used in a very cautious manner, and that the bad effects attributed to it arise from the large doses in which it is often given, it will naturally be inferred that I would recommend its use only in moderate doses of fifteen to twenty grains, repeated if required at intervals of two hours, until the desired effect is produced.

The combination of chloral hydrate and bromide of potassium is often found beneficial in cases of great restlessness and fretfulness, and when a more permanent effect is desired a small amount of morphia may be added to the mixture, or given with either separately, thus prolonging the sedative influence. As a matter of practical experience, it may be stated that it is safest and best not to adhere to one preparation of any class of medicine for a length of time, but to change it for another. If one preparation of opium has been used for a time, substitute another, or if one preparation of iron has been given, it would be found most advantageous to change it for another after a few weeks' use, and not continue the use of any one form more than a few weeks at a time.

There are certain cases of high maniacal excitement, particularly in asthenic cases, where none of the usual anodynes appear to do any good, and where sleep can be readily induced and kept up for several hours by the administration of half an ounce or an ounce of pure old rye whiskey, according to the severity of the excitement, combined occasionally with a small dose of morphia. It must, however, be remembered that the effect of such doses must be carefully watched, and the whiskey withdrawn as soon as it can possibly be done, so as not to induce the habit of drinking. It is always best to give whiskey mixed with some carminative, so as to hide the taste and not allow the patient to know what he is taking. In conjunction with the medical means, strict attention must be given to the regular and systematic administration of food, so as to support the strength and prevent exhaustion from the excitement.

In cases of exhaustive mania, the safest and best treatment, after the preliminary course recommended, will be the exhibition of half ounce or ounce doses, according to the violence of the symptoms, of pure old rye whiskey, with milk and the most nutritious diet which can be given, and the confinement of the patient to the horizontal position. I have found it necessary in some such cases to give an ounce of whiskey every two hours for nearly a day, thus reducing the pulse from 120 to 80, and bringing on quiet, refreshing sleep, and ultimate restoration.

In epileptic mania, the only medicine which seems to control the high nervous excitement is bromide of potassium, regularly and perseveringly given in small doses from day to day, and from month

to month, with special care to prevent constipation, and, if possible, a milk diet morning and evening and a small quantity of meat with bread and vegetables for dinner. The danger in epileptic mania arises after the convulsion, or when unusual irritability takes the place of the convulsion; but any one who will carefully watch the case can generally ascertain by certain changes of manner and conduct, or certain methods of expression peculiar to the patient, when the excitement is coming on; and when these appearances are observed, renewed vigilance must be exercised to prevent any violent demonstration. There is such an infinite diversity in the appearances and conduct that no rule can be laid down for particular guidance, but the physician must study each case by itself and learn how to meet the indications presented.

The most troublesome symptom in melancholia is sleeplessness, and to remove this will require all the tact and ability of the physician in the administration of the different form of narcotics with at the same time such a course of tonic treatment as will bring up the system to the normal standard. The most annoying and perplexing symptom in this form of disease is the disposition to suicide, and the only resource is unceasing watchfulness at all times and under all circumstances. Such cases can never be trusted for a single moment where the propensity is active, and are most to be suspected when they protest most positively that they have given up all idea of such a thing and ask to be left alone; and many cases succeed in their plans by some plausible pretext by which they throw the attendant entirely off his guard.

Cases of monomania have generally assumed such a character when the family are willing to consult the physician that medical treatment cannot be attempted with any hope of success, and the physician's only duty then is to sign the certificates required by law to secure admission to a hospital.

The treatment of puerperal mania in the earliest stages is so clearly marked out by the symptoms presented that every physician will know what is required in the case, and it is only when the disease has assumed a violent form, or has become intractable and troublesome to the family, that the necessity arises for removing the patient from the family to the care of a hospital.

In acute dementia the difficulty of administering food and medicine is so great, and the care in other respects so trying and wearing, that the friends soon see the necessity of placing the patient in some hospital for the insane.

It is a duty incumbent on the physician to impress upon the minds of every family, in which he may be called to treat an insane

person, the fact that mental disorders will, as a rule, require considerable time in the treatment before any decided improvement will be noticed; that very few persons really regain their full mental integrity in less than six months; and that in melancholy the course of treatment will be quite prolonged, generally from nine months to a year and more.

Some attacks of acute mania will pass off in a few weeks, but these are very exceptional cases, and it is always to be apprehended where the attack passes off suddenly that another outbreak of greater violence and longer continuance will follow it a few weeks.

