In wrapping the sheet about him care should be taken to separate adjacent parts, as arms and legs, from the body by folds of the sheet; then he is wrapped in the blankets, tucking closely fold by fold. The patient's head should be wet before he lies in the pack, and after he is comfortably placed in it a wet towel should be wrapped about his head unless an ice-cap is deemed better. If patient is very feeble and temperature of the sur face subnormal more blankets will be required, or perhaps hot bottles at feet. Massage is usually given one-half hour after pack. In cases of active excitement the patient may be taken from the pack, rubbed or douched, and put directly back. If pyrexia is present it should be relieved by cool baths or short packs, with light covering, before the pack, above detailed, is given, otherwise the pyrexia is aggravated. Temperature should be taken twice day, and rise promptly met by ice to the head. Bowels should be carefully attended to to avoid autointoxication. Y Codding (Brit. Med. Jour., Nov. 13, '97).
The treatment of general paralysis, as in the treatment of all mental diseases, is preventive and moral, as well as medicinal.
Preventive: The avoidance of mar riage where a history of insanity is marked, the early recognition of the in cipient stages of the disease, and the avoidance of exciting causes, such as mental strain and excesses.
Moral: When the disease is recognized removal from home surroundings is of great importance, and a quiet out-door occupation the best suited to the bodily and mental health.
Medicinal: Bromides for excitement, and bromide combined with chloral if there is insomnia. In administering sedatives they should be combined with laxatives, and the combination of talis with bromides is most useful in relieving arterial pressure. Fletcher Beach (Clin. Jour., Apr. 6, '98).
Great care is necessary in feeding ad vanced cases to prevent bolting of large morsels of food, and consequent asphyxia from entrance of food into, or compres sion of, the air-passages. Attendants should be instructed how to remove masses of food from the oesophagus.
In the treatment of choking among the insane manipulating windpipe up ward from the outside will force food up into the throat so that it can be reached by the finger. R. M. Phelps (Jour. of Nervous and Mental Disease, Mar., '96).
In the paralytic attacks attention must be paid to regularly emptying the blad der and rectum.
Cleanliness and frequent changes of position in those patients who have be come bedfast from the advance of para lytic symptoms will tend to avert bed sores. When these occur, the recognized
surgical measures—namely: cleanliness, bathing with dilute alcohol, and removal of pressure—are indicated.
Finally, all measures tending to make the patient more comfortable, and less objectionable to his surroundings should be employed.
Catatonia.
Definition.—Catatonia is a form of in sanity characterized by depression, ex altation, stupor, confusion, and de mentia, usually occurring in regular cyclical sequence. There is also a spastic condition of the muscles and a tendency to rhythmical movements.
Symptoms and Course.—There is noth ing peculiar about the prodromic, or primary, melancholic stage. There are the usual symptoms of mental and phys ical depression. Self-accusation and de lusions of negation are not infrequent. Attempts at suicide are occasionally made. Refusal of food is frequent, but not usually persistent. Forcible feeding generally soon overcomes the reluctance to eat. On the whole, the melancholia does not appear to be so deep as in the ordinary cases of melancholia. It has a closer resemblance to the depressive phases of certain cases of general paresis.
In the maniacal stage there is restless ness with exaltation, varying with de pression, delusions of grandeur, or fits of rage, culminating in attacks upon by standers or in destructive tendencies.
Mutisni, or dumb stupor, is usually present as a stage in the course of the disease. It may persist for long periods, or may be transitory. There may be ab solute mutism or simply a refusal to answer questions. The patient sits or stands in one position, with head and eyes down, and apparently taking notice of nothing passing around him. Care ful observation will show, however, that he often gives quick and watchful glances about and that he is not so deeply sunk in stupor as he appears to be. At times the patients mutter to themselves in a low tone, suffering nothing in their vi cinity to distract them.
There is a generalized tension of the muscular system, in consequence of which the patient resists any change of position except such as he assumes volun tarily, or in which he has been placed. Thus, cataleptic states are not infrequent, although not so common as in hysterical conditions. The resistance to movement is probably always due to delusions of anxiety or fear, and is not uncommon in other mental disturbances, especially in melancholia and paranoia.