Page:The New International Encyclopædia 1st ed. v. 10.djvu/734

* INSANITY. 648 INSANITY. sions regarding )iis possessions nnd money, gen- erally tearing poverty or thelt. Syphilitic dementia occurs in victims of ^ypliilis. They evince excitement or depression, loss ot memory, and failure of other intellectual processes, tinally relapsinj; into a condition resembling terminal dementia of the quiet type, of short duration, during which partial and temporary paralyses often precede death. Paretic dementia is also called general paresis, progressive general paral- ysis of the brain, and, improperly, 'softening of the brain." See P.Rt.sis. See also Imbecii.- ITV and Idiocy. Of the complicating insanities, the traumatic variety is a variety of mania following severe injury, such as gunshot wound, and is charac- terized by great restlessness, delirium, and jac- titation. Choreic in.sanity rarely occurs in pro- tracted cases of chorea, maniacal outbreaks, confused delirium, emotional change, and impair- ment of memory resulting. Dementia may fol- low. The post-febrile insanities are psychoses complicating diseases, accompanied by high fever, such as scarlet fever, smallpox, pneumonia, typhus and typhoid fevers. As a rule, the pa- tients are lucid during the day, but sulTer from delirium, illusions and hallucinations, ilelusions of identity, and generally anxiety, during the night. Even though maniacal and melancholic states alternate, and confusion of ideas is con- stant throughout, the prognosis for recovery is generally favorable. Khcuinatic. gouty and toxic insanities are similar. Phthisical insanity, which is intercurrent in some cases of fatal tuber- culosis, resembles the post-febrile variety, but there is also a considerable egotism nnd some delusions of grandeur. It will be seen that perversion of the will is present in almost every case of insanity. This fact led Hammond to, incorporate in his definition of the term the statement that in insanity 'mental freedom is weakened, perverted, or de- stroyed.' Free determination of the will is pre- sented by delusions, by inferences from delusions, by abnormal emotional states, by delirium, by incoherence of ideas, or by dementia. Often the mental processes of the insane are identical with those of the sane, but the premise from which the argument springs is false. In many forms of insanity the ego is preeminent. A lunatic may consider himself powerfully equipped, mentally and physically. He is ex- pansive, elated, extravagant, arrogant, and gar- rulous. This condition is termed hiiperhuUa. . other may be depressed, dejected, apathetic, mentally .slow and impeded, hopeless, and even suicidal. This condition is termed abulia. Fanciful subdivisions have been made by some alienists, founded upon certain trains of thought or often recurring ideas, and terms have been devised to indicate the trend of imagination in patients experiencing these ideas. For example, II f/ora phobia denotes fear of being in an open place or street; claustrophobia, fear of being shut in a room or house; nuisophobia, fear of defilement, pollution, or contamination; pi/ro- phobia, fear of fire; astrnphobia. fear of light- ning; anthropophobia. fear of society. This list might be prolonged indefinitely. Causes. The causes of insanity are divided into two classes; (1) Predisposing causes, in- cluding stress and strain, neuropathic constitu- tion, and heredity (of aTcoholism, epilepsy, in- sanity, or other nervous disease). ('2) Exciting causes, including shock, intense emotion, worry, and inlelleetual overwork, exhausting diseases, excesses (alcoholic or sexual), the strain of childbirth, sunstroke, etc. In the report of the New York State Commission in Lunacy for tin- year eniling September .'tO. I'.MIO, the fidlowiii;,- were the causes assigned for insanity in 4SI' (ases admitted to the New York State Hospitals for the Insane in the juceeiling twelve mouths: .Moral causes: Adverse conditions, loss : sexual excess, '24; venereal ili- eases, !)4 ; imisturbation, !tO; sunstroke, iiO; acii dent or injury, 87; pregmincy, 9; parturition and puerperium, llili: lactation. 1.5; change of life, 100; fevers, i.S; privation and overwork. 80; epilepsy, 1S:J; other convulsive disorders. .I; diseases of skull and brain. Tli; old age, 2:i!i ; exophthalmic goitre, 1: epidi^mic intluenza. 40; abuse of drugs, 44: loss of special sense, tl; nra'mic poisoning, 2; other auto-infection, 1; all other bodily disorders and ill health. 2!t4 ; heredity, .3.57 : congenital defect, 44 ; una.sccr tained. 141.1. It may be added that 4.'5 person^ found not to be insane were committed durin ■ the year. Of the 1819 new cases admitted, 100. i ha to 14. In 1901 the propor tion of native-born insane to foreign-born insaii' was 65 to 3.5. This excess of foreign-born in~aih imposes an immense expense upon the taxpayers, for it is estimated that their maintemmei' cost- not less than $10,000,000 a year. The foreign- born insane cost New York State about $1,000.- 000 annually. The danger to the population from absorbing a deteriorated and dc-'cnerate foreign stock is ajjparent. The pre-4if law (190.3) provides that an immigrant may be re- turned to his native country if he becomes insane within one year. Economists are calling atten- tion to the necessity of making the time of ]irobatiim at least two years, and of ctmdUcting a searching examination into the history and antecedents of all immigrants. PnooNOSis. .■Vbout 00 per cent, of the cases of melancholia and mania recover. Terminal dements, paranoiacs, senile dements, syphilitic dements, and i)aretics never recover. Case- of partial degenerative insanity rarely recover. The average ntnnber of recoveries of all kinds of cases, excepting the hoj>eless, is over 40 per cent. Most recoverable cases emerge during the first year of their illness; few recover after two years have pa.ssed. Early confusion of ideas, inde- eene,v, persistence of delusions, and .obesity are unfavorable symptoms. Recurrence occurs in about "2.5 per cent, of ordinary asylum patients. The offspring of insane parents are defective; therefore no one who has ever Wen insane should propagate children. Treatment. The treatment of insanity is a matter of great complexity. There can be no