A pint of ale or beer, or a glass of whisky and water is often a better hyp notic than the medicines mentioned.
The tendency to suicide in melan cholia requires careful and constant watchfulness. The patients with suicidal tendencies often display great shrewd ness in lulling the suspicions of those having them in charge. The most at tentive and watchful nurses are liable to relax their care, and, before preventive measures can be adopted, the patient has secured a weapon and taken his life. The attendant upon a melancholiac must have an intelligent appreciation of the pa tient's condition and of the persistence of suicidal impulses.
A patient with melancholia, especially the agitated and the stuporous forms, should never be left alone night or day. The danger of suicide is always present and is often a matter of sudden impulse, peculiarly liable to develop if the patient is alone. The diet should be nutritious and quite sufficient. A low' diet, so called, is rarely, if ever, indicated. Pritchard (N. Y. Polyclinic, Mar., '96).
The medicinal agent of most value is opium. Many alienists object to its use on account of the alleged danger of con tracting the opium habit, but when the drug is disguised and is systematically administered, this danger can be guarded against. It is best given in the form of deodorized tincture diluted with whisky and combined with a laxative, as cascara, to diminish the constipating effects of the remedy. The latter, however, are not very marked after the medicine has been taken a few days. The beginning dose is 5 minims of the deodorized tincture, gradually increased to 30 or even 40 minims twice a day. Stress is laid on the regular administration of the drug. When opium or morphine are given at regular times to reduce anxiety or pro duce sleep, it fails entirely in producing its beneficial curative effect in melan cholia. When the desired effects (quiet, diminution of intensity of hallucinations and delusions, disappearance of mental depression) have been obtained, the dose is gradually reduced to the vanishing point.
In some cases the opium produces so much gastric irritability that it must be suspended. These are, however, very few.
Results of personal observations upon the use of opium in the treatment of melancholia summarized as follows: 1. Rest in bed for a prolonged period. 2. Every morning the patient is given on waking a glass of Hunyadi water, pre venting in this way the disturbing effects of constipation. 3. Tincture of nux vomica is given in small doses twice daily before the two principal meals of the day. 4. Laudanum is used in pro gressive doses, commencing with 5 drops and increasing 5 drops each day until distinct improvement in the patient's condition is observed. The writers have never had occasion to exceed 200 drops daily.
After there has been a marked im provement observed in the physical con dition spray-baths of short duration are employed. Bell and Lemoine (Annales Medico-psychol., Jan., Mar., '89.) Systematic observation extending over two years, and embracing the employ ment of over 18,000 single closes of opium in the treatment of various forms of mental disturbance. The treatment em braced over 40 cases of melancholia, 4 of typical mania, and 50 of various forms of paranoia. Of the 43 patients of melan cholia, 2 died of intercurrent diseases, 2 were removed by relatives, and 31 re covered. Although this success certainly cannot be wholly due to opium, as good food, rest in bed, etc., had a great share in producing the favorable results, still the beneficial effects of the opium cannot be denied. In those cases which did not improve under the use of opium, 6 were afflicted with a marked delusional state, with excessive mental disturbance. The opium was wholly given by the mouth, and the constipation, which was observed in about 50 per cent, of the cases, was successfully relieved by the fluid extract of cascara sagrada, and the diarrhoea, which was observed at the height of the treatment and at the suspension of the opium, by tincture of koto, 10 to 20 drops. It would be perfectly justifiable to continue the use of the opium for at least a year, if it could be shown that the intellect was not being impaired by its employment. In mania the bromides and hyoscine can be used to better ad vantage. Theodore Ziehen (Therap. Monats., Feb., Mar., '89).