A Critical Review: Narcosis Therapy

TREATMENT by continuous narcosis implies the use of narcotic substances to induce sleep for the greater part of 24 hours, each successive day, for periods ranging up to 14 days and occasionally longer. The expression " continuous " is a misnomer, since a break is always allowed in the 24 hours, during which nourishment is given and the evacuations attended to. History Griesinger (1882) says that with the use of ether and chloroform, complete and rapid recovery has occurred in several cases of recent melancholia, but he adds that relapse occurs and " with each inhalation the remission gradually shortens until they can no longer be obtained." McLeod (1900) reported recoveries following the use of massive doses of bromide in acute mania. Williams (1845) quotes Adral and Van Swieten as having seen maniacal states cured by accidentally large doses of opium. Sir Thomas Clouston (quoted by Palmer, 1937) mentioned keeping large " numbers of cases under " (the influence of chloral) " day and night for weeks, and many of them certainly got well," adding: " But I do not believe in it so much now." Wolff (1901) used trianol in three cases of " acute confusional insanity," the treatment lasting 12 days, with two recoveries and some temporary improvement. Later in the same year he treated three cases with one recovery. Epifanio (1915) treated a mixed group of 10 cases, which recovered or improved following treatment. Klasi (1922) published a report on which most of the subsequent work has been based. He used somnifaine, and treated 22 cases, mainly of schizophrenia, with three deaths. Since his paper the Zurich school has specially interested itself in the treatment, and has devoted itself to an elaboration of the technique, with the object especially of eliminating the dangers suggested by Klasi's three fatalities. The Zurich patients so treated have been nearly all schizo- phrenics. The chief publications of the school have been those of Oberholzer (1927), Lutz (1930), and Monnier (1936). Muller (1925) collected 311 cases treated by various authors, with 15 deaths. This percentage of fatalities has been misleading, since the largest proportion of deaths occurred in the smallest series, i.e. at the hands of the least experienced therapists. Barkas and Dawson (1929) using somnifaine reported unfavourably on the treatment, saying 45 on August 14,