Insanity
its Etiology, Diagnosis, Pathology, and Treatment, with Cases illustrating Pathology, Morbid Histology, and Treatment. By Edward C. Mann, M.D., Medical Superintendent of State Emi- grant Insane Asylum, Ward’s Island, New York.
This is an admirable retrospect of the subject from the time of Hippocrates up to the present. We are reminded of the old classifica- tion into Furiosi, and Mente Capti, and the following divisions:?
Idiocy.
Dementia.
Delusional Insanity.
Emotional Insanity.
Mania.
During the past twenty years, it appears that in America the in- crease of insanity has been considerably disproportionate to the in- creased population. This is supposed to be due to neglect of physical exercise in consequence of educational pressure, to artificial habits of living, competition in business, etc. It would seem also that this insanity is appearing at an earlier age than formerly. With regard to the predisposing causes, the first is hereditary predisposition. During twenty-seven years, at the New York Asylum, this was traceable in 31 per cent, of all admissions. Morbid impulses and insane traits may not appear in the second generation, and reappear with renewed vigour in the third. Insanity may assume a different form in suc- ceeding generations. Thus, a parent may be maniacal, and the child be afflicted with chorea or epilepsy. Amongst other predisposing causes may be instanced great disparity of age between parents, influ- ence of sex, emotions during gestation, epilepsy, lactation, menstrua- tion, general excess, and onanism.
Among exciting causes may be mentioned, excessive grief,intemper- ance, any kind of excessive excitement, epilepsy, injuries to head or spine and overwork. Intemperance appears to exert a very powerful influ- ence upon the production of insanity. Lord Shaftesbury was of opinion that, in 1859, 50 per cent, of the admissions into English asylums were the subjects of excessive drinking. In many foreign asylums the percentage is stated to be 25, or higher. Dr Mann has traced intemperance as a cause in many cases of general paralysis, and M Lanier considers that 50 per cent, of all idiots and imbeciles in the large cities of Europe have been the children of notorious drunkards At Charenton, in Europe, drink was considered as the cause of insanity in 102 out of 350 patients. Three forms of insanity from alcoholic abuse may be said to exist, viz.:?1. Delirium tremens or mania a potu; 2. Dipsomania; and 3. Chronic alcoholism. The first is an acute and temporary mental affection; the second, an irre- sistible impulse and craving for alcoholic stimulation; the third a peculiar form of chronic insanity. With regard to the diagnosis of insanity, we find some valuable hints. Wo “must examine physical signs and symptoms, and determine by our senses the existence of such diseases.” Previous to seeing our patient, we should find out all we can from the friends, allowing for information concerning hereditary predisposition, for many will deny any pre-existing insanity, unwisely looking upon the same as a disgrace. The patient’s confidence should, if possible, be gained, and enquiry be made with respect to vocation,’ habits, &c., whether there have been any injuries to head or spine,’ sunstroke, &c. The nervous system should be .examined for the pre- sence of paralysis, epilepsy, catalepsy, hysteria, &c. Then we must look to the senses, such as sight, hearing, smell, and touch.
Most fearful crimes have been perpetrated by those who previously have been looked upon as harmless patients. How important then is the responsibility of advising that a patient should be kept at home ! In criminal cases it is most important to bear in mind that, because his ancestors have been insane, a man is not necessarily irresponsible for the crimes he commits. Sometimes the diagnosis of insanity is very easy. A person previously of moral habits, industrious, and affec- tionate, becomes immoral, his affections alienated, his business neglected but the prognosis of insanity is very difficult to determine. The most unlikely cases are those in which the insane diathesis is clearly established, oi in cases of imbecility, dementia, general paralysis, and epileptic insanity. Acute mania, acute melancholia, hysterical insanity, and puerperal insanity not unfrequently recover.
The pathology of insanity is at present in its infancy, but micro- scopical examination of the brain has afforded much valuable infor- mation.
M. Paechaffe, Inspector-General of Asylums in France, informs us that the pathological changes found in the brain in insanity may be divided into three classes:?
1. Those which may be considered accidental?viz., cerebral hfemor- rhaires, softening of white substance, and disease of cerebral arteries. 2. Those found in other diseases, but appear to be concerned in producing insanity?viz., thickening and opacity of arachnoid, hyper- lemia of pia mater, and collections of fluid in arachnoid cavity.
3. Those essential to mental disease, viz., subarachnoid ecchymosis, punctiform injection of cortical surface, with or without softening; extended softening of middle portion of cortical substance ; adherence of pia mater to surface of the brain ; various discolourations of cortical substance ; atrophy of convolutions ; and induration of brain. Histo- logical investigations reveal that although the dura mater is rarely thickened, irregularity and dilatation of its vessels exist, whilst fine granulations have been perceived upon the arachnoid. In the neuroglia grey degeneration, atrophy, and colloid degeneration have been found. The cells have been the seat of atrophy, pigmentary and granular degeneration, calcification, and hypertrophy.
A number of cases illustrative of the pathology and morbid histo- logy of insanity are presented to us in this admirable treatise, among which may be instanced those ol melancholia* dementia, and acute mania, bearing out upon post-mortem examination the remarks before cited. With regard to the treatment of insanity, Dr Mann calls attention to the fact of the foolishu of friends and relatives at first keeping secret the fact of the patient’s insanity, and thus depriving him or her of speedy relief, and in many cases cure. He also shows, by some carefully-considered statistics, the pecuniary benefits accruing from early recovery, when the malady has been encountered at its onset. Allusion is made to the cruel treatment of the insane in times past, and the remarkable contrast at the present date, when kindness and diversion of mind constitute the most successful modes of cure. Amongst therapeutic agents the most effectual are opium, in large doses, and hydrate of chloral, especially as narcotics. We quite agree with the author that the combination of opium with the chloral hydrate is far preferable to either administered singly. Dr Brown-Sequard some years ago found that ergot was very valuable in some cases of insanity, and the writer of the work before us quotes a number of cases in which this drug proved of immense value. The dose given should be 5j of the liquid extract. The cases in which it is specially applicable are chronic mania with lucid intervals, recurrent mania, and epileptic mania.
Dr Mann concludes this interesting discourse by giving numerous cases illustrative of the treatment of the insane, therapeutically and otherwise; and we hope we may have many future communications from the same source.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.