INSANITY (ante), unsoundness of mind. Unhealthiness and unsoundness, accord. lug to general. usage, arc not synonymous terms when applied to the mind. A perfectly healthy mind requires a perfectly healthy body, and it also needs a certain healthy or normal training. The degree and also the quality of unhealthiness or unsoundness to constitute insanity must be such as to destroy a certain amount of the self-control of the individual, or to produce a degree of perversion of the intellectual or moral faculties. Modern alicuists hold that such perversion is always connected with physical disease of some part of the nervous system. In most cases post-mortem examinations, as they are now made, reveal nervous lesions of some kind in all persons dying insane. Certain rules, useful, though sometimes empirical, for the diagnosis of insanity are adopted by physicians. Persons threatened with insanity are usually depressed in their manner, or are easily excited, the excitement being greatly out of proportion to the cause. A want of co-ordination of the faculties of the mind leads the subject to erroneous conclusions, and the formation, therefore, of false data; hallucinationsappear, and the mind becomes completely unhinged. All forms of insanity have one important symptom in common, which is an impairment of the faculty of attention, arising, probably, from the loss of will. Delusions and hallucinations are, however, more certain symptoms, and clear ideas as to the definition of these terms are important. A delusion is more nearly con nected with the mind; a hallucination is the result of an error in some sensory function. A man laboring under a delusion may beiicve that he is about to lose, or has lost, all his property when there is no foundation for such a belief, or that he is some other person, or that he is.in possession of great riches. These delusions, therefore, may be of a gloomy or of a hopeful and exalted nature. A person laboring under a hallucina tion may imagine that he sees a spirit, or a person who does not exist, or different kinds of animals. ln the temporary insanity of delirium tremens such hallucinations often occur. H ilIncinations affecting the organs of taste and smell are common among the insane, and they are usually of an unpleasant character. Hallucinations of sight are common in those stages of insanity accompanied by exhaustion of the brain, when supernatural visions are likely to occur, atid such patients often imagine that they hear voices commanding them to perform certain acts, often of a criminal nature, and of course they are then dangerous. Insane persons Intro a disposition to take off their clothes, sometimes probably from a feeling of oppression, sometimes with the idea of exposing the person. Insanity, especially that connected with epilepsy, often manifests itself in homicidal tendencies and acts. Although the qualities of insanity are infinitely various, as must be the-result from the infinitely various parts of the nervous system which may be the cause of the aberrant phenomena, or the infinitely various ways in which those parts may be affected, still it is found convenient to classify the various forms into certain general groups, and the practice is not entirely empirical, but is con nected with sound philosophy. The division of the older writers was mainly into mania, or violent insanity, and melancholy, with many subdivisions. There were then many fanciful distinctions because the researches of histological pathology had not con nected physical phenomena with these causes. It was believed that physical disease was the chief cause, but what the nature of the aihnent might be was not as well under stood as now. Thomas Arnold, in 1802, made a classification into ideal, and notional, including over thirty varieties. Among certain sub-varieties, which he called pathetic, of which there were sixteen, were amorous, jealous, avaricious, misanthropic, suspi cious, bashful, timid, sorrowful, etc. Pinel (q.v.), one of the original reformers iu the treatment of the insane, made four principal divisions—mania, melancholyAlementia, and idiocy. Esquirol added monomania. Dr. Pritchard, in 1835, discriminated between moral and intellectual insanity, but many authorities do not recognize such a disease as moral insanity. That insanity is hereditary is now admitted by all alienists and physicians; also, that the inheritance is one of a physical nature, stamped deeply upon the typical structures of the organs of the body. Drunkenness is considered as one of the most powerful causes of insanity, and statistics support the opinion. The report of the commissioners of lunacy in England, in 1844, attribute 18 per cent of about 10,000 cases to the effect of alcohol. Dr. Benjamin Rush attributed the drinking of alcoholic liquors as the caase of more than one-third of the eases in America. Dr. W. B. Carpenter, of London, in his work on Mental Physiology, says that this indul gence weakens the will to. that extent that control is lost over the emotions. 'Weakening of the will is, indeed, one of the important features of insanity, and the powerful influ ence of the extreme use of opium and tobacco in this relation, as well as in weakening the memory, has been the personal experience of many. Dr. Maudsley believes that one of the most powerful causes of insanity is the eager pursuit of riches. He says: "In several instances in which the father has toiled upwards from poverty to vast wealth, with the aim and hope of founding a family, I have witnessed the results in a degeneracy, mental and physical, of his •offspring, which has sometimes gone as far as extinction of the family in the third or fourth generation. When the evil is not so extreme as madness or ruinous vice, a mother's influence having been present, it may still be manifest in an instinctive cunning and duplicity, and an extreme selfishness of nature. I cannot but think, after what I have seen, that the extreme passion for getting rich, absorbing the whole energies of a life, does predispose to mental degeneration in the offspring—either to moral defect or to moral and intellectual deficiency, or to out breaks of positive insanity under the conditions of life." Institutions for the Insane.—The history of the care of the insane is full of interest. Among the ancients mental disease was less frequent than in modern times, but there were cases of insanity, and these were looked upon with a degree of awe, and the disease was often held to bd sacred. In modern times. until the present century, less regard has been paid to the humane treatment of the insane than in any other period of history; although, during the dark and middle ages, the ignorance upon the subject, and . the unsettled state of public affairs, must have led to great neglect or cruelty. But neglect to the unfortunate lunatic was much preferable to the care he received when imprisoned within the walls of a madhouse, and subject to the will of a keeper, who was often chosen more on account of his physical than his moral or intellectual quali ties. In Europe one of the first measures in the reform of institutions for the insane
