INSANITY.—It is in melancholia and the mental disorders connected with the menopause that thyroid extract finds its greatest usefulness. In recurrent mania, delusional insanity, excellent results have also been reported. MacPhail and Bruce consider its use dangerous in cases of acute mania and melancholia where there are rapid loss of body-weight and mal assimilation of food; also in cases where there is active phthisis or valvular disease of the heart. The profound effects of the drug on the circulatory system render it imperative that during treatment, and for at least a week afterward, the patient should be rigorously confined to bed.
Osler is of the opinion that the cases of insanity in which thyroid extract proved beneficial were probably cases in which there was some derangement of the thyroid gland. The pulse ran up under its influence in some cases to 160, but in none had it caused any serious results.
Kinnicutt, in sustaining this view, thinks that the very fact that in a large majority of the cases the treatment is without effect, while now and then it is so strikingly successful, would indicate that in the latter the trouble was prob ably connected with diminished or per verted secretion or function of the thy roid gland. As in other disorders, the use of thyroid has to be continued after recovery to prevent relapse.
In twenty-five cases internal adminis tration of thyroid induced true febrile process; resulting action beneficial. Spe cially useful in insanity of adolescent, climacteric, and puerperal periods, and frequently so in eases where recovery is protracted and tendency is to drift into dementia. Bruce (Jour. of Mental Science, Jan., '95).
Four cases of insanity with well marked stupor where the outlook had become unfavorable, if not hopeless. A decided reaction sought for, and the dose of thyroid regulated by the tolerance of each patient. No benefit in one case; two sufficiently benefited to be dis charged from the asylum, and a fourth materially improved. Cell-nutrition is undoubtedly affected in a striking man ner, and increased metabolism occurs as the result of quickened circulation. The autotoxic process, so frequently present in eases of mental disease, is interfered with in a way that may be beneficial. C. K. Clark (Canadian Pract., Oct., '95).
Cases of post-melancholic hebetude fol lowing a lengthy period of depression offer the best prospect of improvement and are more or less influenced in the majority of instances.
Cases of stuporous melancholia of long duration arc usually improved by thy roid. Cases which recover appear to have a special predilection to relapse.
Maniacal cases whose attacks have been unduly prolonged give a very en couraging prognosis.
Cases of cerebral exhaustion following acute delirium or stupor whose elimina tion of urea and other nitrogenous com pounds is greatly reduced, offer a fair chance of improvement.
Many eases of chronic mama without fixed delusions may be benefited by a course of thyroid treatment.
In doubtful cases thyroid may assist in clearing up the diagnosis. It will early differentiate between true stupor and dementia. In delusional cases of a doubtful nature a course of treatment will usually show whether delusions are fixed or temporary, as the latter will vary in character or entirely disappear during treatment, while the former un dergo no change whatever. W. L. Bab cock (State Hosp. Bull., Utica, N. Y., Jan., '96).
The early use of the thyroid and treat ment of forms of insanity not associated with myxcedema appears to have been based upon observations made in the use of thyroid in other conditions, showing that a mild febrile reaction follows the employment of the gland. It was to induce this febrile reaction that first sug gested the employment of the thyroid in non-myxceiematous cases of insanity.
Case characterized by delusions of doubt and fear, especially of fear of con tamination, improved. Better control over most of the ideas of contamination.
Case of chronic delusional insanity, violent, untidy, destructive, with rough skin and scanty hair, rapidly improved.
Case of a mild case of simple melan cholia with slight enlargement of the thyroid gland; at first more depressed, but now convalescent.
Case with attacks of recurrent mani acal excitement. At first evident eleva tion of temperature, flushed face, free perspiration, and slight nausea. Patient practically convalescent.
Two cases of chronic melancholia in men in which no improvement was mani fest.
Inclined to indorse the views of Bruce, that the thyroid undoubtedly produced a more or less feverish condition, the action and reaction to which are of con siderable benefit to the patient. Thyroid is a direct cerebral stimulant, and there is a strong probability that at some periods of life the administration of thy roid supplies some substances necessary to the bodily economy. E. N. Brush Jour. of Nerv. and Mental Dis., Apr., '96).