arsenious acid in its solid form in corresponding quantities, though it has appeared to me that the latter preparation is preferable.

Besides its own specific effect upon the brain, arsenic is an excellent tonic, and tends to prevent the excessive debility which sometimes accompanies the use of the bromides in large doses.

There are other medicines which are also of great service in the treatment of insanity, to obviate certain pre-existing, accompanying, or secondary conditions. Thus, emmenagogues are indispensable when there is a functional arrest of the menstrual flow; diuretics, when the kidneys are inactive; purgatives, when the bowels are constipated; and so on with other classes of remedial agents. The latter are very generally required at some time or other in nearly every case of mental derangement.

I

Schroeder van der Kolk' has pointed out the efficacy of aloetic purges in certain cases of mental derangement with depression, accompanied with accumulations in the colon. have frequently had occasion to be gratified with the success obtained by following the plan of treatment in question. I often give a grain of the watery extract of aloes in pill three times a day for a month, or even more if necessary, and again one pill at bedtime only, consisting of two grains of the watery extract of aloes, three of inspissated ox-gall, and from a quarter to half a grain of podophyllin. Under this plan of treatment I have repeatedly seen the most intense melancholia disappear in a few days. The treatment is also of service in all forms of insanity except the dementias and certain of the constitutional types, unless specially contraindicated.

Electricity. In the chapter on insanity in the earlier editions of my work on "Diseases of the Mind and Nervous System," "I stated that "electricity had not in my hands been productive of any marked benefit, though I have used it in all its various forms and methods." Since those lines were written, the great improvements which have been made in the construction of statical or Franklinic electrical machines have enabled us to employ statical or Franklinic electricity to

1 "Die Pathologie und Therapie des Geisteskranken auf anatomisch-physiologischer Grundläge," Braunsweig, 1863, p. 185 et seq.; also, translation by Dr. James T. Rudall, London, 1870, p. 134.

much better effect than was then possible. I now very generally employ it as a counter-irritant, capable of making a very rapid and decided impression on the system. In cases of mental derangement coming under the class of emotional insanities, and in primary and secondary dementia, it is of decided benefit. I place the patients on the insulated stool and draw long sparks from the whole length of the spine. They very generally express themselves as feeling better, and they are perfectly willing to have the operation repeated. Whether or not the action is anything more than that of a counter-irritant I do not pretend to know. The seance may be repeated daily, or every alternate day, for as long as benefit appears to be derived. No single application should last longer than ten minutes.

Dr. Clifford Allbutt' has called attention to the good results derivable from the use of the continuous or galvanic current in certain forms of insanity. In cases of acute primary dementia decided improvement took place; in mania and atonic melancholia-melancholia with stupor-the benefit was less decided; in chronic dementia and in some cases of melancholia, no effect was produced; while in hypochondriacal melancholia and, perhaps, in brain wasting, the result was unfavorable.

General bloodletting, once so much in vogue, can scarcely ever be required at the present day. There may be cases of acute mania in which it might be useful, and perhaps also certain instances of epileptic insanity, but certainly no others. On the other hand, local bloodletting by cups or leeches is often a useful measure, especially in those cases in which there are pain and heat in the head accompanied with insomnia and excitement. A half dozen or so of cups to the nape of the neck, or as many leeches to the temples, are often of marked and immediate advantage. A couple of leeches to the inside of the nostrils are remarkably efficacious in relieving cerebral hyperæmia and mitigating the violence of the physical and mental symptoms resulting from it.

In milder cases, dry cups may be applied to the nape of the neck and upper part of the spine every day with good results.

As to counter-irritants, such as blisters, croton oil, tar

"The Electric Treatment of the Insane," West Riding Lunatic Asylum Medical Reports, vol. ii, 1872, p. 203.

tarized antimony, and the actual cautery, cases every now and then appear in which they seem to be of service. I have, however, several times aggravated the mental and physical symptoms of insanity by their use. I suppose the most generally advantageous agent of the kind is the actual cautery very lightly applied to the nucha, but then the action in such a case can scarcely be called counter-irritant.

In a few cases of chronic intellectual mania I have derived slight benefit from the use of croton oil to the scalp, but it is scarcely worth while to go through so much to get so little.

The application of cold to the head or nape of the neck is useful in all cases of insanity belonging to the hyperæmic type, unless there is some special reason why it should not be employed. In mild cases it is sufficient to apply a lump of ice to the nape of the neck for two or three minutes just before going to bed. It generally aids effectually in producing sleep. In more severe cases the ice may be applied in a special ice-bag to the upper part of the spine and the occiput, and in others to the cortex.

In those cases due to cerebral anæmia embraced in the groups of melancholias and dementias, heat immediately applied is of great service, not only in quieting agitation when it exists, but in rousing the mind to something like its original degree of activity. I suppose one reason why good results have not more generally been derived from its employment is that it has not been used to a sufficiently high degree, and another is that it has not been continued long enough. The bags used for ice may be also used for hot water, and the application may be made in a manner like that employed for ice. Water heated up to 120° or even 130° is not generally of too elevated a temperature.