Treatment.—The treatment of pubes cent insanity should be tonic and structive. If the patient appears to be too active in movement, he should be put to bed and carefully fed. Weighings should be made weekly to determine the bodily gain or loss. So long as the pa tient gains, he is doing well; if he loses weight, it is the duty of the physician to ascertain the cause.
The tendency to sexual excitement and to masturbation should be counteracted in a moral way. The administration of anaphrodisiacs is generally followed by more harm than benefit. Mechanical straint of the insane for any purpose is bad practice. It is better to allow a pa tient to masturbate than to put him in a straight-jacket, or confine his hands in a "mnff." Climacteric Insanity.
Definition.—Insanity occurring dur ing the period of sexual involution in women.
Among the more serious accompani ments of the menopause is mental dis order. Statistics show that insanity in women is especially frequent between the ages of forty and fifty years. As this is also the ordinary period of cessation of the menses, the conclusion seems reason able that some relation exists between the two conditions, although it must not be assumed that mental disturbances at this period are necessary consequences of changes in the functional activity of the sexual organs.
Symptoms.—Any of the clinical vari eties of mental disorder may be present during the climacteric; but melancholia is most frequent. In 22 cases studied by Goodall and Craig, melancholia was pres ent in GG per cent. In 21 cases under my observation exactly the same proportion were of depressive forms at the time they came under notice. Bevan Lewis states that, at the early evolution of climacteric insanity, painful mental states invariably prevail, and in the large majority of cases mental depression exists through out the attack.
Hallucinations of hearing and of smell are frequent. Religious delusions color most cases. The class of cases termed by Savage "unpardonable sinners" are especially frequent among women who become insane during the climacteric. Bevan Lewis refers to these cases in the following terms: "Delusional states were recognized in 73 per cent., and out of a
total of sixty-one deluded cases, sixteen were victims to the terrible delusion that the soul was eternally lost, and that the subject was to be consigned to the flames of hell. It is strange to witness the prevalence of this religious despondency at a period when, as we are aware, the generative organs are undergoing an im portant cyclical transformation, and to contrast it with the converse states of religious exaltation so frequently asso ciated with the sexual transformation and excitation of adolescence, of hyster ical and epileptic forms of insanity." The fear of death, immediately im pending or more or less remote, is often present. Frequently the memory and judgment are but little but the patients complain loudly of confusion of thought, fear they will become insane, will never recover, etc.
Delusions and hallucinations referable to the sexual sphere are common. Most cases of pseudocyesis occur during the climacteric. Fear of grave disease of the pelvic organs is often present. The sub jective sensations of itching and burning in the external organs and the presence of leucorrinna are probably the causes of this morbid fear. Actual disease of the sexual organs is, however, often present, and all cases should be thoroughly exam ined to determine this point. The great frequency of uterine cancer at this period of life must not be overlooked.
Delusions referred to the digestive or gans are also present, although not char acteristic. One case insisted that her internal organs were all decayed, and that therefore it was useless to give her food or medicine. If she had a stomach, she might possibly recover, but as this organ had been entirely destroyed there was no possibility of ever getting well. Another case insisted that her entrails had been taken out and thrown to the chickens. On her admission to hospital she refused food, but after several days' forcible feeding she began to eat and im proved rapidly in her physical condition. Her delusions gradually disappeared and she was discharged recovered after two months' treatment.
Delusions of grandeur are sometimes present in the maniacal and paranoiac cases.