Regarding the much-discussed ques tion of institutional or home treatment, the decision should in all cases be in favor of the former. It is, of course, as sumed that the institution is up-to-date in all respects, and that the treatment is according to modern methods.
The general physical treatment con sists in good food, rest in bed in acute cases, and out-door life after the acute stage is over and danger of exhaustion has passed.
In the majority of cases it will be found that the digestive and assimilative functions require attention, and that re storative tonics are indicated.
Mental disease is usually attended with malnutrition, and in treating in sanity the nutrition should be made as perfect as possible, and as soon as pos sible. A. R. Moulton (Amer. Jour. In sanity, Oct., '94).
Treatment by rest in bed tried thor oughly in a large number of eases with very favorable results. There is no re straint, but the patients are kept con tinuously under observation. If lie can not be kept in a ward he is pia into a separate room. Even for 'noisy patients this is much more satisfactory than iso lation in a cell without observation. No difficulty experienced in keeping pa tients in bed. They are much more easily watched, and bad habits can he more effectually prevented. Patients rise for their meals and to go to the closet. Wizel (Ann. Med.-Psych., Nos. 1 and 2, 1901).
Insomnia can generally be combated by baths, out-door life, attention to hours of feeding, proper bed-clothing, and, when necessary, hypnotics. These medi cines should, however, be avoided if pos sible, as they are nearly always attended by some untoward effects.
In the employment of hypnotic meas ures excellent results may be obtained with the wet pack. Though it produces sleep in patients with a very high de gree of excitement, in some cases it be came necessary to repeat the application frequently for a period extending over half a year, but no diminution in its effects were observed. Umpfenbach (Ther. Monats., June, '89).
Forty-six to 62 grains of sulphonal are necessary to get the best hypnotic effect. Sleep is produced quite rapidly. The
same persistence of the hypnotic effect after the suspension of the drug is ob served. The nervous disturbances from sulphonal are divided into four groups: (1) those which compare to the well known feelings in the morning, after a heavy drinking-bout of the night before; (2) that of drunkenness, with all its pe culiar individual traits; (3) where idea tion and memory are failing; (4) those of stupor, vertigo, difficulty in walking and speech, and even paresis of the limbs. Marandon de Montyel (La France Med., Nov. 14, '89).
Sulphonal found useful in many cases among the insane, and comparatively inert among others. In 100 cases it was followed with SO per cent. of successes, the average time in which sleep came on being three hours. The average dose ad ministered was 12 grains. L. C. Toney (St. Louis Mcd. and Surg. Jour., Jan., '91).
The hydrochlorate of morphine is of great value in the treatment of mental and nervous disorders. Aug. Voisin (Bull. Gen. de Ther., Apr. 15, '91).
In comparing trional with sulphonal, preference given to the former as an hyp notic. Steiner (Deutsche med. Woch., No. 13, '95).
Chlorobrom—a mixture of equal parts of potassium bromide and ehloralamid dissolved in water—has less action upon the heart and blood-vessels than chloral. Not particularly disagreeable to take and leaves no ill after-effects. Wade (Amer. Jour. of Insanity, Apr., '95).
Snlphonal administered to forty-one insane females. Disagreeable effects fre quently observed: frequent spitting, un easiness, vomiting, staggering gait, and sometimes diarrhoea. If sulphonal was discontinued the patients, without excep tion, recovered completely. It should never be given in daily doses of 30 to 45 grains more than several months without discontinuing it from time to time. Schedtler (Therap. Monats., June, '95).
The special and elective action of potassium bromide on the bulbar region, with elective action of opiates and chloral on cerebral lobes, may be advan tageously combined. The following mixture recommended ;— 13, Potassium bromide, 2 drachms. Chloral-hydrate, V, drachm.