PARALYTICS sometimes, from voracity of feeding, liable to suffocation : such should be put on a spoon diet. Castration been known to cure a lunatic, but such instances cannot lead to any practical conclusion, and can only be viewed as cases of powerful revulsion. Recommends walls high enougji to prevent escape ; the possibility of escape being a constant source of excitement to patients who are contemplating the means of getting out. Bedsteads of refractory should be massive, to prevent patients from easily moving them about ; and on each side of them should be slides for straps and buckles to keep down the bedding and enforce quiet. Bedsteads of epileptics to have a strap and buckle, to secure one of their hands during the night : as they will not unfrequently turn on their faces and be smothered : these patients should be lodged on the ground floor, and should wear a padded cap or turban, to protect the head in their sudden falls. During the night the clock should not strike ; as the striking of the hours aggravates the sufferings 390 of the melancholy, who count them with miserable solicitude until the break of day.
It is most essential to discover, if possible, the nature of the mental impressions that may have developed the disease, as moral treatment is to be founded on this. Equally desirable to ascertain physical causes, if such exist. Whatever the cause, removal from their families essential, and to be placed under the immediate control and constant surveillance of a physician experienced in the treatment. No disease requires more constant attention in its early stages : vigilance of physician to be incessant in watching every favourable opportunity of breaking the links of the morbid catenation, to obtain the patient's confidence, overcome their resistance to curative means, and subject them to an appropriate regimen of mind and body. As essentially gregarious, isolation rarely requisite, and generally injurious. In a large establishment the following classification will be found suffcient : 1. The turbulent and noisy maniacs. 2. The dirty, indolent, and slovenly ; demented cases not idiotic. 3. The quiet, tractable, and cleanly. 4. The epileptic. 5. The paralytic. 6. The convalescent., and patients enjoying lucid intervals. In it much discrimination required from the medical attendant. To be abstracted from all morbid impressions and associations connected with their mental aberrations. Occupation of mind and body ; and constant exercise to be enforced. Gardening and various agricultural works particularly. Tradesmen and operatives to be employed in their former pursuits, and trades to be taught to those who were never brought, up to any profession. Discrimination as to amusements. Music, dancing, and various games, which may prove beneficial to many, but are frequently of too exciting a nature to be allowed-the same judgment requisite as to books. Aberrations and absurd conversation never to be the subjects of mirth or derision. Should be rarely contradicted, while we gradually draw them from their delusive train of thinking. Great versatility of conversation requisite, and to fly from one subject to another, until we find a gratifying topic foreign to their delusion. Only in religious monomania, opposition wisely managed may be resorted to. Except in cases of violent mania, restraint rarely necessary ; unless to prevent the mischievous idiot and maniac from destroying and breaking anything they can lay hold of. May be occasionally employed as a punishment, the dread of which keeps many lunatics in order. Reprobates attempts to do away with all restraint. However desirable, such a system can never prevail, without much danger to personal security, and a useless waste and dilapidation of property. Objects to strait waistcoats, as impeding respiration. Sleeves of canvass; by means of which the arms are kept loose alongside of the body, are preferable. Leather muffs useful for those always tearing or destroying their clothes or bedding. A restraint-chair advantageous : patients having the free use of their arms and hands, and only prevented from roving about, and committing mischief. Muffling (tying a cloth over patient's head and mouth not to be allowed. Fear aggravates lunacy, instead of acting as a proper discipline. The utmost kindness far preferable : but whilst kind, a, certain degree of firmness absolutely necessary. Should endeavour not to promise what we cannot or it is improper to comply with, at the same time avoiding irritating by a positive refusal ; their demands should be eluded with address. Restraints should be enforced by the keeper after having been ordered or allowed by the superintendent. 391 Keepers to be held in some awe, but the physician should rule by gentle means, and a patient should be taken out of restraint invariably by the superintendent. Politeness of manner essential, as they deeply feel such things ; often entertain a high sense of honour and delicacy, which should be always flattered: has met with patients whom restraint could not keep in order, but who became manageable, after pledging themselves to remain quiet. The morose will frequently feel much gratified by such marks of confidence, and will boast of it. Physician should regulate visits of strangers, as sometimes hurtful and sometimes exciting. Every safe amusement to be allowed. Restraints should be resorted to with calmness and steadiness : an expression of impatience and anger will only aggravate patient's violence ; a suffcient force to show that resistance is in vain. Physician should have supreme power. He thinks that patients whom the physician considers proper subjects should attend divine worship on Sunday ; considering it as a useful occupation of the mind on an unoccupied day, though unprofitable in a religious sense. Judgment necessary with respect to the sermon, and discrimination with regard to the patients ; many of those most ardently- wishing to attend being most decidedly unfit. If the patient has travelled and obtained some knowledge of a foreign language, conversation in this language, and recalling to their memories scenes in other lands, will frequently be valuable in breaking down a morbid train of thought. Most punctual regularity in the duties of an asylum necessary, as it reconciles patients to being there.
