Although she could not be prevailed on to take any solid food, she was coaxed at times during the first two days after her admission to take ½ gr. of morphia in a little brandy, but she was almost invariably sick after it; moreover, the excitement continued, and she could obtain no sleep.
On the third day the hypodermic injection of ½ gr. of morphia was commenced, and continued every four hours except during the middle of the night. On the fifth day she was calm, although incoherent, and had slept during the whole of the previous night, took her food well, and had lost nearly all the typhoidal symptoms. Moreover, the irritability of the stomach was completely allayed.
She has since then recovered without a bad symptom, and she is now convalescent.
This case showed in a very marked manner the advantage of the hypodermic injection of morphia over its administration by the mouth in cases, which so frequently occur, of acute mania with marked asthenia and irritability of the stomach, causing refusal of food.
Case II. Chronic Mania.—W. H., No. 950, aged 68, single, groom. Form of disease, chronic mania, characterised by frequent recurrent attacks of maniacal excitement.
History.—Strong hereditary taint of insanity. Nearly all his brothers and sisters are more or less insane or eccentric. Much given to habits of intemperance, but, although often strange and eccentric, was never sufficiently insane to warrant his being placed in a lunatic asylum until he was 64 years of age, when he was attacked with acute mania and removed to Hayward’s Heath.
Progress.—During the attack of mania under which he was suffering when admitted into the asylum he was treated with small doses (♏︎x) of tincture of digitalis every four hours. The symptoms lasted for nearly three months. He was then calm for many weeks. On the next outbreak of mania, equal parts of liq. opii were added to the digitalis, and with a beneficial effect, the attack not lasting so long.
He was thus treated for some two or three years. He generally suffered from three or four attacks in each year.
In April 1868 he had an unusually severe attack of excitement, combined with much noise and destruction of clothing. The usual medicines having no effect, he was treated with the subcutaneous injection of morphia (½ gr.) three or four times in the twenty-four hours, and with marked benefit.
On the recurrence of the next attack subcutaneous injection was had recourse to at once, and the period of excitement was reduced to little over a fortnight.