During the past year I have systematically employed rest in bed in the open air as a special method in the treatment of all patients newly admitted to the Ayr District Asylum; and during the past six months I have carried out the same method in the treatment of all resident patients exhibiting relapses or phases of active insanity, the latter including the most difficult and most dangerous cases in the institution. At present, there-fore, all patients in Ayr Asylum who manifest their insanity in such active forms as marked morbid excitement, exaltation or depression, distinct delirium, confusion or stupor, vivid hallucination and delusion, active homicidal or suicidal tendency, impulsiveness and the like, are being treated by the method of rest in bed in the open air, a method which may be conveniently termed the sanatorium or open-air rest treatment of active insanity. Although it is yet too soon to speak as to the ultimate therapeutic value of this system, and several years must necessarily elapse before its effect on the recovery rate in insanity can be definitely ascertained, even a short experience has sufficed to demonstrate the immediate benefits and strong points of the system, and to show that it is a more satisfactory method of treating those who are actively insane than either the outdoor exercise or indoor rest procedures hitherto in vogue, and that, indeed, it secures the advantages without the disadvantages of the exercise and rest systems combined. The particular combination of rest in the recumbent position and in the fresh air of the open would indeed seem to be Nature's specific for at least the alleviation if not the cure of an attack of insanity; and the method is not only based on sound physiology and correct pathology, but it is so easily carried out in practice, it so obviously benefits the health of the patients–not to mention also that of their nurses–and withal it is so pleasant a remedy both in the receiving and the giving, that even a comparatively short experience of its employment has convinced me that the systematic open-air rest treatment of active insanity has come to stay, and that at no distant date it will secure a wide sphere of application in asylum practice, and in the treatment of the psychoses and neuroses outside of asylums. Before describing the sanatorium treatment of active insanity I wish to put before you the stages in its development, and to show how, after an apprenticeship in the exercise system of treating active insanity, I came to adopt the rest method, and by allying the latter with the open-air cure, as suggested by the modern treatment of pulmonary tubercle, I arrived at the combined method of rest in bed in the open air, which has been in vogue at Ayr Asylum during the past year.
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