In considering the usefulness of any particular line of treatment in melan cholia, due weight must be given to the tendency of this disease to recovery in the great majority of cases.
Taking then the indication suggested by the age of the patient for or against the use of opium, patients of fifty years of age and over react most strikingly to its employment, and rapidly improve under its use. On the other hand, pa tients of about thirty years of age and under are made notably worse by it. Those between the ages of fifty and thirty react uncertainly to opium; and where such cases do improve the progress toward recovery is much slower than in older patients. It does not appear that the form in which opium is given is of much importance.
The dose should always be rapidly pushed to the limits of tolerance; and also continued sufficiently long to give it a fair trial.
In looking for a substitute for opium in cases of melancholia in the first half of life, no drug has given such good re sults as sulphonal. Given in average doses of 30 grains each night it speedily acts not only by inducing sound and refreshing sleep, but also by what might be called its after-effects: it makes a patient rather heavy during the day fol lowing its administration. This is an advantage; there seems to be mental suf fering, and suicidal tendencies and ob stinate refusal of food are often relieved. This after-effect of sulphonal must be reached by increasing the dose with caution if necessary, and maintaining it for a few days in the full amount, then gradually reducing it, and only increas ing again if there is any threatening of a relapse.
It has not been found necessary to give a larger quantity than 30 grains; they always begin with this dose, and never give it more frequently than every night. J. R. Gasquet and J. A. Cones (Journal of Mental Science, July, '97).
Melancholia with anxiety, due in great part to vasomotor disturbances, is greatly benefited by nitroglycerin and sodium iodide given as follows:— B. Spirit of nitroglycerin, 30 drops. Water, 10 lluidounces.
One tablespoonful twice a day.
This is given for the first ten days of each month, and the other twenty days the following mixture is administered: 1 Sodium iodide, 2 drachms. Water, 10 fluidounces.
Tablespoonful twice a day.
To counteract the destructive action of the iodine on the blood-corpuscles, glycerophosphates and strychnine arse nate are given hypodermically. Paoli
(Riforma Medica, 1900).
An important thing in all cases of melancholia, as in other forms of insan ity, is a careful examination of all the bodily organs, and the treatment of such as are diseased.
Mania.
Definition.—An abnormal exaltation of mental activity, with incoherence, lucinations, illusions, and delusions of variable character. There is reason to believe that mania is accompanied by an hyperaemia of the cerebral cortex.
These symptoms may all occur as a stage in some other form of mental dis turbance. Thus, paranoia, general pa resis, gross brain disease, and develop mental psychoses may have maniacal at tacks as part of the clinical history. In true, uncomplicated mania the exalta tion is the characteristic manifestation.
Symptoms and Course.—An outbreak of mania is usually preceded by some days or weeks of depression or irritability of the patient. He loses appetite, the sleep becomes disturbed, and there is ob served a disinclination to his usual occu pation. Sometimes there is headache, or a sense of pressure in the head. These symptoms, after a time, become changed in character. The depression disappears, the patient feels exalted and becomes talkative. If asked about his health, he will tell you he is well—"never felt bet ter in his life," etc. Schemes for his own advancement or that of others are re garded in an optimistic spirit. Visits are made to friends and acquaintances and private business affairs are discussed with more prolixity and less reserve than are usually agreeable to others concerned. The recollection of past events is some times very accurate and the minutest and least important details of some long past transaction arc often recounted in the most wearying manner for the hearer. The patient in this stage does not care whether you reply to him or not. lie only wants a good listener into whose ears he can pour his connected or dis jointed verbosity. He also usually be comes a voluminous letter-writer. In some cases there is a tendency to make rhymes which are sometimes very in genious. This must be differentiated from the verbigeration or chattering of delirium or of acute confusional insanity.