Page:Encyclopædia Britannica, Ninth Edition, v. 13.djvu/119

INSANITY 109 hysterically insane. Men, although very rarely, are liable to this form of insanity. In a sense the prognosis is favourable, inasmuch as prolonged treatment procures great abatement of symptoms, if not actual recovery. Insanity occurring with locomotor ataxy strongly resembles general paralysis. Taken over all, it may be stated that the symptoms differ more in degree than in kind, not being so intense. There is not the same extravagance of delusion or violence of mania. IV. INSANITY FROM THE PRESENCE OF ADVENTITIOUS PRODUCTS is marked by progressive dementia of a dull heavy character and the absence of delusion. Prognosis is unfavourable. V. INSANITIES ASSOCIATED WITH MORBID CONDITIONS OF THE GENERAL SYSTEM. Phthisical insanity is stated to be characterized by a short period of mania, melancholia, or delusion, which soon passes into a mixture of subacute mania and dementia. The symptom, according to Clouston, is a tendency to be suspicious. (Consult Clouston, "Tuberculosis and Insanity," Journ. of Mental Science, April 1863.) Rheumatic insanity is characterized by hallucinations of sight, touch, and taste, loss of memory, acute delirium succeeded by confusion of ideas and slug gishness of mind, accompanied by choreic movements of the limbs, deadening of reflex action, and even paralysis. These symptoms appear as the articular affection diminishes or disappears ; they are, as it were, one vicarious of the other. Prognosis is favourable. (See Griesinger On Mental Diseases, p. 189 ; Clouston, Journ. of Mental /Science, July 1870; Sibson, in Reynold s System of Medicine, vol. iv. p. 280.) In gouty insanity the alternation of the joint anil head symptoms is also well marked. The latter are general mania with delusions of suspicion. Prognosis favourable. (Vide Berthier, Annales Medico-Psyckoloyiyues, 1869. Sydenham also alludes to the condition.) Syphilitic insanity frequently commences with acutely maniacal symptoms, shortly followed by hypochondriasis of marked character, paralysis of energy, and rapid progressive dementia. Extravagant delusions often present themselves so strongly as to render the diagnosis between this condition and general paralysis difficult. Prognosis unfavourable. (The most important paper on this form of insanity is by Mickle, Brit, and For. Medico-Chirnrgical Review, July and October 1876.) In anxmic insanity, however produced, the general train of symptoms is violent mania of short continuance followed by melancholic dementia. Prognosis favourable. VI. INSANITIES OCCURRING AT EVOLUTIONAL PERIODS OF LIFE. Insanity of pubescence and adolescence is mani fested by various trains of symptoms. Acute mania is on the whole the most common : it is characterized by motor restlessness; the patient walks, talks, smokes, drinks, must ever be on the move. Where self -abuse comes in as a factor, the sufferer is melancholic and suspicious, self-accusing. Dipsomania is a not unfrequent symptom. But whatever may be the general symptoms of these three sets of patients, they have one common symptom, a perversion or increase of the sexual instinct. Prognosis is favourable as regards the attack present, unfavourable as to the probability of recurrence. Climacteric insanity, which is nearly as common in men as in women, is marked by pretty constant symptoms of a melancholic character. Prognosis generally favourable. Senile insanity is symptomatized by dementia with frequent intercurrent attacks of mania. Prognosis unfavourable. The most frequent symptoms of the insanity of pregnancy are melancholy and moral perversion, the latter taking the form of dipsomania. Puerperal insanity shows itself during the first seventeen days after labour, and is of sudden incidence ; the mental symptom is acute delirious mania. Prognosis is favourable in this, as in the insanity of pregnancy. ( Vide J. Batty Tuke, " On Puer peral Insanity," Edin. Med. Journ., May 1865 and June 1867.) VII. Toxic INSANITY. Insanity of- alcoholism in the acute form may be marked "by acute mania of a transient nature, mania a potu ; by melancholia, frequently accom panied by delusions and hallucinations of a frightful character ; in the chronic, by a type of dementia frequently simulating general paralysis. Prognosis of the acute form favourable, in the chronic the reverse. In employing the above classification it must be clearly borne in mind that the term of the symptom should, whenever possible, be appended to the pathogenetic term ; thus, puerperal mania, climacteric melancholia, senile dementia, acute idiopathic mania, epileptic mania, <kc. If the terms are combined, the nature of the disease and its general psychical characteristics are expressed in terse language. It will be noted that no separate notice has been taken of such popular terms as homicidal or suicidal insanity. They in no wise indicate a class of the insane ; they are symptoms common to many insanities, especially to epi leptic, traumatic, puerperal, and idiopathic insanity, and as such must be regarded as incidents in a given case- Terminations of Acquired Insanity. Insanity terminates in recovery, in death, or in. chronic mania or chronic dementia. Accurate statistics of the two first-named terminations are unattainable, as a large number of patients are treated at home ; and asylum statistics do not therefore show the result overhead, only that of the more aggravated cases. The result of treatment in lunatic hospitals gives about 40 per cent., calculated on the admis sions, which, however, include idiocy, chronic terminative insanity, and such acknowledged incurable forms of the disease as general paralysis. This figure does not of course represent the results of treatment of all the insanities, which, although there are no figures at command to support the assertion, may "be fairly estimated at not less than 70 per cent., excluding idiocy. There is a general tendehcy of all insanities to shorten life ; as already noted, some are in themselves fatal, or render their subjects less able to withstand disease. Asylum statistics show from 7 to 8 per cent, per annum as the average mortality calculated on the numbers resident. It is needless to attempt a description of the various phases of chronic terminative dementia and mania. De lusion may continue, or the patient may become more or less sottish and degraded in habits ; or, on the other hand, he may retain a considerable amount of mental power, still not sufficient to render him a responsible member of society. The great mass of the inmates of asylums belong to this class of lunatics, mostly harmless, yet precluded from mixing with the world as much for the convenience and safety of society as for their own benefit. A small proportion are detained on account of their liability to suffer from recurrence of attacks of insanity, although they are not actually insane during the intervals. To this condition foreign authorities have applied the iermfolie circ.ulairt, and some have asserted that it is the characteristic of certain cases ab initio. It is mostly confined to persons strongly hereditarily predisposed. The term explains itself : after intervals of comparative sanity, the patient manifests symptoms which run their course through the prodromal, the acute, and the demented stages, on again to recovery, in manner similar to a recent case. Treatment. In speaking of the treatment of the insanities, it will simplify matters to eliminate, in the first place, those forms