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Related post: the single and essential exception that the sleep did not improve, or was wor.se. This was a valuable indication in the prognosis of permanent return to reason. To the cardinal signs of con- valescence should often be added the disappearance of decided fear of a return of the attack and dread of the stigma to follow. It was iinportatit to he informed regarding the normal and usual physical troubles of the patient, as their reappearance was an- other and valuable indication of recovery ; also in regard to a knowledge of the secquence of immediate prodromata of an at- tack. They were often repeated in reverse order while the pa- tient was getting well. Complete mental rest during menstrual epochs, so highly important at this time, was often disregarded, and application of the mind, even to a slight degree, in study or other work, was equally to be deprecated. Early discharge from the asylum, or from special care away from home, was to be advised against, as a rule, especially in cases of melancholia with a history of suicidal attempts, and after acute mania, the most exhausting form of ins.mity, and one which left the patient particularly susceptible to slight influences for a long time. On the other hand, we should frequently advise early removal in other cases convalescing from melancholia, particularly when home.sickne3S was a marked feature and occasionally when there was refusal of food. Certain patients with mild mania, also paranoiacs who were independent in the asylum and actively opposed treatment, were steadied by outside life. A change also worked well until its novelty had worn off. The first year or so after recovery was a very critical time. The reader gave a number of indii'ations in special cases, and suggestions for prevention of relapse. These remarks ai)plied chiefly to well-to-do patients. An important branch of this subject was the means for the after- care of the pauper insane. There was practically no pro- vision outside of asylums for this class, and practically little advice or other help was given these unfortunates on leaving asylums; while for the physically sick, on the other hand, there was abundant provision for their care during convalescence, and the discharged convict was greatly helped and encouraged by charitable societies for the purpose. Asylum physicians often hesitated to set certain patients, whoso menial condition seemed to have so far im|iroved as to make it useless to keep this class longer under care (and even some who had fully re- covered), at lil)erty, for fear that, thus suddenly thrown on their own resources, without oversight or perhaps means of sup- port, they would fall back into their old habits of life which had given rise to their insanity. This fact, and their delicate mental condition, often rendered them easy victims to designing people. These and other reasons had led to the formation in France of protective societies, called Societies of Patronage^ under official auspices. Their duties were to .aid convalescent or re- covered pauper patients by gifts of money, clothing, tools, re- demption of articles in pawn, payment of rent, admission to convalescent homes in cottages intermediate between confine- ment and complete freedom, or in hospitals or houses of refuge ; securing situations for them, and finally their supervision wher- ever employed. This work continued during the first month or two after the patient's discharge. iSimilar societies or means of relief had been adopted in England and Scotland. They were described in detail. There was no better work on the score of both humanity and public economy than the adoption in this country of similar means for the prevention of insanity. Dr. E. D. Fisher was of the opinion that patients left the asylum too early. In cases where they were oversensitive re- garding their previous incarceration, something must he done to care for them and obviate a relapse. He was in favor of establishing convalescent homes for such patients, and spoke at length in confirmation of the views of the author of the paper. Dr. Dercdm thought this matter a very important pha~o in the care of the insane. It was, however, quite difficult to deal with individual cases. Where the element of exhaustion had been a prominent causative factor, the patient required deten- tion and care much longer. Dr. Stare was glad to know that Dr. Stedman favored the earlier removal of nielanchohcs from asylums. One of the chief difficulties was in controlliug the families who did not know how to manage the patient alter his return. Dr. .Jones, of Minnesota, said that Ticlid 250 Mg in Minnesota, since the word asylum had been changed to that of hospital, it had tend- ed to remove any of the supposed stigma that had been usu- ally attached to people who had been in institutions for the in- sane. Dr. Knapp and the President concurred in the views ex- pressed by the reader of the paper. Dr. Dana said that the subject was of great economic as well as medical importance, and he would suggest that a com- mittee be appointed to investigate the matter. This suggestion was then presented in the form of a motion, which was carried. The President then appointed as a committee Dr. Stedman, Dr. Dana, and Dr. Dercum. A Suicids's Erain with Two Pistol-bail Wov.nds.— Dr. Burt G. Wilder, of Ithaca, exhibited a specimen and showed a dozen photographs of various aspects, and blackboard diagrams of the left side, and of a transverse section at the level of the fatal wound. W. I. B., a dentist, thirty five years old, of llliaea, N. Y., was found dead in his office on the 7th of April, 1894. A 0*22 revolver was clasped in his right hand. There were two bullet holes, one in the middle of the forehead and the other in the right temple, neither ball having emerged. In accordance with his written directions, the brain had been preserved in the museum of Cornell University as specimen 3,129. The first ball, presumably deflected by the skull, had passed caudo- ventrad to the cranial floor, and had been reflected dorso- caudad at nearly the same angle to a point just cephalad of the 2H PROCEEDINnS OF SOCJETJES. [N. Y. Med. Jocr., precominissiire, where it Ijad lodged, having merely ahnided tlie niesiiil surface of llie left Irontal lobe. The second ball had en- tered at the rij;ht subfrontal fryrus, passed obliquely siiiistro- caudo-dorsad, hail toru the callosum and intervening: stnictuixs, and emerged in the central seeimd left central fissure. As there had been no suspicion of foul play, and documents in the de- ceased's handwriting had declared his intention to commit sui- cide, the ease exemplified the possibility of two self infiisted bullet wounds of one brain. The fissures presented many pe- culiarities. The most perplexinf; was the apparent coexistence of two central fissures on each side. The only two similar cases hitherto observed had been recorded by Giacomini and C^lori. Suicide had been committed by a grandfather ai-d one ancle, and attempted by another uncle. Dr. Dercum had examined a large number of brains of the insane, but he had never seen such an instance as that presented by Dr. Wilder. Dr. Dana said that he bad no doubt tliat the anterior of ihe two fissures was the fissure of Rolando. The interruption of this Buy Ticlid fissure on one side by a bridging convolution was extreme- ly rare and very interesting. The brain had presented a uniipie fissuration. He could not understand how a primary fissure like the Rolandic could be doubled in any event, and was skep- tical of the genuineness of reported cases. Related links: Purchase Sleepwell Online, 5 Benzoyl Peroxide Face Wash, Order Neem Online, Cheap Celexa Online, Saw Palmetto Nz, Benzac Wash 10, Buy Penisole Online, Cheap Wellbutrin Xl, 40 mg lisinopril, Ordering Retin-A
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