Physical Treatment.-First indication is to meet symptoms of local congestion, especially when a determination of blood is evident in the encephalon. Bleeding, at least general bloodletting, scarcely ever necessary. Collapse from depletion frequently not only alarming, but fatal. Excitement so transient that the pulse is not a suffcient guide. However, when plethoric, and an evident increased impetus in the cerebral vessels, moderate bloodletting. Leeching or cupping more advisable ; from the temples and back of neck : leeches applied repeatedly, and in small numbers, and aided by warm fomentations. When subject to epistaxis, and seeming to suffer from its suppression, leeches to temples and nostrils. When catamenia irregular, leeches to labia of essential service : to tie placed close to each other, and in great numbers. In mania with hysteria, this of great advantage. The artificial discharge to be resorted to when the catamenia are expected ; after the application, the warm bath, with cold to head. In suppressed hemorrhoids, leeches to the margin of the anus repeatedly applied. When cerebral determination is evident, care, before bleeding, to ascertain the state of the circulation. Carotid artery may be found to pulsate with apparent strength and fulness ; but if easily compressible, and the radial artery is feeble, general bloodletting inadmissible. When pressure on the jugular vein produces a sense of heaviness in the head with pain, but these symptoms cease the moment the pressure is suspended, bleeding is dangerous. When the extremities are cold, The skin clammy, the tongue furred, cold and tremulous, with tremour of the limbs and rigour, notwithstanding the symptoms of cerebral congestion, general bloodletting is dangerous. In puerperal madness, general bloodletting not advisable. Mania not unfrequently assumes the character of dementia and fatuity after imprudent bleeding. Pinel says, " Bleeding is an evacuation so rarely employed in the Salpétrière, that it may be considered an epoch in the treatment. 392 How many patients also we see cured, without having been bled, and how many have been bled and remained incurable !" When there is much excitement and increased action of the heart and arteries, it will be found that aconite, in fractional does, will procure a state of calmness more rapidly than detraction of blood : the endemic inspersion should always be aided by counter-irritation in the intestinal tube. Great excitement frequently arises from the want of sleep : here the salts of morphia will frequently procure rest ; endermic method preferable, producing a slight vesication on the back of the neck, sprinkled with acetate of morphia. When considerable determination to the brain, cold applications to the bead, while a slight pressure is made upon the carotid arteries, will often relieve the excitement. Arterial pressure a powerful agent in brainular excitement, which is mostly transient.
Emetics useful when there is a torpid state of the system, more especially in cases of melancholia connected with dyspeptic affections Haslam confines their use to such cases. Best mode of exhibition a solution of tartar emetic in water, in small does, until vomiting. Where any cerebral excitement, with predisposition to paralysis, emetics of a doubtful efficacy, and have not unfrequently been followed by fatal effects. Although tartar emetic as an emetic may be hazardous in many instances, as a nauseating medicine, it is often highly- beneficial. A solution of about 1/4 gr., or even 1/16 gr., in a quart of water, two ounces of which to be given from time to time in the course of twenty-four hours, most efficient, especially in mania. Calmness by exhaustion from emetics to be viewed with caution, as not unfrequently the precursor of cerebral congestion and effusion.
