Suicidal tendencies are frequent, al though usually not so persistent as in melancholia generally. In one case, however, the patient set fire to her clothing "to escape from the devil," and was so severely burned as to result in death. Lewis refers to a case in which an attempt at self-destruction was made to escape a similar alleged danger. The apprehension of death by fire is frequent.
In some cases the depression and men tal anxiety lead to the use of alcoholic stimulants, resulting often in confirmed intemperance.
While there is no specific form of mental disorder that can be properly termed "climacteric insanity," there can be no doubt that the menopause must be considered as one of the exciting causes of mental disease.
Table of 100 cases showing truth of Morel's statement that, although the brain is always the seat of insanity, it is not always the seat of its cause. In 17 cases distinct post-climacteric atrophy; 9, enlarged uterine cavities; 12, enlarged cervices; 43, erosions of varying degrees of severity; 7, lacerated cervices; 17, retroversion; 3, anteversion; 7, latero version, etc. Clara Barrus (Amer. Jour. of Insanity, Apr., '05).
The relation between insanity and dis turbances of the sexual function due to pelvic disease must be considered in treating the insane. When such dis ease is suspected, a thorough examina tion should be made. In investigating criminal acts committed by women with irregularities of menstruation due allowance should be made for their in fluence on the mental condition. The special dangers of the climacteric as regards the development of melancholia must be remembered. Macnaughton Jones (Brit. Gymec. Jour., No. 2, 1900).
Some writers devote much attention to the consideration of a climacteric insan ity in the male sex, but there is no period in the life of man that corresponds with the menopause in women. The parallel that has been drawn between the period of involution of the sexual power in man and the climacteric period in women is, as Bevan Lewis says, "more fanciful than Strictly correct." Prognosis.—The prognosis of the in sanities of the menopause is, according to authors, rather favorable. In my cases, including even those who had already passed into dementia when they came under observation, the recovery-rate was 43 per cent. Goodall and Craig had 38 per cent. of recoveries; Sutherland a fraction over 40 per cent.; Lewis 48 per cent.; Merson nearly 50 per cent; Skae 53.5 per cent., and Clouston 57 per
cent.
Death is rare as an immediate conse quence of the psychical derangement. Suicide and marasmus in those cases re fusing food form the largest contingent of deaths in the acute condition. Among the chronic cases, tuberculosis claims the largest share in the death-rate.
Treatment.—The treatment of the mental disturbances of the menopause often tests severely the patience as well as the therapeutic resources of the prac titioner. Refusal of food often depends upon delusions, but at times disorders of the prime vice are responsible. In the latter case stomach-washings, laxatives, and intestinal tonics such as mix vomica and physostigma are indicated. Where the reluctance to take food or its absolute refusal depends upon delusions that the food is poisoned or that the viscera are decayed, forcible feeding must generally be resorted to. In cases of aggravated gastric catarrh the subcutaneous infusion of a nutritive saline solution heretofore recommended will often be beneficial. After a few days' rest the stomach will take up its functions with renewed vigor.
The prfecordial anxiety and palpita tion of the heart, if troublesome, will generally yield to moderate doses of Hoffman's anodyne. For insomnia, pa raldehyde is probably the least harmful hypnotic that can be used, although, where its odor and taste are objection able and there is no cardiac weakness, trional may be substituted.
The physical depression needs good food, fresh air, and tonic medication. In states of great weakness absolute confine ment to the bed is necessary to prevent exhaustion.
Symptoms referable to the sexual or gans are not always evidence of delusion, and should not be so declared until a careful physical examination has shown the absence of local disease.
Mental depression is best combated by cheerful surroundings, out-door life, and medicinally by opium. This drug should be given systematically, as recommended in melancholia. Cannabis Indica and belladonna are also at times useful. Co caine has been recommended, but is dangerous on account of the tendency to establish a habit.
The good effects of thyroid extract re ported, especially in melancholia, en courages to further trial with it.
The depressive hypnotics and seda tives—such as chloral, bromides, sulpho nal, antipyrine, etc.—should generally be avoided in depressive mental states.