The symptoms of this disease are slight trembling of the hand, especially when extended, and of the tongue, when protruded, and lips, when peaking. There is a marked change in character and disposition. The patient is subject to extravagant delusions, speech is thick, gait is shuffling and resembles that of a drunken person; in an advanced stage of the disease, convulsions may appear. The disease lasts from a year and a half to four years. It is almost certainly fatal. The principal causes are intemperance and dissipation.

The Treatment of Paresis Or General Paralysis Of The Insane

There is probably no disease in the treatment of which so marked improvements have been made in modern times as in the case of insanity. In ancient times, and, indeed, in times very near to the present, the insane have been treated like wild beasts. As soon as evidence of mental disorder was discovered, they were considered at once as doomed, and no efforts made to ameliorate their condition. Many times they were treated with great inhumanity and cruelty. Indeed it has only been within the last century that the treatment of insanity has been made, in any degree, rational; and often, at the present day, there are evident opportunities for further improvement. It is of great importance that the first beginnings of mental disease should be detected; hence every individual should become, to some extent, intelligent on the subject. When a person shows, in a marked degree, any of the symptoms above mentioned, he should be carefully watched. If the individual himself feels strange impulses, and an almost uncontrollable disposition to take his own life, or do violence to others, he should at once consult an intelligent physician, or put himself under the watchcare of some one sufficiently intelligent to care for him. There is good reason for believing that no small proportion of the crimes of violence committed are due to temporary or obscure mental disorders.

In the treatment of the insane, attention must be given to every function of the body, as well as to that of the brain, since the disease of the brain often depends upon disease of other organs. Disease of the digestive organs, producing malnutrition of the brain, is one of the most common of all causes of insanity, and we doubt not that many who are now inmates of insane asylums might have been readily cured, had this fact been recognized and the difficulty removed at the outset We have treated quite a number of cases in which the patient had been confined for a longer or shorter period in an insane asylum, and by giving attention to improvement of digestion, thus securing better nutrition of the brain and nervous system, have succeeded, in nearly every instance, in restoring the patient to complete mental soundness.

In women, the condition of the reproductive organs should receive particular attention, as local irritation in these organs not infrequently occasions the most serious mental aberration.

The question of confinement in an asylum is one of very serious moment. It is often decided without a careful consideration in all its bearings. When the condition of the patient is such as to make physical restraint necessary, and when this cannot be secured at home, together with intelligent medical supervision, or when the disease is so thoroughly confirmed that the prospect for recovery is exceedingly small, undoubtedly confinement in a well regulated asylum is the best disposal that can be made of the patient; but when the individual has still sufficient intelligence to appreciate his condition, it seems as though confinement in an asylum with large numbers of other individuals, suffering with all the grades of mental disease, must be, in a high degree, detrimental to the patient's recovery, especially when the aversion to such confinement is exceedingly strong on the part of the patient. These difficulties exist, of course, in a much less degree in small institutions, where but very few patients, or only cases of a mild character are received; but by far the most preferable plan, is that which has been for many years pursued in Holland, where certain country districts are devoted to the treatment of the insane, patients being placed separately in the families of farmers who are employed to care for them under competent medical directors. Not more than one or two patients are generally received into a family; and they are treated as members of the household, and are thus saved from the possibility of any sort of damaging influence from asylum confinement and restraint, and especially the contact with other individuals in a condition similar to, or worse than, their own.

In acute mania, in which there is marked congestion of the brain, the treatment elsewhere prescribed for congestion, or hyperaemia, of the brain should be administered. The patient should be kept as quiet as possible, the diet should be nutritious but unstimulating. If the fever is considerable, the patient should have frequent sponge-baths. If he will not submit to treatment, the cool air-bath can be readily administered with good effect. When it becomes necessary to employ drugs for the purpose of controlling the mental excitement, bromide of potash is to be preferred to almost any other, but no drug should be administered without the advice of a physician. In addition to all other remedies which may be employed, mental and moral treatment should not be neglected. Efforts should be made to cultivate the patient's will-power and self-control, and lead him to appreciate his condition and to co-operate with the treatment as far as possible. Thanks to the modern advances in the management of this affection, it is now by no means so hopeless as it was formerly supposed to be; and by perseverance in the proper line of treatment, a large number of recoveries may be hoped for, especially if early attention is given to the disease.

In conclusion, we wish to remark, that from a personal acquaintance with the superintendents of a number of large State asylums for the insane, we are thoroughly convinced that the prejudice which in some parts prevails against these institutions is altogether unfounded. The numerous stories which are circulated respecting the cruelties practiced in the management of patients are generally put in circulation by patients who have been discharged before complete recovery has taken place, and are generally unreliable. Superintendents of insane asylums are, as a rule, humane and kind-hearted men, and do all in their power for the relief of patients under their charge.