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MARYLAND MEDICAL JOURNAL. 
274 
feature of her delirium. The case ter- 
minated fatally. 
Dr. Arnold had not noticed this re- 
lationship in any case. Hemorrhage 
is exceedingly common, whilst puerperal 
insanity is comparatively rare. It might 
bring it on, like other causes, in those 
predisposed to insanity. 
General paresis of the insane is the 
only form of insanity, which in a number 
of cases can be referred to the existence 
of distinct anatomical changes in the 
brain, but such is not the fact in regard 
to other species of insanity. This is not 
remarkable for our present state of know- 
ledge of the physiology of the brain is 
very unsatisfactory. 
Dr. Kemp had had four cases. One 
died, one still has the attacks, two recov- 
ered, in three weeks and fifteen days 
respectively. Two were of families in 
which insanity had occurred. One case 
occurred after delivery, and vas brought 
on by an accident to her husband, which 
proved fatal. This was the case that 
died. One case had mammary abscess 
and phlebitis in the left leg. His treat- 
ment in three cases was chloral in the 
attacks and food in the intervals ; in the 
fourth (that of three weeks standing) the 
mixture of Graves, of Dublin, was used 
with decided advantage. 
Df . Neff related a case in which an 
albuminuric had convulsions before and 
after delivery ; these were followed by 
coma, and this by delirium, lasting four 
or fiye days. She was relieved by bro 
mide of potassium, chloral and digitalis. 
He attended this patient in her next con- 
finement and nothing unfavorable oc- 
curred. 
In another case the husband came 
home intoxicated ; in consequence of this 
the wife had uncontrolable mania, refused 
nourishment and medicine, was sent to 
Mt. Hope and there died. 
Dr. Erich could only recollect three 
cases, in none of which was hemorrhage 
a prominent feature. He did not think 
it likely hemorrhage had anything to do 
with it, as acute mania is generally due 
to congestion. 
When the patient resists, the chloral 
should be given by enema ; it acts as 
promptly thus as by the mouth, and the 
dose is about the same. It may be given 
in simple water or milk. 
Dr. Arnold said, in asylums the oeso- 
phageal tube was used. 
Dr. Morris agreed with Dr. Erich, 
that chloral acted as well by the rectum 
as by the mouth, and instanced a case of 
insomnia which had lasted eight or nine 
nights; opium increased the excitement, 
but an injection of Div of chloral pro- 
duced sleep. 
He thought the cases of acute mania 
that terminate in three or four days are 
due to acute meningitis, and alluded to 
hyoscyamia as a new remedy said to 
have a wonderful power in calming pa- 
tients ; I- 120 grain will produce effects. 
Dr. Arnold differed with the previous 
speaker about the relation of mania and 
meningitis. In the former there is no fever, 
no strabismus, no convulsions, nohyper- 
aesthesia, no paralysis, no vomiting, no 
rigidity, and the post-mortein appear- 
ances do not indicate the previous exist- 
ence of the inflammatory process. ‘Pa- 
tients are perfectly relaxed and exhausted 
before death takes place. Acute deliri- 
um he thought an appropriate name. 
The ice-cap does no good. Every mo- 
ment is precious, and we must act 
promptly ; chloral and nourishment must 
be gotten in in some way. 
Dr. Erich referred to the hypodermic 
use of chloral. He had injected chlo- 
ral subcutaneously in two cases with fatal 
results. The end of the syringe em- 
ployed was corroded. The dose em- 
ployed was 20 grs. saturated sol 
The highest dose of chloral which he 
had administered by the mouth was 3 ji ; 
ordinarily he gives 3 ss, and repeats it 
in half an hour if it does not produce 
sleep. 
Dr. Kemp had used chloral hyoder- 
mically in ’73 ; in the space of three days 
he gave 12 injections of 30 grains each, 
with four abscesses as the result. 
Dr. Uhler, as a rule, does not give 
over Dij of chloral at a dose, but has 
given as much as 3 i. He prefers to 
employ bi-carb. sod^ or some other al- 
kali a short time (say one hour) before-^ 
hand, so as to ensure its proper decom- 
position in the blood. ^ 
