Considerations on the Cures in Insanity
- Author:
George PI.
davage, iVi.D., Assistant Medical (Jllicer Bethlehem Koyai Hospital. In this article the basis of the statistics is formed by the annual returns of Bethlehem Royal Hospital during ten years, from 1865 to 1874 inclusive. We are told that cure may be gradual or sudden, simply progressive or vibratory?a case may pass from depression to exaltation, or vice versa. When there are alternations of excitement and melan- choly, it is dangerous if the periods become longer and longer at each attack. In women, if the periods coincide with menstruation, chronic insanity is to be feared. During the ten years, 852 male and 1,222 female patients were admitted, making a total of 2,074. In that time 367 male and 717 female patients were discharged cured, making a total of cures of 1,084. This is 43 per cent, of cures on the male admissions, and 58*67 on the female admissions. Cases of illusional insanity are unfavourable. Nearly all cases of epileptic insanity are unfavourable, and all cases of progressive general paralysis end fatally sooner or later.
Cases get well in much larger proportion if sent to an asylum early. The time for cure is early, and if past may be past for ever. Amongst the unfavourable complications of insanity may be classed the follow- ing :?Epilepsy, loss of power over the bladder, apoplectic symptoms, hsematorrhoea auris, and paralysis. A very hopeless condition is one in which the hands and feet are congested and blue, and the superficial vessels distinct. As a rule, thin, wiry, dry hair is more constant in the chronic than in the acute cases, and points to smaller chances of cure.
It is an evil sign when a patient becomes fat and well favoured, but gains nothing mentally.
With regard to the influence of age on prognosis, as a rule, young cases get well more rapidly than older ones; but any form of mental disease coming on before puberty is very dangerous. Sex and the social state must, of course, be taken into consideration; but more experience seems necessary before we can say how far their influence may be relied on.
Every asylum has traditional sayings. Among these may be quoted as follows:?Patients who make and wear rings of paper or thread are seldom cured. The ring is often mistaken for a real token. Patients who are constantly ” wishing you good morning” are generally hopeless.
Amongst the most rapid and unsatisfactory cases of cures are those in which drink has played the chief part. In cases dependent upon uterine irregularity the prognosis is by no means easy ; since, in many cases, the same cause that produces insanity produces amenorrhcea.
In phthisis the prognosis frequently varies inversely with the disease. In regard to syphilis, in connection with insanity, the prog- nosis is rather that of the syphilis than of the mental state. Dr Savage has compiled a most able and instructive pamphlet, and has treated the subject in a thoroughly exhaustive manner. We have great pleasure in recommending the work to our readers, who will be amply rewarded by its perusal.
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