As to other forms of insanity, the question of treatment in a private home or in an asylum depends on the nature of the case and chance of recovery. When the mental disturbance has been caused by pressure of troubles or by ex cesses in drink, or immorality, and where lapse of time has not confirmed the disease, the best treatment consists in total change of circum stances. The business man must be freed from his business worries, the literary man from his books; or, if the insanity has been caused by loss of friends, disappointments, or failures, only change of circumstances, with abundant exter nal attractions in the shape of new acquaint ances, new occupations, new surroundings, is capable of diverting the mind from its morbid dwelling upon itself, and of driving from the memory old and sad associations. This may be effected, if the patient's means can afford it, by intrusting the person to some skilled attendant, under whose charge he may be permitted to travel, or by sending the person to sonic private home at the seaside or in the country kept by a properly qualified medical man.
Some cases manifestly must go to an asylum, such as cases of mania, cases where suicide is possible, or where violent outbursts might lead to murderous attacks, cases, in short, of mania, monomania, and melancholia of pronounced character.
It may be observed that cases of insanity affecting women, often young women, and asso ciated with sexual functions, cases with a strong element of hysteria, can never be properly treated by the patient's friends. They require
firm control, while the patient's friends invari ably find themselves unable to resist the thou sand-and-one whims and caprices which are so perplexing au element in such cases. Fre quently such cases, curable at first by proper control, become hopeless from the difficulty of proper management in the patient's own home, owing to the leniency and affectionate but unwise solicitude of friends.
The medicinal treatment of insanity, if any were adopted, would be determined by the view taken, in the particular case, as to the causes of the mental condition. General conditions of ill-health, diseased conditions of stomach, liver, kidneys, and in women affections of the genera tive organs, ought to receive appropriate treat ment. Indeed the very first thing to be done, in the case of any person showing signs of mental alienation, would be to have the person carefully and systematically examined by a physician in order that any contributing cause, connected with other organs than the brain, might be discovered and removed, if possible. But it should be noted that in cases of morbid depression remarkable results have been ob taMed by treatment with thyroid extract, and also by the galvanic, and the high-frequency, electric current (see Vol. II.. p. 468).