was made by Pinel, who, in 1792, liberated fifty-three patients at the from chains in winch they were bound. But he had been preceded in the same direction by Dr. Franklin, with others, as early as 1750, in the organization of the Pennsylvania hospital, in which a department for the care of the insane was established. A system of treatment was there adopted which was afterwards practiced by Pinel. In England, during the 16th, 17th, and part of the 18th centuries, considerable attention appears to have been given to insane asylums, and lunatics often received comparatively kind treatment; but for various causes, which seem ever to be the accompaniments of human institutions, the management became bad, and the society of Friends, in 1702, established an institution called the "Retreat," which was so successful that the atten tion of the government was finally called to the subject. A commission was appointed by the house of commons, whose investigations revealed a horrible state of affairs. It was brought out in the evidence before them that it was customary, when lunatics were taken to Dublin, to tie them to the back of a cart and force them to walk the whole distance. About one in five lost an arm from this treatment. It was found, in one house where there were 23 confined-14 men and 9 women—and where 7 of the women were supported at their own expense, that one room on the ground floor, 21 by 16 ft., and 7 ft. high, contained only six cells, 9 ft. long and 5 ft. wide, with a passage of 3 ft. between. There were no windows, and no means for ventilation; and the door opened opposite• pigsty and dung heap about 7 ft. distant. Three cells had hoard floors. the other three were on the bare ground. The bedsteads consisted of wooden boxes, 6 ft. long and 2i wide, to which the patient was chained. These unfortunates were taken into the open air once a week, when the straw was changed. The patients were so dirty that careful inspection was impossible. In regard to treatment, the physician at Bethlem said: "Twice a year, with a few exceptions, the patients are bled, and after that they take vomits once a week fora number of weeks, and after that we purge them. That has been the practice for years, long before my time." The different forms of insanity are usually considered under the following divisions: 1. Melancholia; 2. Mania: 3. Dementia; 4. Imbecility; 5. Idiocy; 6. General Paralysis. Melancholy is usually preceded by hypochondria, and this is caused or accompanied 'with certain diseased conditions of the bodily organs, very frequently of the liver and digestive organs. The condition is often relieved by frequent administration of cathar tics, combined with good diet, wine, iron, exercise, and recreation. When these remedies fail the patient will generally pass into a condition of mania. This is the case when the brain is the subject of degeneration through disease. This deprives the patient of the power of exercising the will; delusions and hallucinations supervene, and the con dition becomes one of decided mania. Restraint often becomes necessary, but the ten dency is to its abolishment as much as possible, it being rarely practiced except in the acute stages. Mania may be acute or chronic. When there is hereditary taint it may be caused by grief or disappointment; hut peculiar forms accompany epilepsy and general paralysis of the insane. The subject of mania exhibits the presence of the disease generally by great mischievousness or filthiness or obscenity. or by all of them. The 'bodily health of a maniac often does not seem to suffer. but frequently there is great constipation, and serious disturbances are taking place in the cerebral substance, as post-mortem examinations often reveal: but often they are not of a nature to cause death. The strangest of all forms of insanity is what is called general paralysis of the • insane, an affection not to be confounded with ordinary paralysis. It has been only within the present century that the disease has been recognized. M. Calmeil gave a description of it in 1826, and since that time it has been carefully studied. It has three stages: 1. The stage of incubation; 2. The acute maniacal stage; 3. The chronic maniacal stage. A fourth stage might be added, that of dementia, but it is as well regarded as the sequel to or a part of the chronic stage. The subject of this grave disorder gen erally shows, at the commencement of the attack, a strangeness of manner which is different from that of all other forms of insanity, and which is usually easily recognized by the experienced alienist. The subjects are nearly always males. A man is observed to depart suddenly from his ordinary habits; he seems to have lost his conscience; will make no apology for misconduct, of which he is constantly guilty. He fails to keep appointments, is often extremely immodest, and is easily roused.to uncontrollable passion. As the disease advances he becomes sullen and more excitable, so that before long his friends are obliged to put him under restraint. He is prone to imagine himself a great personage, possessed of boundless power and riches, and boasts of performing the most wonderful feats of strength or agility, even after his disease has seriously impaired his bodily strength.. In consequence of these peculiar delusions the French have called the disease manie des grandeurs. The speech becomes defective, accom panied by a peculiar stammer which is difficult to describe, but which is almost diag nostic to the experienced physician. Fits somewhat resembling those of epilepsy take place from time to time, but which are not at all amenable to treatment. A diagnostic distinction between these fits and those,of true epilepsy is, that in the latter disease the patient usually bites his tongue, while the general paralytic does not as a rule. One important symptom is irregularity of the pupils of the eye. In 108 cases examined by Dr. Nasse, of Sieburg, irregularity was found in all but three; and Dr. Austin found the exceptions only two in 100. This, taken together with the other symptoms, is decisive. The average duration of the disease is about two years; sometimes it runs its course in a few weeks. Sometimes there is, for a short period, apparent recovery, and the patient may attempt to resume his occupation, but the attempt has always failed. The last stage, that of dementia, is truly pitiable; there is constant tremor, he loses his power to swallow, and will often cram food into his mouth until his cheeks are no longer capable of distension.