The influence of microbian diseases among the insane leads, in the majority of cases, when the subjects are young, to a more or less considerable ameliora tion of the mental condition. M. Renf Charon (Archives de Neurol., May, '96).
The majority of authors agree that the prognosis of insanity, complicated by "insane-ear," is sufficient evidence of its incurability, while a few contend that there are cases in which perfect re covery has taken place. Out of 7000 ad missions to the Connecticut Hospital for the Insane there was only one case that developed hwmatoma curium and re mained well. L. P. Clark (Amer. Med. Surg. Bull., Aug. 22, '96).
Decidedly hereditary cases of insanity are often the most curable, although there is more likelihood of a relapse than in those in which the hereditary tend ency is absent.
It has been estimated that 63 per cent. of recoveries from insanity take place before the age of twenty-five, although the young are more subject to relapses. The menopause is another period of life at which recovery occurs in many cases; but the disease is usually of long dura tion, not ending until the cessation of the menstrual function is complete. Genuine climacteric insanity, however, is rare.
Acute forms of insanity in which re covery is especially apt to occur are stuporous insanity, or so-called primary dementia; confusional insanity; puer peral and lactation insanity; and that which follows acute physical disorders. But systematized delusional insanity be longs to the chronic class and is rarely curable. The secondary, or terminal, stage, dementia, as well as recurrent and alternating insanity, is hopelessly in curable.
General paralysis of the insane is al most inevitably fatal. Henry R. Sted man (Boston Med. and Surg. Jour., June 10, '97).
In the Eastern Michigan Asylum, out of 327 cases of mania, 190 (or 53.7 per cent.) recovered; and, out of SOO cases of melancholia, 282, giving a percentage of 35.2, recovered. Recoveries from at tacks of melancholia occur much later than recoveries from mania; among the latter a chronic or recurrent condition results more rapidly. I. H. Neff (Treat
ment, Apr. 13, '99).
Of 200 cases of acute mania, 171 re covered, S3 per cent., the ratio of deaths being thus only 3.S per cent. Although excitement and sleeplessness had been marked in all, sedatives Were not used-: a fact to which the high proportion of recoveries was attributed. C. K. Hitch cock (Jour. of Mental Science, Jan., 1900).
Case of melancholia in a man, 23 years of age, of intemperate habits, with a spe cific history. He passed into a condition of stupor, refusing to leave his bed or voluntarily to take any nourishment, and remained in this state three and a half years. During all this period he was fed three times a day. He finally began to show signs of returning mental activity, and was subsequently dis charged as recovered. Cecil MacCoy (Jour. Nervous and Mental Ms.. July, 1901).
Toxic action is by far the most im portant factor in the pathogenesis of insanity. The large majority of cases of insanity are not primarily diseases of the brain at all, but are dependent upon 1 he action of toxins derived from else where that affect the tunctional activity of the cortical nerve-cells by disorder ing their metabolism and often perma nently damaging or even destroying many of them. The common view that the mental disease is the primary condi tion. and that any accompanying bodily disease is secondary, is, in general, founded upon an erroneous conception of what is taking place. W. F. Robertson (Brit. Med. .Tour., Oct. 26, 19011.
General Principles of Treatment.—In asmuch as insanity is here considered as purely physical disease, it is evident that purely psychical remedies occupy a very subordinate part in the treatment. They are limited to what may be called, in a general way, the management, or hand ling, of the patient. A tactful nurse— one who combines the in modo with the fortiter in here essential. Agreeable surroundings and keeping at a distance sources of irritation may also he classed with the psychical remedies. Isolation is not to be recommended, espe cially in hallucinatory and delusional forms.