Every physician should impress on those who have occasion to place a member of the family in a hospital for the insane, that, having shown confidence in the physician of the hospital by placing the patient under his care, they should be willing to continue that confidence, and be guided by his judgment as to the proper time at which the patient may be removed. Never encourage the family to be trying experiments to ascertain whether a change of scene might not be of benefit and hasten restoration, for in a mind weakened by disease the most careful and cautious management will be required to prevent the injurious effects of certain scenes and associations. Every physician of a hospital for the insane, who has had many years' experience, can count scores of cases where irreparable injury has been done, and the disorder rendered chronic and incurable, by these efforts to try change of scene and associations during the convalescent period. The patient himself will urge the change in the very strongest manner, and make a most pitiful appeal to the friends by persuasion, threats, promises, and complaints, and the mode in which this is done ought to convince the friends that the man has not regained his healthy mental action, and at this critical juncture, the calm and dispassionate opinion of the physician ought to be more potent in enabling them to reach a correct conclusion than the passionate appeals of one just recovering from a serious disorder, and whose brain and nervous system have not yet acquired their full healthy operation.

The question of the removal of a patient from home and friends to a hospital and the care of strangers is surrounded with so many considerations involving the welfare and happiness of the patient and the family, that it is almost impossible to lay down any rules to which many exceptions may not be taken; but when the necessity does arise, and that period is generally much earlier than the friends are willing to act, the sooner the decision is reached and carried into effect the better for the patient and the family. It is always far better to be frank and honest with a patient when it has been decided

to send him to a hospital, and tell him the plain truth of what has been thought best to be done, and not deceive him by a variety of tales which he will soon find to be false, and which will rankle in his mind, cause ill feeling, and often bitter dislike to those who deceived him, and interfere in many cases with successful treatment and restoration, for it intensifies the distrust already existing in his mind, and renders it extremely difficult for the officers of the hospital to disabuse his mind and acquire his confidence. It is difficult under the most favorable circumstances to acquire the confidence of the insane, and when they have been deceived in being brought to the hospital, their distrust is intensified, and they consider all in the hospital in league against them, and the difficulty of treatment is greatly enhanced. The physician should also impress upon the minds of the family the very great importance of early treatment, and the continuance of that treatment in the hospital until restoration is fully effected, and the physician of the hospital can recommend the removal with safety. At the same time he should endeavor to disabuse their minds of the prejudices entertained by so many against hospitals, and impress upon their mind as strongly as possible the idea that the treatment in all well-regulated hospitals at the present day is conducted on the principles of kindness, forbearance, good-will, and charity in its noblest and most expansive expression.

THE ADDRESS IN HYGIENE.

BY BENJAMIN LEE, A.M., M.D.,

OF PHILADELPHIA.

IT has been greatly the fashion during the past ten years, both in England and in this country, to stigmatize the heir apparent to the British throne, the wearer of the prince's feather, as, to say the least, an altogether useless appendage to the national government. From such an opinion I humbly beg leave to dissent. I desire to express my conviction, that H. R. H. the Prince of Wales stands first among living men, not alone in his own noble realm, but in the civilized world, as a benefactor to humanity. Not as a mighty hunter, bearding the monarch of Bengalese forests in his native. jungle from the safe elevation of a second story, or braving the peril of that deadly viper of Ceylon, the tic prolonga; not as a munificent Telemachus on his travels, bestowing largesses with princely hand on those who can well afford to return them with interest; not even as a philanthropist acting as chairman at a charity-dinner, would I urge his claim to this proud-this most enviable distinction. I would rather ask you for a moment to contemplate him as a fever-stricken patient on his uneasy couch at Sandringham. I would call your attention to the hushed and mournful group outside the gates of the lodge, awaiting with such intense eagerness the posting of the frequent bulletin announcing that this life, which has suddenly become so dear to the nation that all its past errors are forgotten, is still spared. I would ask you to remember that this anxious assemblage is but a representation in miniature of the whole English people, hanging, by towns, by cities and by hamlets, on the hourly revelations of the telegraph: nay, that even distant continents, and, above all, this English-born and English-speaking continent of ours, throb hour by hour to the electric pulse that beats almost in unison with that of the royal sufferer— and then, when the long suspense is over, and cautious science dares to give the glad prophetic word of hope, to follow with me the steps of those sagacious physicians, who, believing their duty but