Syrup of morphine (French Codex, 'A, grain to the ounce), 1 ounce. Distilled water, ounces.—M.
Luys (Lyon Med., July 14, '95).
Unusual toxic effect of trional ob served in a case of insomnia when re newed small doses were administered. J. W. Irwin (Amer. Therapist, Oct., '95).
Lactophen given for insomnia in over 200 cases, with very good results. The dose given varied from 15 to 45 grains, the drug being administered in some sweet emulsion. Like most hypnotics, it loses its effect after continued use, but after a short intermission can be used again with good results. It is quite safe and more generally useful—in insane subjects—than opium, chloral, trional, or other hypnotics. Cristiani (Rif. Med., June, '98).
Opium is rarely necessary in insanity in children; when sedatives are required, a warm bath daily will be found useful, and when there is intense delirium one can add to this the application of cold to the head; in other cases a wet pack will be preferable. The administration of bromide of sodium in doses according to the age of the child will act as a calming agent, especially in cases of epi leptic mania. In cases where there is much sleeplessness trional, in doses of from 3 to 8 grains, may be given for a few nights. A tonic treatment is to be pursued, and in those who masturbate the administration of quinine and cam phor will be found convenient. Care must be taken to keep the bowels well open. Open-air exercise is to be em ployed in all cases, but gymnastics should be made use of as a recreation in cases of melancholia, and as a regulator of movements in choreic insanity. In some cases it will be necessary to stop all intellectual occupation; in others to encourage it, and also to make the child interested in the general affairs of life.
One of the most important parts, if not the most important, of the treatment is the separation of the child from his friends. Visits from friends should be permitted rarely at first, and regarded as a favor or reward for good behavior.
Children suffering from moral insanity should be put into institutions in which they should undergo industrial training, and be kept under control during the period of their lives.
The prevention of insanity in childhood is most important. Life in the open air, work in a garden or on a farm, recrea tion of all sorts, absence of forced pro longed intellectual labor, and the sup pression of excessive emotion are the chief hygienic indications in those pre disposed to insanity. Fletcher Beach (Journal of Mental Science, July, '98).
To administer trional to the insane an effervescent-magnesia solution is not only a convenient method, but it permits a smaller dose: 7 to 15 grains. Its more easy absorption is due to the presence of carbon dioxide. Thus administered, gastric and intestinal disturbances, so easily excited in the insane, are avoided. Corrado Ferrarini (La Riform a _Medico., No. 109, 1900).
When food is refused on account of gastric derangement, lavage of the stom ach and careful systematic feeding will soon correct the disturbance. Refusal owing to hallucinations and delusions may sometimes be overcome by tactful solicitation, but in other cases forced ali mentation must be resorted to. Often the tubular mouthed vessel called a "duck" will enable sufficient liquid food to be introduced. Where this is not suc cessful the food must be given through a nasal or oesophageal tube. Many alien ists prefer the former, but in the experi ence of the writer the oesophageal tube is as convenient as the other, and its larger calibre allows the requisite quan tity of food to be introduced into the stomach more rapidly.
Care must be taken to vary the food given through the tube. The constant use of milk or milk and eggs often offends the stomach and failure of diges tion results. Such vegetables as potatoes, rice, beans, peas, or lentils can be mashed and reduced with milk to a thick fluid mass, easily passed through the tube. Beef can also, after thorough boiling, be pounded in a mortar, or ground in a meat-grinder and likewise reduced to a thick paste. The various beef-juices (not extracts) and beef-powders, such as Mosqueras, or peptonoids, may also be given in the same way.