To obtain the best results in prolonged narcosis, much
depends upon the attitude of the patient towards the treatment
and the environment in which he receives it. The less severe forms of mental illness benefit most from narcosis therapy, and
the admission ward of a mental hospital is not the best place for
the treatment of such cases. To overcome this difficulty,
patients may be treated either in a "nerve unit" in the grounds
of a mental hospital, or in a special ward of a general hospital.
At this hospital a different arrangement has been used. A country
house in pleasant surroundings about a mile from the mental
hospital, has been converted into a nursing home which can accommodate twenty -five male and female patients. It is under
the administration of the mental hospital and has a trained staff
for nursing mentally ill patients. The stigma of a mental
hospital does not exist, the patients are all voluntary and
selected for their willingness and ability to co- operate in
Prolonged narcosis is best induced with sodium amytal and
paraldehyde, while toxic complications may be minimised by the
routine use of glucose and insulin with a high fluid intake.
Narcosis therapy is a valuable therapeutic procedure if
used in suitable cases, disappointing results will be obtained
if it is used indiscriminately without regard to diagnosis.
Cases that respond best are those of short duration, occurring
in patients of good previous personality and precipitated by acute
environmental. factors. Reactive depressions and anxiety states
where the causation is largely exogenous do well. Prolonged
narcosis restores the equilibrium in those cases of depression
or overactivity, that are not too acutely ill. It may be likened
to a rider on a laboratory balance, which by itself, can restore
equilibrium when not too great an adjustment is necessary.
Recurrent affective disorders either of mania or depression
show improvement, the length of the illness being shortened.
There is no evidence to suggest that the cyclothymic processes
are affected, for recurrences will occur. The more severe
depressions, where retardation is marked, may need a course of
E.C.T. Involution depressions do not respond well and may become
confused and hallucinated. If active measures of treatment are
needed, E.C.T. will give good results in many cases.
Early schizophrenics do not respond satisfactory to
prolonged narcosis and should be treated with insulin coma as soon as possible. Chronic schizophrenics who are excited can
be calmed down by narcosis therapy, but the disordered mental
processes are not fundamentally altered.
Patients, who are too agitated or overactive to benefit
from psycho-therapy, can be restored by a course of prolonged
narcosis to a more co- operative and receptive calm.
Prolonged narcosis is a useful procedure for quietening
and calming excited patients. In an admission ward such patients
can he kept quiet and under control, and apart from the benefit to
the patient, the ward remains orderly. New admissions are not
frightened by noisy and excited patients when they enter the ward.