Drastic purgatives require much caution, as they will often increase the excitement which they are exhibited to relieve. Are useful in epileptic cases, and in cases of sudden determination to the head of blood ; when constipation has been obstinate, aloetics the most efficacious. The compound colocynth pill is also a valuable medicine. Croton oil is to be used with reserve, as he has observed frequently increased cerebral excitement, with stupor after it. Compound powder of jalap also a useful purgative. As purgatives are frequently followed by a state of o~stipation, it is necessary to keep up a steady action on the intestinal tube, and here laxatives are indicated; bowels may be kept open by- a solution of creafn of tartar ; when this is insufficient, a solution of sulphate of magnesia, One Ounce. in sixteen ounces of infusion of roses, to which is added 1/16 gr. of tartar emetic, in doses of two ounces four times a day, a valuable adjunct. Preparations of mercury, more especially calomel, should be used with caution ; they act upon the nervous system, and frequently increase the despondency of the melancholic. Laxative injections should be frequently used ; the best form, perhaps, simply soap and water ; turpentine glysters sometimes prescribed, but generally produce great excitement. When violent drastics have failed, laxative articles of diet have procured the desired effect, as stewed prunes with senna leaves. In the south of France has seen the tomato, or love-apple, employed with singular good effect : an extract of the tomato a most valuable medicine. In dyspeptic and melancholy cases, the compound rhubarb pill, given repeatedly and in small doses, will be found most effectual ; in these cases has found castor oil injurious, as it will often bring on a troublesome, if riot fatal diarrhoea. Elaterium should be prescribed with great caution, as it will often bring on an incurable diarrhoea, especially 393 in cases of dementia and melancholy. In hysteric females, a suppository of soap and aloes, with one drop of croton oil incorporated with it, has relieved the most obstinate constipation. Bowels of the insane more prone to diarrhoea than constipation, and here reprobates constant purging. Drastics only when milder medicines have failed, when the tongue is foul, yellow on the edge, and brown in the centre. Air and exercise with laxatives to obviate costiveness ; and it will generally be found that the bowels will become regular as the cerebral excitement decreases.
Exhibition of opium requires much discrimination. Injurious in cases of cerebral congestion and great vascular action, as it will often occasion phrenitis. Never to be given if premonitory epileptic or paralytic symptoms. When no great excitement, and the pulse is small and weak, not only with safety, but evident beneficial results. To the sleepless internally, will rarely produce repose ; more effectual oftentimes endermically. Acetate or muriate of morphia on the blistered surface of the neck or epigastric region. Battley's sedative solution best mode internally. When indicated, should be given in large doses, gradually tried, and at intervals. When, after its use, patient awakes in a state of increased excitement, it should be given up.
Hyoscyamus, belladonna, and conium, have produced rest, when opium has utterly failed : of these, has found belladonna most beneficial. Extract of belladonna externally in the endermic method, often very effectual in reducing excitement, more especially when applied to the epigastric region. Extract of lettuce of no use in his experience. When calomel or blue pill is given, it will be found beneficial to combine it with hyoscyamus.
On digitalis can place little reliance ; confinement in a recumbent posture necessary to assist its action, as he has rarely found it depressing the circulation when the patient was allowed to take exercise. Has noticed apparent favourable results when combined with camphor ; but difficult to say which calmed. Large doses inadmissible, as they produce dizziness, vertigo, and increased cerebral determination.
Camphor most valuable, but requires discrimination ; not advisable when cerebral excitement, with a hot, dry skin, full pulse, and wild countenance ; but when much uneasiness and restlessness, with a low, weak pulse, and the skin is cold and clammy, will be found most beneficial combined with liquor ammonite acetatæ. Has often prescribed it with great advantage when symptoms of low nervous fever; however, it has been overrated.
