MANIA.
The treatment of the different forms of mental disease, as mentioned under Insanity, can only he carried out in special institutions possessing the numerous requirements which are now considered necessary for the successful management of the insane. This remark applies also to ordinary acute mania, but it will be to briefly refer to the management of acute delirious mania, a serious and often fatal disease coming on with surprising suddenness. and requiring treatment before the necessary removal to an appropriate asylum can be determined upon or carried out.
The first point in the management of such cases after isolation from friends and relatives is to look closely to the feeding, and as the patient almost always refuses food, forced feeding should be commenced without delay, and steadily insisted upon in spite of all obstacles every third or fourth hour during the day and night. Strong broths, beef essences, milk and eggs, and a small quantity of stimulant in most instances should be introduced into the stomach by means of the India-rubber tube. Nutrient enemata should be also given.
Sleep and quiet must be secured, and Sulphonal, Trional, Paraldehyde, Bromide of Potassium, Hyoscine or Veronal is called for. Hydrobromide
of Hyoscine subcutaneously in doses of gr. every hour for three doses is relied upon by Savage in severe cases. Opium is to be avoided, unless other hypnotics fail. Chloral is the favourite drug, and with many specialists the treatment of this affection is summed up in the words " feeding and chloral." Peterson advocates the use of the hot wet pack as the best sedative in this condition, and the patient (who often falls asleep) may be kept in it for hours.
W. Graham recommends the warm bath (96' to 98') in acute mania, the patient being immersed for several hours at a time, during which food be administered. There can hardly he a doubt about the advisability of removing this class of patient to a properly equipped asylum as soon as arrangements for his admission and conveyance can be completed. The danger of sending such cases on a sea-voyage as soon as the first outbreak of delirium or impulsive excitement has subsided is obvious, though in ordinary acute hysterical mania in its later stages a change of scene under the skilful control and close attendance of a trained nurse is often advan tageous.