patients quickly respond to the good effects of this treatment. Super vision of suicidal cases is also much easier if patients are kept in bed.
The production of sleep is most im portant. Depressing hypnotics, such as chloral, bromide of potassium, etc., are not beneficial. If an hypnotic is neces sary, morphine, sulphonal, or paralde hyde should be used.
As trional may cause unpleasant effects in patients affected with heart disease, especially where there is defect ive compensation, it should be prescribed in such cases with the greatest caution. Keppers (These de Wurzbourg, '93).
Chlorobrom highly recommended in melancholia and brain-exhaustion from overwork, when insomnia is the most serious symptom to combat. Keay (Lan
cet, Mar. 18, '95).
Chlorobrom is most favorable in melan cholia, especially of the milder type; and in acute mania its action is fully as reliable and lasting as any other hyp notie we possess. Wade (Amer. Jour. of Insan., Apr., '95).
Case of acute melancholia in which the patient had attempted suicide, and who refused to lie down and sleep. A bottle containing an indifferent mixture labeled "laudanum" was left in her room; she immediately drank it, lay clown, and slept several hours. J. M. Gibbons (Med. News, Sept. 30, '99).
Certain classes of mental and nervous agitation which appear to be particu larly benefited by codeine. Codeine phosphate was the substance used, especially with good results, in melan cholia with acute feelings of misery, epigastric pains, shallow respiration, feeble secretions, and general bodily de pression. Careful observations were made of its effects on 15 patients, namely: 5 males, 4 single and 6 mar ried women. The ages of the patients varied from nineteen to seventy-six years, the following being a few selected eases: Woman, aged 76 years, senile melancholia, treated with marked bene fit; man, aged 50 years, melancholia with insomnia, much improved; man. aged 32 years, melancholia with self accusations, great improvement; man, aged 26 years, melancholia with mutism and delusions of persecution, greatly improved; single woman, aged 29 years, with delusions of persecution, hallucina tions of sight and hearing, zobpsia, and hysteria, no effect; man, aged 21 years, hebephrenia (exaltation and mental con fusion), with sexual excitement, no im provement. From careful analysis of the cases and results the following con clusions are drawn: (1) marked im provement follows the treatment with codeine phosphate when there is melan cholia with anguish and great moral suffering (dou/eur morale), and corre sponding disturbance of general sensi bility; (2) such patients were rendered bright, cheerful, and happy, and sleep was obtained; (3) the action of codeine on the bowels was not nearly so consti pating as opium or morphine, while the respirations were increased in depth; (4) the dose of the codeine phosphate was 4 to 6 centigrammes to 1 grain) hypodermically, or 6 to S centigrammes (1 to grains) by the mouth (ex cessive dosage produced headache, nausea, vertigo, tachycardia, and myosis of the pupils) ; (5) the drug was contra indicated in all eases of intense excite ment, including simple mania, as it in creased such disorders. Jules Clausse (These de Paris, 1902; Brit. Med. Jour., June 21, 1902).