Never observed any decided advantage from musk or asafœtida. But where connected with hysteria, ammoniacal tincture of valerian valuable. Blisters often beneficial, especially in mania and melancholy : in the former as a revulsive ; in the latter, their irritation diverts the mind from morbid train of thought. Blisters to head highly injurious, increasing excitement, and preventing application of cold, one of the most powerful auxiliaries. On the approach of an epileptic fit, a blister to the back of the neck will often shorten the duration of an attack, and render it less violent. The actual cautery has been known to correct the morbid aberrations of the monomaniac affected with demonomania, the pain excited drawing their attention from their melancholy apprehensions. An iron of a globular form, at a white heat, should be momentarily applied to the mastoid processes. Has been known to cure patients who fancied 394 that they heard various menacing voices denouncing perdition and celestial wrath. Setons of little avail, except in cases where paralysis is apprehended and vision impaired. Most advisable in the neck. A steady counter-irritation kept up on the back of the neck by the tartar emetic ointment, or other stimulating applications, of much benefit in recent cases, more especially when a maniacal type has been assumed. Counterirritants of great service when any eruption has disappeared ;indeed, they are beneficial in all cases of metastasis. When a tendency to coma and lethargy, mustard cataplasms to the lower extremities of great service ; but care sinapisms are not left on too long, as there is a tendency to sloughing in most of these cases. Blisters of essential service in puerperal madness. Says the lotion employed by St. John Long has often proved most effective in mania (this we believe was composed principally of ol. tereb. and some mineral acid.-G.). One of the most powerful agents to equalize the circulation is the warm bath ; but should be aided by the application of cold or ice to the shaved head, whilst the body is immersed in the bath. The douche, with a rose-bib, a valuable method of directing a broken stream of water to the head. The shower bath, or a spout. douche, should be used with much caution. When there is great cerebral determination, their employment is followed by a reaction, which is not unfrequently alarming, and increases the excitement which it was intended to check. An imprudent afl'usion has been followed by paralysis. Friction of the lower extremities, while the patient is in the warm bath, is often very beneficial, especially in hysteric females. In general, should remain in the warm bath for about half an hour, but care lest the degree of heat such as to occasion vascular excitement. Best method of applying cold water or pounded ice to the head, a double linen nightcap dipped in cold water, or between the folds of which the ice is to be introduced ;found it practised at Hanwell when appointed superintendent. The wet cap should be removed every ten minutes, the abstraction of heat being amazingly rapid. It will be found that some points of the head are hotter than others, and when the douche is used, the stream, either from the single spout or through the rose-bib, should be directed to those parts. Should always be recollected that the douche occasions severe pain, and that the terror of the patient arises from the agony it inflicts. Esquirol describes it as though a column of ice was broken on the parts, being more supportable on the occiput than before. His head seemed benumbed an hour after the application. When any point on head feels hotter than others, care to ascertain if no circumscribed puffiness of the integuments, or that they are not loose or wrinkled: here probably the membranes of the brain are inflamed, and the douche should be suspended. Cold water or ice may, however, be safely applied, and a blister to the back of the neck is also admissible. Irritation of the scalp sympathizes with the membranes of the encephalon, and requires attention. In profuse leucorrhoea, the rose-bib douche on the lumbar region most beneficial. In uterine excitement, and when complicated with mania, cold water and ice to pudenda and inner and upper part. of thighs advantageous ; enemata of cold water in large quantity also useful. These cases, frequently attended with a papular, and sometimes a vesicular eruption about the labiæ, with more or less excoriation, and the secretion of a most unpleasant fetor ; best application an infusion of green tea, which should also be injected in the vagina. In elderly and married females, a pessary of great advantage in calming 395 uterine excitement, but in young married females leeches produce singttlar good effect. In many of these cases, young females more especially (when the catamenia are not regular), express a desire for pressure pressure upon the pubes by the clinched hand of the nurses, often procures immediate relief, and may be very violent. In furor uterinus, has directed an opiated suppository with evident success. Plunge bath a dangerous method of treatment, and should be used with great circumspection, if not altogether abandoned. Sudden terror may be attended with benefit, but too dangerous an experiment. Esquirol ridicules the bath of surprise, and reprobates rotatory motion. Baths, shower baths, douches, should never be confided to the servants, but used in the presence and under the immediate direction of the physician : never after a meal. The shower bath should never be used as a punishment, it being a powerful agent, and either useful or injurious medicinally. Cold bath rarely beneficial, although he has used it with apparent advantage in patients debilitated by masturbation. In these cases a shower bath on the lumbar region also of service. In most patients injurious, as proved by their shivering on coming out. Rotary motion he thinks of little advantage, and injurious in many cases, particularly if present cerebral congestion : small doses of ant, tart. will diminish vascular excitement better : and terror he is against.
