NEITHER SCANTY, NOR TOO STIMULATING.

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constitution, and the previous habits of the patient,--if the curative plan be reducing, the diet must be correspondent; if tonic, the same.

In some cases, wine in moderation may be necessary; and, if the patient have a strong craving for food, which is the case with some, he may be allowed bread at any time. But a system of regularity, of fixed periods for meals, &c., should be invariably observed; otherwise, some would stuff themselves so much, as to bring on vomiting and indigestion.

But whilst on the one hand the error of a too stimulating diet should be avoided, that of a too scanty one should be equally so on the other. As a general rule, the diet of the ordinary inmates of pauper asylums, should be somewhat more nutritious and liberal, than they usually, or at least frequently, meet with in their own cottages. The mere change, indeed, on admission into a pauper asylum, from a scanty to a liberal diet, has, in many cases, appeared to effect a recovery, without the employment of any more special means. Still, we must recollect, that in case of recovery, the patient has to return to his old habits, and, as regards the diet of asylums, that which is good in quality, and sufficient in quantity, and not materially different in kind, from that to which the patients have been accustomed, would appear to be more desirable, than one materially different, even though more nutritious.

Before leaving this subject, I cannot do better than

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MISCHIEVOUS EFFECTS

illustrate the mischievous effects which may attend a too scanty or improper diet, than by the following quotation from Pinel:

"I leave to the historian of the revolution," says he, "to paint in its proper and odious colours that most barbarous and tyrannical measure which deprived infirmaries and hospitals of their valuable endowments, and abandoned the diseased and the infirm to all the vicissitudes of public fortune. It is sufficient for my present purpose to mention a few facts of which I have been myself an eye-witness, and of which the recollection cannot but be painful to a man of any sensibility.

To meet the well-ascertained wants of the Hospital of Bicêtre, it was determined by the Constituent Assembly to increase the allowance of bread to one kilogramme daily. For the two succeeding years, I witnessed with great satisfaction. the operation of the salutary measure. I then ceased to be physician to the hospital. But during one of my friendly visits which I occasionally paid to my old insane acquaintances, I learnt that the usual allowance of bread, had been reduced to seven hectogrammes and a half per day.* A great many of the old convalescents, had relapsed into a state of raving madness; and were complaining loudly, and bitterly, that they were about to be starved to death. But this system of retrenchment, was afterwards car

* A hectogramme is equal to 3oz. 4dwts. 8·40grs. troy,

OF TOO SCANTY A DIET.

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ried to still greater lengths; the allowance being gradually reduced to five, four, three, and even two hectogrammes of bread, with a small allowance of biscuit; which frequently was far from being of good quality. The consequences were such as could not have escaped attention.

Upon inquiring into the state of the institution, it appeared, that in the short space of two months, the total number of deaths, in the department for lunatics alone, had been twenty-nine; while, during the whole of a preceding year, twenty-seven only had died.

A similar, but still more deplorable result, was obtained from a survey of the same kind, which was made of the state of the Salpêtriére. In the months of October, there were no fewer than fifty-six deaths, which were more immediately occasioned by the extreme frequency of colliquative diarrhoea and dysentery."

REFUSAL OF FOOD.

Various delusions, lead the insane to this determination. Some conceive it sinful to eat, others, that their bowels are closed up,- that poison is mixed with their food,-that they are unworthy to live, and that it is their duty to starve themselves,

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MEANS OF FEEDING PATIENTS.

-or that, being really dead, food is unnecessary. Patients in a state of catalepsy, and some other spasmodic diseases, also require to be fed.

We sometimes succeed in overcoming the reluctance to take food, by placing the patient where others are eating, with some savoury diet near, and leaving him alone; or by placing food in his room at night. When all expedients fail, we must have recourse to some of the instruments which have been invented

for the purpose.* That which is employed in Bethlehem Hospital, is the stomach-pump. Amongst the worst that can be employed, is that which is termed the spouting-boat (a spoon resembling a flat tea-pot with a spout), to introduce which, one or more teeth have been forced out.

Another mode of feeding, is by means of the hollow bougie, used in France. The patient being properly secured, the bougie, previously dipped in oil, is gently introduced into the nostril, and from thence into the stomach, and fluid nourishment poured in night and morning.

It is rarely necessary to continue these means long, because patients finding that they are forced to live, in spite of themselves, at length give in.

* Sometimes the mere sight of the stomach-pump is sufficient to overcome the opposition of the patient. A patient under my care, who had refused food for five days, with the intention of putting an end to his life, as he could get nothing to eat but "poisoned filth," found his resolution give way as soon as the tube of the stomach-pump was put into his mouth. He several times afterwards refused to take food for a day or two; but the threat of the stomachpump was quite sufficient to induce him to comply.

CHAPTER XVII.

MORAL TREATMENT.

THE indications to be fulfilled by moral means are, in the first place

a. The removal or diminution of the action of moral causes.

b. The separation of the patient from persons and objects, which increase the peculiar symptoms of the case.

c. The prevention of acts, prejudicial to himself or others.

Moral means are also employed, in the second plaće

a. To dissipate errors of perception, giving rise to delusive ideas and disorderly actions.