Volume 2

A dictionary of medicine : including general pathology, general therapeutics, hygiene, and the diseases of women and children / by various writers ; edited by Richard Quain ; assisted by Frederick Thomas Roberts and J. Mitchell Bruce ; with an American appendix by Samuel Treat Armstrong.

  • Quain, Richard, 1816-1898.
Date:
1895, ©1894
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of medicine : including general pathology, general therapeutics, hygiene, and the diseases of women and children / by various writers ; edited by Richard Quain ; assisted by Frederick Thomas Roberts and J. Mitchell Bruce ; with an American appendix by Samuel Treat Armstrong. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    25/1298 (page 13)
    enemata cannot easily be given in the vio- lent stages. It used to be the fashion to apply bhsters to the nape of the neck or calves. This is most unadvisable, for such parts may become very sore, owing to the restlessness of the patient, and thus deprive him of sleep. Neither is it necessary to cut aU the hair off, which in the case of a lady may be a very grievous matter. If very long, it may be shortened without being cut close to the head. II. Acute Mania.—Quite different from the unconscious raving of maniacal delirium is the conscious but violent excitement to which we give the name of acute mania. The former is a disorder dangerous to life, running a rapid course to death or amend- ment in a week or two. The latter may go on for weeks or months with little danger to hfe, but with excitement so troublesome that the sufferers require the restraint and discipline of an asylum. Though most insane, full of de- lusions and outrageous habits of every kind, they know what they are about, and are all the more mischievous in consequence. They can take every advantage of an opportunity, and know how to exasperate those about them. They generally eat weU, and sleep indifferently, but suflBiciently to support life; and their bodily health often remains wonder- folly good considering what they go through. They will destroy clothes, windows, bedding, and deny or justify aU they have done. The termination is not usually fatal, unless the health gives way through some other disease. The patients generally recover gradually, or sink into chronic mania or dementia. Prognosis.—The prognosis in cases of acute mania will depend upon circumstances. (1) The munber and duration of the attacks are important. In a first attack the pro- gnosis is favourable. If recent, we may have hopes, even if there have been preceding attacks of a like character. (2) If the patient is not of advanced age or of broken health, the prognosis is favourable. (3) If the mania consists of violent, turbulent conduct, rather than of fixed delusions, as is firequently the case, there is more hope. If the patient hears voices, the prognosis is bad. If there are delusions which impel him to refuse food, and he does so persistently and violently, it may be difficult to give sufficient nourish- ment, and he may smk from exhaustion, or become a chronic maniac. Treatment.—Patients suffering from this form of mania do not require, like the last, to be kept in one room; on the contrary, they should take plenty of exercise in the open air. This wiU promote sleep more than drugs, though we may give an occasional dose of chloral hydrate, or bromide of potas- sium, or the latter with chloral hydrate or with Indian hemp. Such medicines, however, should be given only to procure sleep, not to allay excitement; we may also try sulphonal or hyoscine. In many cases, however, sleep procured by drugs appears to prolong the attack, and, where there is no danger to life, it is better to omit them, and to let natural sleep come after the fatigue of exercise. Plenty of food is required, for the waste is great. Patients of this kind are not to be cured or even kept without discipline and moral treat- ment; and great tact, firmness, and patience are required for their management. They may be very dangerous and spiteful, will know how to provoke attendants, and how to take them unawares if off their guard. Moral treatment will be far more efficacious than drugs, but it can only be carried out in an asylum. Patients in this condition, if kept in private houses, must be rendered quiet by drugs ; but there is great fear lest by this method the disease, instead of being cured, may be converted into a chronic and in- curable mania. III. Mania.—A great variety of cases are grouped under this name, arising from vari- ous causes, but alike in the fact that they are marked by excitement rather than de- pression, by exaltation or v?rath, but not by gloom. Excitement and noisy and irrational conduct characterise some, but most patients present delusions coinciding with their temper and bodily condition when in health. Almost always this form of insanity is marked by delusions, if it lasts long enough; but some- times a short burst of excitement—a tran- sitory mania—may pass away without the stage of delusion being reached. The diagnosis of an ordinary case of mania is not difficult. The prognosis must depend on the cause ; the age of the patient; the character of the delusions, if there be any ; the occurrence or non-occurrence of previous attacks, and their history. Attacks of mania are frequently recmTcnt, and may be repeated again and again through a long life; recovery may take place on each occasion, or the dis- order may at last turn iato chronic mania or dementia. The period of excitement in many cases is followed by one of depression, and these may alternate with great regularity for twenty or thirty years ; and even when the patient is sunk into hopeless dementia the period of excitement may occiur as regularly as before the mental powers had given way. Treatment.—Of the treatment of these cases a great deal cannot be said. The ma jority will require the care and vigilance to be found in an asylum, at any rate during the excited stage. The intervening or rational period will often be prolonged ad- vantageously by removal from the asylum; and when this is the case there will be fre- quently foimd less reluctance to return to it when the necessity arises, and instances are not uncommon of patients even themselves, seeking its shelter. Or. F. Blandford.