Out of 71S2 deaths in the insane asylums of England and Wales, 13 re sulted from diseases of joints and bones, and 11 from fractures or dislocations. In 1897, out of 67S3 deaths, 15 resulted from diseases of joints and bones and 13 from dislocations and fractures. J. F. Briscoe (Jour. Mental Science, Apr., '98).
In a subject in whom the mental image is morbid the pathology of this image is an almost complete paralysis of inhibition. The appearance of the morbid image, aside from the question of its spontaneity, has place in the field of conscience, without the subject being able to exercise a control or a power of arrest. The normal man has in his mental life numerous morbid mental images, but he generally has conscience and the possibility of utilizing his in hibitory faculty; the mental image in this ease is only a fit, so to speak, of passing expansion, the subject being able to manage, more or less volun tarily, the system of images that arise. It is possible in abnormal subjects to have, on the contrary, an inhibitory power which is too strong, but this is only a perfectly explainable appearance; and when there is, so to speak, a suf ficiently prolonged arrest of the act, as in the obsessions, it is necessary to attribute the arrest principally to the intensity and t he distinctness (eclat) of the mental image. Vasehide and Vur pas (Revue de Med., Dec. 10, 1002).
—Among these is emotional instability, the minor grades of which are especially noticeable in neurasthenic conditions and hysteria. In maniacal states, paranoia, and the early stages of general paresis, the emo tional instability is much heightened. The patient is easily "upset"; slight irri tants may cause violent outbreaks of anger or rage with destructive attacks.
In melancholia the emotional in stability tends to react to painful impres sions. The patient is easily moved to tears, or is subject to morbid anxiety, sorrow, or fears, so often present in neu rasthenic states and depressive forms of insanity.
The distinctive psychical symptoms of insanity are sensory and intellectual dis turbances. The former are termed hal lucinations and illusions, and the latter delusions and impulses.
Hallucinalions.—An hallucination is a false sense-perception having no object ive basis. There may be hallucinations
of the special senses: hearing, vision, smell, taste, or of common sensation. Auditory and visual hallucinations are especially frequent, and are often symp toms of dangerous forms of insanity. The patient hears some one call him op probrious names as he walks along the street, or voices in the wall, the chimney, outside of the door annoy him. Some times the voice is an internal one and commands him to kill his persecutor or destroy the latter's property. Hallucina tions of hearing are especially frequent in paranoia.
Visual hallucinations are less frequent than those of hearing. They are present in paranoia, mania, and epilepsy. One of the most dangerous visual hallucina tions seems to be that of "seeing red." The suggestion of blood often leads to homicide.
Hallucinations of taste are found in paranoia and melancholia. In the for mer the patient "tastes poison" in the food and hence refuses to eat, unless he can get food secretly. The hallucina tions of taste of the melancholiac are, perhaps, sometimes exaggerated perver sions of taste due to digestive disturb ances. The same may bd said of the hallucinations of smell. Hallucinations of smell are not rare in paranoia, climac teric insanity, melancholia, and espe cially, according to Savage and Krafft Ebing, in mental disturbances connected with ovarian and uterine disease.
The hallucinations of the various spe cial senses are often associated. Thus, auditory and visual hallucinations and those of smell and taste are frequently combined. In one well-marked case of paranoia hallucinations of all the senses were present and caused the patient much mental suffering.
Hallucinations of common sensation often give rise to complaints of vermin crawling upon or burrowing in the skin. In some cases they are, doubtless, evolved from parfusthesim, being, in fact, illu sions, and not hallucinations. Insane persons frequently tear off all clothing and go about in a nude state. This is often regarded as a desire to exhibit the nude body, but it is probable that the clothing is taken off on account of some sensory disturbance attributed to the clothing.