Hallucinations caused by narcotic substances, require, under most circumstances, therapeutic means. The treatment is evident when they have been occasioned by datura or belladonna, etc. The medicaments used are those which belong to cases of poisoning by those substances. When hallucinations are caused by the use of haschisch or opium, nature must be left to herself; the symptoms will cease in a few hours. If the effects of the opium be too much prolonged, appropriate antidotes must be applied.

Nervous diseases, such as catalepsy, epilepsy, hysteria, hypochondria, and rage, which are more or less accompanied by hallucinations, do not point out any especial indications against this symptom, unless it prevails over all the rest When it occurs in epilepsy, the results may be very serious, and the great-est attention is required on the part of the medical attendant Moral treatment is chiefly applicable to hypochondria; but if the patient be a man of education, enlightened, irritable, and wilful, the method of Leuret may hare unhappy drawbacks.

When hallucinations which have arisen in nightmare continue on waking, or when they are nightly reproduced, it is necessary to have recourse to medical advice. Every organ should be examined with the greatest attention, for it not unfrequently happens in this case that they are connected with a derangement of the digestive organs. At other times, a moral emotion, or a painful impression will cause them. Schenkius speaks of a man, on whom every night a woman flung herself, and who was so terrified that he was like a madman. Two or three conversations with his physician effected his cure. In another case, mentioned by the same physician, it was necessary to resort to medicaments.

Hallucinations may be exhibited in dreams, and precede the appearance of insanity; they have then a distressing character, which fact, combined with a knowledge of the temperament of the person, his antecedents, and any bodily disorders may point out the path to be pursued. A judicious employment of medical means may perhaps succeed in checking the development of insanity. When hallucinations disturb the rest of the insane, they require, in most cases, the employment of remedies. Bleeding, purging, and a bath are sometimes sufficient to insure relief.

Ecstasy frequently attaches itself to a morbid nervous over-excitability, which can only be calmed by therapeutic agents. According to the cases, physical or moral means should be adopted. In the Swedish epidemic, of which Dr. Souden recently gave a description, the diminution, and, probably, the cessation of the malady was, in a great measure, owing to the non-accomplishment of the promises made by the hallucinated ecstatics. Let us add, however, that, in this moral epidemic, medicine was frequently useful.

The treatment of hallucinations which are consequent on acute delirium, and in those maladies which do not 'belong to the different "categories which we have enumerated, constitute nothing special; it is almost always such as is proper to each of these affections. The false sensations created by fever, disappear with it. We recollect the case of a young man, of sanguine temperament, who, being suddenly attacked with a violent cephalalgia, with fever, saw shadows flying before him, amongst which he chiefly distinguished that of a female in white. At times he recognized the falseness of these sensations, whilst at others he would address these fantastic personages, and express his surprise at their appearance.

On the following day, these illusions had entirely passed away. Sometimes, however, hallucinations persist after the fever has ceased. In such a case bleeding is necessary, either by leeches or cupping, with purgatives, and baths with cold affusions; and, in cases where they do not yield to these various means, a blister might be successfully applied.

Intermittent fevers sometimes become complicated with hallucinations. Should this symptom be prolonged in convalescence, sulphate of quinia should be resorted to.

Hallucinations are frequently observed in typhus, and we have remarked them also in some cases of typhoid fever.* They, in general, disappear in proportion as strength returns. It may, however, happen that the overthrow, which the nervous system has received, prolongs them much beyond the ordinary time. Tonics and a good hygienic regimen are extremely essential under such circumstances. With the re-establishment of health, the errors of the senses cease.

A morbid condition of the digestive organs is sometimes an occasion of hallucinations. The organs must then be examined, which, in fact, should always be done when any derangement is manifested in the economy; cooling and refreshing drinks, and a dietetic regimen, are the only means required. Hallucination may arise from the presence of some substance offensive to the stomach. One of our brethren reported the case of a lady who saw visions whenever she partook of coffee; here may be repeated the aphorism: Sublata causa, tollitur effectus*

* See the work of M. Gaultier de Claubry, in which the identity of typhus and typhoid fevers is powerfully sustained.

