Phthisical insanity, or that connected with consumption, is a very interesting variety. The patients are suspicious and unsocial, and often have no cough or spit or outward sign of consumption, which may not be discovered till the chest is examined. In some cases it is curable. There are various forms of in sanity connected with derangement of the reproductive f unctions. Uterine, amenorrhceal, ovarian, hysterical, and masturbational insanities; while preg- nancy, childbirth, and nursing are the causes of the insanity of pregnancy, pu erperal insanity, and lactational insan ity. These form 10 per cent. of mental disease in the female sex. They are the most curable of all forms, recovering in over 80 per cent. of the cases. Puer peral insanity occurs commonly within a fortnight of childbirth, and is the most acute and one of the most dangerous to life of all insanities, while the most cur able, and is attended by the highest temperatures, sometimes reaching 105°. The different periods of life have each their own form of insanity. Pubescent and adolescent insanity is always heredi tary, commonly acute and maniacal, usually has remissions and exacerbations and recovers in over 60 per cent. of the cases, those not recovering commonly passing into the most typical form of secondary dementia. It is one of nu merous diseases to which the period of development is subject. Climacteric in sanity occurs at the period of the meno pause or the "change of life." It is usually melancholic in character and re covers in 53 per cent. of the cases under proper treatment and conditions of life. Senile insanity is typically seen in the senile dementia of extreme old age, when the memory and all the faculties have faded away.
A number of rarer and less important clinical varieties of insanity have been described. Traumatic insanity, from in juries to the head; anemic insanity, from thinness of blood; diabetic insanity; in sanity from Bright's disease; post-febrile insanity, following all kinds of fevers, especially scarlatina; the insanity of lead-poisoning; and myxcedematous in sanity.
Causes of Insanity.—Hereditary tend ency is the chief predisposing cause of insanity. All sorts of disturbing influ
ences to the brain bring out this predis position into actual disease. No doubt 70 per cent. of all cases have an insane or neurotic heredity. Epilepsy, drunk enness, all nervous diseases, consumption, too exciting or depressing or exhausting employment, or unfavorable conditions of life in ancestry may cause insanity in the offspring. Marriage of near rela tives causes it if the stock is bad; not if it is good. The physical causes of in sanity affecting the body, such as alco hol in excess, produce insanity in four times the proportion which mental and moral causes, such as affliction, losses, love-affairs, and religious excitement, do.
Nature of Insanity.—No one now doubts that it is due to disorder of func tion of a certain portion of the brain— viz., that part of the cortex which is the vehicle of all mental function. The ex act pathology of many forms of insanity has not as yet been ascertained; but in 80 or 90 per cent. of the cases that die some abnormality can be found in the brain.
Treatment of Insanity.—The general principles of modern treatment may be divided into bodily and mental or moral. The bodily treatment may be generally said to loe to put all the organs and functions right if wrong; to get up the strength and fat of the body; to restore the tone and right working of the nerv ous system; to restore the sleep; to in vigorate and soothe by life in the open air; and to let off undue and morbid nervous energy by much exercise, gym nastics, and massage in some cases, and to secure complete brain and body rest for others. The mental treatment con sists chiefly in careful observation, com panionship, control, distraction of the mind from morbid thought and feeling, by suitable occupations and amusements, and guarding against the dangers of sui cide, homicide, and self-neglect.
All the States and many of the larger cities in the United States are equipped with hospital facilities for the insane. In 1918 there were reported in the en tire United States 239,820 insane per sons. Of these 125,919 were males and 113,901 females. In the State hospitals were 109,994 insane males and 97,711 insane females.