The next attack passed off in an equally satisfactory manner. In the January of the present year an attack of recurrent mania being evidently imminent, the old treatment of digitalis and opium was tried for fully a fortnight, but without benefit. On February 8th ½ gr. of morphia was injected, and the injection continued every six hours, and on February 10th (to quote from the case-book) he was decidedly improved and free from excitement and noise.
Not only, therefore, is the duration of the attack of recurrent mania diminished in this case, but during the attack the excitement is much less intense under the hypodermic method of treatment.
Case III. Melancholia.—M. T., No. 1,397, female, aged 57, married, domestic servant. Form of disease, acute recurrent melancholia.
History.—No hereditary taint of insanity. Has been insane and confined in asylums three or four times. She is temperate in her habits, and her attacks of insanity appear to have followed on most occasions the puerperal condition, but the present illness is stated to be due to family troubles.
Progress.—On admission she was suffering from the most acute type of melancholia, combined with insomnia, refusal of food, and a strong suicidal tendency. Moreover she was in a poor physical condition, having lost much in weight, and being thin and anæmic.
In the first place she was treated with stimulants, sedatives, and a nourishing diet, but she remained from May 14th, the day of admission, until May 20th, without any improvement, and was becoming so reduced, from want of sleep and constant worry, that her life was despaired of. On the 20th May, 1868 (to quote from the case-book), “she passed a very restless night, and is much exhausted this morning: injected acetate of morphia gr. j, and she soon fell asleep; took her food well on awaking.”
On the 23d, “injected gr. j of morphia twice daily since the last entry, and with decided benefit, and she is much less excited. Sleeps well, and the suicidal tendency seems to have passed away.”
On July 15th the entry is as follows:—“Has improved uninterruptedly ever since the last entry, and is now tolerably sane.”
She was discharged recovered on 7th December, 1868, and has continued sane to this date, although in such a case another relapse is most probable.