With this view, the treatment ought to consist very much in the employment of purgatives and diaphoretics; but, as the bowels of many delicate women in this state, are very irritable, gentle purgatives are to be preferred to drastic ones. Warm bathing is also very useful. Blisters applied to the head are hurtful; much benefit, however, has been derived from their use, applied to the nape of the neck, in Bethlehem Hospital, as also from the insertion of an issue in the neck or arm, to supply, in a measure, the place of the suppressed natural determination.

When cerebral excitement, manifested by flushed face, heat of head, and throbbing of the arteries, has been diminished by local abstraction of blood, if necessary; by cold applications to the head and by purgatives, opiates may be tried, should the restlessness continue. Amongst these, the preparations of morphia appear to be the most beneficial; hyoscyamus and camphor, are likewise employed with good effect.

When the breasts appear swelled and tense, they demand the same attention as in the sane state; as do likewise uterine or other symptoms. The child, in the early period should be weaned, and the breasts regularly drawn, so long as the secretion of milk is not suspended.

If the insane state continue after the active stage, in spite of remedies employed, the indications then presenting themselves, are to be tried as in other

MORAL MANAGEMENT.

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cases of the disease. The moral treatment is the same as in insanity from other causes.

Removal from home, in cases of recent delivery, may not be practicable; and, where not required by the features of the case, is hardly advisable.

SECTION V.

PERIOD OF CONVALESCENCE,

I shall now consider the treatment of the insane state when it is declining, and approaching to convalescence; together with that which is appropriate in the states of Dementia, Imbecility, and Idiocy.

DECLINE OF THE DISORDER.

We find the symptoms in this stage of the disorder frequently differing considerably from those of the preceding stage; for instance, a patient who has been very irritable, may now have very little sensibility, or vice versa. Increased irritability, is particu

larly the case in convalescence from Mania; we are therefore to be regulated in our mode of treatment, more by the actual condition of the patient, than by the original form of the disorder. The decline and convalescence may be impeded in its progress by various circumstances, such as debility, irritability, want of sleep, plethora,-and certain local affections, as head-ache, suppressed menses, costiveness, &c.

With respect to the first of these, debility, it may be observed, that the state of increased action is often succeeded by depression and debility; such patients become very timid, their ideas, though sane, are few, and feebly expressed,-they answer tardily, and their speech is sometimes embarrassed,-they have little appetite, their digestion is not well performed, -their countenance is pale; sometimes they have oedematous swellings in the legs and feet, or their limbs are apt to swell on the least exercise; they are averse to motion and to society, and sometimes sleep much.

The remedies indicated in this state, are tonics and stimulants, such as quinine, steel, and bitters, the moderate use of wine, together with country air, the shower-bath, and sea-bathing. If the embarrassment of speech be so considerable as to lead to a suspicion of a paralytic tendency, a blister to the nape of the neck, or the insertion of a seton, will be proper.

An irritable state, with disturbed sleep, is not an uncommon occurrence in convalescence. Long after the delirium has subsided, harrassing ideas continue

to intrude themselves, without the consent of the will, and the patient is disturbed by uneasy dreams. Want of sleep appears to be more wearing out at this time than in the earlier stages of the disorder, when the mind, being in a passive state, is capable of bearing long watching and fatigue. In this state, anodynes, as preparations of opium, hyoscyamus, camphor, &c., are particularly useful. Warm bathing too, is indicated, and as much exercise as the patient can easily bear; so as to induce moderate fatigue.

Our

I have next to notice a state of plethora; which occurs in convalescence. When this is the case, diet of a less nourishing description, exercise, and mild laxatives are indicated. We ought to avoid taking away blood, unless the plethora rapidly increases; or the symptoms depending upon it are urgent. attention also should be directed to the suppressed state of the menstrual discharge, since its suppression increases any tendency there may be to general or to cerebral plethora, or to head-ache. We must also ascertain the period of its expected appearance, and employ appropriate remedies about that time; such as aloetic purgatives, the hip-bath, pediluvia, &c. The compound decoction of aloes with camphor-mixture is a remedy which has been employed with much success in Bethlehem Hospital.

Head-ache is another symptom which sometimes retards the progress of convalescence. When slight, laxatives and anti-spasmodics, the pediluvium, and tranquillity, will in general be found sufficient to re