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wrong, although he is often sustained in it by hisfam- ily and friends. The derivation of the word melancholia throws some light upon its most common etiology. The two Greek words, meias— black, and cAo!e=bi\e, while not accepted in their original application and significance in the sense of meaning that melancholia is actually due tobile in the blood, yet disturbances of the diges- tive organs, the intestinal canal, and the liver have a most important relation to the production of the dis- ease. In many cases there is a strong hereditary ten- dency, but its actual onset is due to some viking voyage game special ex- citing cause that in very many cases is removable by proper prophylaxis and treatment. I have known sev- eral instances in which insanity prevailed largi the family history, vet in which it has been ward by attention to simple measures of hygiene and sea- sonable treatment. Of course, if the patient is suffer- ing from special disease, such as rheumatism, hemor- rhoids, neuralgia, or syphilis, or from any physical defect, such as eye strain, an old stricture, or any one of many ills, the attention of the physician will be directed thereto and to its appropriate treatment; but most cases of simple melancholia are idiopathic, or are so apparently. You will find in these cases that there is, as a rule, some disturbance of the digestive system. The patient may suffer from some form of dyspepsia, and almost always does suffer from constipation. Constipation may be quite certainly counted upon, and with it hemorrhoids. There are sometimes much flatulence, a sense of weight and distress after meals, often ill- defined feelings of discomfort or vague pains in the abdominal regions. These conditions are relieved somewhat by gaseous eructations, sometimes accom- panied with acrid or bland fluids, but more commonly free from them. The belching of gas often gives a sense of relief, which is temporary. While stomachic disturbances are not the most prominent and are not always present, there is, as we have said, almost uni- versally a state of chronic constipation. It is to this condition that attention has been more or less attracted of late, through the vikings voyage free play theory that many forms of mental disease, not only in their initial stages but also in re- current and periodic forms, are due to intestinal in- fection or autotoxis. It is reasonable to ascribe also other forms of mental disease to this source of toxic infection. In no form is this more true than in melan- cholia. The intestinal contents are retained, and by being absorbed poison the circulation by toxic agents that seem to work directly upon the nervous system: and not only this, but digestion itself is so imperfectly performed that the food is not assimilated and does not nourish the body. Melancholiacs, as a rule, are reduced in weight and are often emaciated. The evacuations from the bowels are scanty and frequently suppressed for days. The patient's appetite often is poor, and the reason is frequently given as an excuse for constipation that the patient eats nothing and a faecal movement is not deemed necessary. The evacu- ations, when they do take place, are often small cylin- ders or lumpy, and are usually dark or occasionally extremely light in color, and often extremely offensive. This condition of retained faces in the intestinal canal often leads to what is termed coprasmia or fa;cal auto- toxis. The chief duty in all cases of this character is to pay attention to the digestion and to the atonic state of the bowels. It is not well to prescribe violent ca- thartics, but to give in daily closes vikings voyage slot machine small amounts of buckthorn or cascara. The pill of aloin, strychnine, and belladonna, continued day after day. is a most excellent remedy. An occasional dose of calomel is also efficacious, in the form of small doses of the tritu- rates in one-half or one-tenth grains, frequently re- peated. It acts as a laxative and. in the opinion of many, as an intestinal antiseptic a-- well. All of these patients should be taught that one of the most ser- viceable methods to promote regularity of the bowels is to take some special time of the vikings voyage to america slot day for die perform- ance of this duty. The habit of defecation at a cer- tain hour can lie acquired, and it is extremely impor- tant that these people should be taught to acquire it. They should be made to persevere for a long time. even though no apparent benefits ensue. The Sara- toga mineral waters ami some oi the stronger aperient waters are useful when taken regularly as an aid to this result. The appetite of melancholiacs is not often good. They need more than the usual amount of food, even though they are not actively exercising. One ^\ the most encouraging things in the treatment of these cases is the gain in weight which indicates improvement. This is one of the criteria of suc- treatment, and is often the first evidence of re- turning health. It is well to weigh your patients from time to time. In certain cases ,>t obstinate dyspepsia January 9, 1S97] MEDICAL RECORD. 4r it is sometimes necessary to wash out the stomach by lavage before meals, but simple aids to digestion will ordinarily be sufficient. The drinking of hot water sometimes serves a good purpose. Reliable prepara- tions of pepsin, in ten or fifteen grain doses, or ether digestive ferments, are of service. Xitromuriatic acid or hvdrochloric acid is a useful remedy for continu- ous use. The subgallate of bismuth is an efficient agent in the disease, and may be given in doses of five or ten grains, it exercises a mild antiseptic influence upon the digestive tract. Salol, in from two to live grain doses, I have found to produce good results. Naphthalin, in from one to three grains, and its allied products, have been used also for the purpose of local intestinal antisepsis. It will be found necessary to vary your remedies from time to time with notional patients. This can frequently be done, seemingly, without any actual change of medication, or a slight one ; for the melancholiac is a variable patient, with- out much enthusiasm, and his confidence in drugs soon wanes unless reinforced by an apparent change. Cod- liver oil, a most nourishing diet, with plenty of butter, eggs, milk, and cream are indicated. The important element in treatment is to get the patient's bowels in condition and give him good digestion, and then or simultaneously insure the ingestion of large amounts of nourishing food. Phthisis, though not often, yet is sometimes attended with melancholia, and in this dis- ease gain of weight brings with it corresponding cheerfulness of spirits. With the arrest of the disease, the melancholia usually disappears. In all these cases, of course, attention should be paid to the pa- tient's clothing, and warm woollen underclothing and warm stockings should be worn, and the patient kept comfortably and hygienically clad in all weathers and under all conditions, and he should take only moderate and pleasant exercise. Sleeplessness is often a factor that is difficult to treat. When the true cause of the patient's worry can be discovered, its removal, or, if that cannot be effected, strong judicious counsel on the part of the physician, may often do much to ameliorate the condi- tion by encouraging the despondent patient and giving him moral support. Hyoscine in small doses in these initiatory stages is often of service. A single dose of chloral, or chloral and bromide combined, in doses of ten to fifteen grains vikings voyage slot each, often act well. The prac- tice of giving these patients hypnotics and sedatives frequently through the day is. as a rule, bad. In many cases it intensifies the mental symptoms, and often the complete stoppage of all medication in cases of over- drugging will be productive of very apparent benefit to the patient. A glass of dry wine, or an eggnog, or a full meal even, will dispose the patient to sleep. Sulfonal or trional in these cases acts well if given in

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