Hallucinations have been manifested in the most diverse affections. The Edinburgh Journal relates the ease of a lady who, after an attack of gout, was assailed by phantoms. She was cured of this disturbance of the senses by cataplasms on the feet, gentle medicine, and above all, by a slight attack of her disease. Sometimes hallucinations appear in the last stage of chronic diseases; an agreeable surprise, in this case, has caused their instantaneous cessation. When they occur in the weakness of convalescence, good nourishment, pare air, and tonics are the most suitable remedies.

It would be easy, on examining the many works on pathology, to increase the number of diseases which are complicated with hallucinations. We have limited ourselves to those which most frequently offer that symptom. The cases which we have indicated, and their analogy, will point out the rule of conduct to be followed in similar circumstances.

M. Michea recommends in many cases society, a light cheerful situation, the avoidance of any object connected with the nature of the hallucination, and the awakening of attention.*

Recapitulation. - The treatment of hallucinations has long been completely unnoticed in France. The examination, however, of their causes, symptoms, and particularly of clinical facts, proves the possibility and certainty of their cure.

Leuret was the first to reduce to a system the treatment of hallucinations. The only objection that can be made to his method is, that it is too general and too exclusive.

Etiology, symptomatology, and clinical facts prove that physical and moral agents, separate or united, must be used in the treatment of hallucinations according to circumstances.

Solitude is a necessary measure in a great many cases; but it must not always be insisted on.

Two divisions should be established in their treatment; that of physical agency, and that of moral means.

In physical treatment, the most useful therapeutic agents are bleeding, refreshing drinks, baths, purgatives, and blisters, to which occupation and exercise must be added. In a case of delirium tremens wo successfully applied thirty leeches along the sagittal suture, after having shaved the head.

* Michea, Du de1ire des Sensations, p. 326, et seq.

In hallucinations with excitement, we have found great advantage in the use of baths, prolonged six, eight, or ten hours, with irrigation, according to the method employed in the treatment of fractures.

A violent shock, physical or moral, has often been the means of curing hallucinations.

Bleeding even to syncope in one case made the patient blind, but did not cure him of his hallucinations.

Physical agents appear to act generally in calming the periods of excitement.

Hallucinations are occasionally cured by an effort of nature alone. We have elsewhere noticed the case of a lady, with whom the malady, which had lasted nearly two years, intermitted every other day.

Medicaments may effect a cure, not by their therapeutic effects, but by breaking the chain of ideas in the mind of the patient, as, for example, opium in greatly prolonging the sleep of an hallucinated person far beyond the time at which a particular symptom returns.

Experience has not yet decided on the use of datura stramonium in cases of hallucination.

Moral means may be exercised with great success, but they must not be relied on exclusively. In their selection, the mind, education, and nature of the delirium should be taken into consideration.

That moral treatment, which, in following symptoms, hastens or retards its method according to circumstances, alters its plans according to persons, and proceeds with prudence, appears to us to unite the greatest chances in favor of recovery.

Leuret's method (moral revulsion) is very difficult to apply to persons habituated to reflect, to compare, and to will. The obstacles encountered in persuading by reasoning, appear to us almost insurmountable with insane persons of the educated classes, especially when their prejudices are openly attacked; we therefore think that this method should be restricted to a certain number of cases evidenced by the social condition of the patients, their general character, and the quality of their delirium.

In the treatment of hallucinations, recourse must sometimes be had to physical means, sometimes to moral, and sometimes to the two influences united. 32

Simple hallucinations, each as exist with mental alienation, only require a use of the means we have just described; tat these are not the only hallucinations; there are others combined with diseases of a different order, such as catalepsy, epilepsy, hysteria, hypochondria, fevers, and acute inflammatory or chronic diseases, etc Hallucinations which are manifested m the course of these diseases should be treated by methods more or less active; often, such means alone as are usually directed against the diseases themselves. Moral treatment has been successfully applied in several instances.

It is sometimes necessary to use therapeutic agents against hallucinations compatible with reason.