Page:The American Cyclopædia (1879) Volume IX.djvu/315

INSANITY 303 times obscure, of the viscera. The patient become* peevish and suspicions, is easily fa- tigued, a mental apathy takes possession of him, and he becomes weary of life ; or he passes into a state of extreme anxiety. The mention of a disease will often cause him to fancy that he is afflicted with it, and he is constantly feel- ing his pulse and examining his tongue and ex- cretions. He often changes his physician, and also his opinion of the nature of his ailment. His feelings are not all imaginary ; there is fre- quently indigestion, sometimes of an aggrava- ted character, accompanied with great evolu- tion of gas. which by its distention of the in- testinal canal occasions uneasiness. The tongue is foul, the appetite irregular, the bowels con- stipated, and the skin in an unhealthy condi- tion. Moral treatment is often beneficial, but should always be accompanied by therapeutical measures calculated to remove pathological conditions. This state is very often accom- panied by an inherited tendency to mental disease, and when not relieved passes into that condition more definitely styled melancholia. His delusions take a more decided character, and he fancies himself a criminal He is now evidently to all observers an insane man, and becomes the subject, not only of delu- sions, but of hallucinations ; he imagines that he is beggared, and that his family are to be thrown helpless on the world; that he is destroyed by odious diseases: that he has leprosy, and that a loathsome smell emanates from his body. His countenance expresses in- tense woe, and he stands for hours in one place and in one posture, either in solitude or in the street; or he may be impelled to con- stantly wander about. He deeps badly, and generally eats but little ; the bowels are obsti- nately constipated, the breath offensive, and the pulse slow and weak. The age at which persons are liable to melancholia is often the prime of life, or when the vigor is beginning to fafl, at 40, 60, or 60 years. Of 338 cases of melancholia admitted into St. Luke's hospital, London, only 9 were under 20 years of age. Women who have been weakened by parturi- tion are sometimes the subjects, when it gen- erally assumes an acute form, with sleepless- ness and obstinate refusal of food. In this state there is almost always a disposition to commit suicide, which mav manifest itself sud- denly; sometimes it appears earner in the dia- - . . . _ . _ . _...._ . . chronic or with its not - its history an indispensable The treatment of a case of sab-acute melancholia will vary and symptoms. An asylum is if the patient's means are provide him with proper care. He may be benefited by travel and change of scene; bt when ms condition will not admit of this, a proper place, either a private house or an *! !>. should be selected, and an at- made by therapeutical and hygienic mea- to restore the cerebral defect by deep nourishment of die body. In many cases ~ :: voi. rr. so recovery will be observed to rapidly follow medical treatment alone, some bad cases get- ting well in a couple of months. There are three conditions which require constant at- tention : want of sleep, rejection of food, and constipation. To remedy the first, chloral is much used by some ; others prefer the effects of morphine or Dover's powder, believing that chloral is better suited to the more vio- lent condition of mania. Wine and brandy are also used to give temporary strength, and have been observed to be of practical benefit, inducing sleep in some forms of insanity. As to whether the dyspepsia and other visceral disorders are the cause of the melancholia, or whether they are in common with it, the re- sult of a primary nervous disorder, is one of those disputed matters about which physicians will probably never be perfectly agreed. The practical aim is, however, to produce regularity of the evacuations by laxative medicines, and to sustain the strength with nourishing food and wine. The prognosis in cases of melan- cholia is generally good. Some have recov- ered after having been a long time in asylums, and subject to suicidal impulse and delusions and hallucinations. If the melancholy be- comes paroxysmal, or runs into mania, the prognosis is not so favorable, as pathological cerebral changes of a permanent character are liable to occur. The symptoms are inten- sified; there is now no longer mere depres- sion or silent stupor or anxiety, but the pa- tient becomes frenzied. He will hardly sit or lie in one position for a moment, and has to be placed in restraint, either mechanical or mnnl He is extremely suicidal, and will not only try to put an end to his life, bat win attempt to injure his person by gouging out his eyes, or swallowing nails or pieces of glass or corrosive liquids. He is not liable, like a sub- ject of general paralysis or an epileptic maniac, to make homicidal attacks ; but he will resist with violence the assistance of his attendants. He will not take food, will not be washed or remain in bed. and win strip himself of cloth- ing. There is an increased weakening of the wiU, indicating great deficiency in cere- bral nutrition. There is a great tendency to sink rapidly from exhaustion, and therefore die patient has generally to be forcibly fed, or, as is said, to be fed u mechanically." This is accomplished by forcibly opening the jaws and putting nourishing food into the pharynx with a spoon, or by introducing it with the (Esophageal tube, which is generally preferred, will sometimes succeed in prevailing on the patient to swaBow his food voluntarily, and mast of coarse be tried until found of no avail. One great danger is death from starvation, and therefore food most be grfwa, and in considerable quantities. Chloral is considered appropriate, and may be given alone, or in combination with conium. hyoscy- amn?. Arc. If the pctient refuses, it may be giv- en by the recnnn. Morphine is also of service,