Diarrhoea one of the most frequent and fatal complications. Generally makes its appearance in the weak and debilitated, and not unfrequently after drastic purges ; from improper and scanty diet of a liquid form oftentimes. When pain and tenesmus, small doses of castor oil repeatedly given, with a few drops of the tincture of opium, beneficial, and starch glysters, with opium in small doses, tend to check the tenesmus. A suppository of soap and opium has succeeded when other means had failed. When no pain, and the stools are watery, tincture of rhubarb with some astringent, as tincture of kino and catechu, should be exhibited, with the chalk mixture and the pulv. hydrargyri c. creta. Has found a strong decoction of the rind of the pomegranate very beneficial. Pinel considers the decoction of the rubus dumetorum a valuable remedy. A dose of Dover's powder given every night is also advisable. Dysentery not an unfrequent complication : frequently from irregularity in diet sometimes attended with nausea and vomiting, often of a stercoraceous character. Here has found a blister to the stomach of great advantage, acetate or muriate of morphia being sprinkled on the vesicated surface ; small doses of creosote have also relieved the urgency of the symptoms. Both in diarrhoea and dysentery, demulcent drink and rice water should be freely given. Has found barley water to increase the disposition to flatulency. Profuse perspirations during the night. not uncommon, and in general symptomatic of hectic fever. Has found phosphoric acid, in an infusion of roses, more efectual than the sulphuric. Fractional doses of the muriate of gold highly beneficial in checking night-sweats. Suppression and retention of urine frequently occur, and although in the sane there is here excruciating pain, yet lunatics have died without the malady being observed during life. Of great importance, therefore, to ascertain whether the urine is regularly voided. In some cases of ischuria and dysuria, drops of urine will dribble in the bed, and wet the bedding ; leading to the idea that the discharge of urine is free, where there is fatal retention : prudent, therefore, in all such cases, to examine the state of the bladder. 396
In puerperal madness, the lancet should be used with the utmost caution, if its use is indeed ever indicated. If cerebral connestion, leeches more effectual and safe. Blisters to nape of neck ; afterwards sprinkled with acetate, or muriate of morphia. After the bowels have been freely moved, opiates of the greatest advantage. Bartley's sedative, or the salts of morphia, the best preparation, and the latter should be introduced by the endermic method ; to these hyoscyanrus is a valuable addition ; and when vascular excitement is high, small doses of aconite also advisable ; mustard sinapisms at the same time to the legs and feet, and inner part of the thigh. When there has been a suppression of the lochia, a slight pressure upon the crural artery, by a turniquet, might prove beneficial. Emetics of service, but should be exhibited with much caution, especially when the face is pale, the skin cold and clammy, a quick and weak pulse, with great mental depression. Purgatives in general most useful; amongst these, castor oil, followed by repeated small doses of calomel and rhubarb, often most beneficial. Hyoscyamus, with camphor and belladonna, valuable. The hyoscyamus may be given in extract or tincture, a drachm of the latter at night. Chief indications, to keep down excitement, and overcome the characteristic constant restlessness. Ammoniacal tincture of valerian of great service when the excitement has somewhat abated. A light but nutritious diet absolutely necessary ; good broth at short intervals, with Port wine and water, or claret, and, as convalescence progresses, ale and porter may be allowed, with animal food of easy digestion. Removal to an asylum rarely necessary, and generally imprudent, but should be carefully separated from their relatives, and kept from all sources of irritation. However, when, in her delirium, patient calls for her infant, and fancies it has been murdered or stolen, it may be brought to her. Must endeavour to recall the secretion of milk, and draw it off frequently. During convalescence, tonics and stimulants necessary, but. we must be guarded in exhibiting bitters, such as gentian, quassia, which very frequently bring on severe headaches.
From the foregoing observations, we may resume the medical treatment of lunacy in the following order: 1. To keep down excitement by gentle antiphlogistic means, that are not likely to debilitate the patient; 2. To keep the bowels regularly open; 3. To diminish cerebral excitement by the local abstraction of heat and topical bleeding ; 4. To produce revulsion by counter-irritants ; 5. To procure rest by such narcotics and sedatives as may appear best suited to the case ; 6. To endeavour to equalize the circulation by warm baths, and the occasional application of cold ; 7. To combine a proper diet with the therapeutic treatment. Exhaustion of excitement and agitation necessitates a liberal diet, abundant in quantity and of a nutritious quality. In' general they require more nourishment than a healthy person. Eating little and often preferable to three meals, and it lvould be desirable that they were fed every three hours. Dietary should consist of half a pound of meat (without bone) four times in the week, with a pound of bread every day, to which should be added a pound of potatoes. Soup, unless thickened with barley and rice, an improper article, and to fluid aliments diarrhoea is mainly to be attributed. On days when meat is not issued, cheese, and dumplings also, a nourishing article of food, when bodily health is good. Meat, beef and mutton ; pork in any form improper. Veal and lamb also objectionable. Good table beer and draught porter should be 397 allowed at dinner. Gruel may be a good breakfast and supper in general, but as it disagrees in many particular cases, it should not constitute the breakfast of every patient. Bread and cheese will frequently be found preferable. Tea rarely to melancholy and monomaniac patients. Coffee in many cases also objectionable. Wine and spirits rarely required, excepttn great debility and old age. Great care that they consume enough salt, and as they will frequently not use it of their own accord, it should be sprinkled on their food. Stimulating condiments also necessary, as pepper and mustard, and a sufficient quantity of Cayenne pepper should be invariably put in their soup and served out with vegetables. Vegetables of a flatulent nature should be rarely served, such as cabbage and turnips; potatoes, carrots, and parsnips preferable. Fruit of a wholesome description should be freely given, and in winter stewed prunes and baked apples, being agreeable and laxative. Except where indicated, milk not a healthy article ; when cold it frequently produces diarrhcea, and when hot will often cause constipation. Diet should vary according to their distribution and classification. Patients on a particular diet should be kept together, to prevent jealousy and irritation amongst them. Objects to a general scale, as being unsuitable to many. When they obstinately refuse food, and seem determined to destroy themselves by starvation, force sometimes necessary, but coercion rarely required. When practised, should be under the immediate eye of the medical attendant. Various instruments been invented, but the best, perhaps, the screw-gag: the spouting-boat should not be employed. When the patient obstinately clinches the teeth, the nose may be pinched, or some snuff given : the jaw being opened when sneezing takes place, a spoon or gag is introduced ; where one or more of the grinder teeth are wanting, a curved tube may be introduced through the aperture, through which liquid food can be poured. Quiet and orderly should take their meals in a day room. Has seen patients who have obstinately refused the diet of an asylum eat with voraciousness toasted cheese or a red herring. H. D. would not eat anything for several days; at last said he would like a beefsteak with mushrooms: immediately prepared, and afterwards he regularly took the usual food of the establishment. Refusal of meat often owing to patient's being a Catholic, and to consequent religious delusions and fears; in such instances interference of a priest often induces eating. In some cases when the food is rejected by spitting it out, the stomach-pump may be used with advantage. Knives and forks as at Hanwell and other asylums ; knife blunt and prongs of fork short. Ivory and bone knives show distrust. When mastication or deglutition is difficult, food should be minced up, rolled into forced meat balls. Very requisite with idiotic and paralytics, who must be fed with a spoon. Keeper should feed such, and not fellow-patients. Rich should be separated from poor, as better diet and dress excite jealousy and irritation. Snuff and tobacco preferable as a reward for labour to any alimentary recompense, as less calculated to excite jealousy. If a better diet to labourers, should receive it separate from others who cannot work. Engagements to be religiously fulfilled.
DR. JOHN WEBSTER observes, that when dangerous to others, or likely to inflict injury upon himself, restraint may become necessary. 398
DR. JACOBI recommends that convalescents should not be removed from the class in which they were originally placed. Speaks of masks for those who gnaw their clothes. Music promises to be a powerful means: hand-organ best. Strait waistcoast useful in the hands of the judicious. For calming and strengthening the mental powers, reading, writing, arithmetic, geography, philosophy, and the high mathematics. Should be seven classes : 1st. The raving and violent. 2d. The noisy. 3d. The dirty. 4th. The hurtful from some propensity. 5th. The melancholy and suicidal. 6th. The quiet. 7th. The convalescent.
In the Utica report for 1841, Dr. Bell says: On admission, we make their friends tell the patient in our presence where he is, that he was brought here as a lunatic, that his stay will depend on the physician's judgment of his condition, and that his privileges will necessarily depend on his conduct and self-control. Placed at first in the intermediate gallery between the highest and lowest class of patients. Mr. Read says, that in St. 'Vincent's Hospital, at Baltimore, they prefer linen mittens to those made of leather, as less liable to stretch. Usual mode of restraining the violent, a sort of sleeve, attached to a frock body, made to lace up behind like a lady's corset. Sleeves some inches longer than the arm, closed at the end, drawn around the body, and fastened behind. Festoons in front to support the arms, as in slings. To hide it, a female dress may be thrown over all. No confidence in pledges. Where the patient. is too sullen for labour, some slight bodily annoyance, as a blister, cupping, or a mild cathartic, to engage their attention. If anything is prohibited by way of censure, soon after anticipate their wishes by supplying some gratification, so as to gain their like. Carry them shopping and to mass.
Dr. Brigham says, not unfrequently the timely remarks of the chaplain have given hope and encouragement to the melancholy, and aided us in their treatment.
Dr. McDonald recommends a reception room or room for observation, so as to view them when they think themselves unobserved. Teaching them.
DR. KIRKBRIDE says, in his report for 1841, that in the institution over which he presides, the attendants call for medicine at physician's office half an hour before breakfast, i.e., 6 A.M.; find it in cups labelled with patient's name : at noon, i.e., half an hour before dinner, and at 7½ P.M., i.e., an hour and a half after tea. If patient refuses it, medical officer is informed. General health being restored, many have recovered promptly ; others have required a very chronic course of treatment, and in some, we have seen no indications of giving medicines of any kind (mostly recent cases here). Each takes the warm bath at least once a week. One of the gardeners, before he commenced outdoor work, rarely more than a month without a period of excitement, mischievous, and requiring seclusion ; no occurrence this summer. Cared little for the kind of work, and whatever object appeared most likely to excite a new train of thought, has received our approbation. Reading 399 the Scriptures on the Sabbath of forty minutes' continuance. Mittens of canvass or leather; soft bands about ankles in rare cases. Two patients have been kept on their beds with much advantage, by an apparatus of leather.