VII. Psychoses due to developmental changes in the brain, nutritive or struct ural. In this class are placed pubescent and climacteric insanity. It may be questioned whether these forms of in sanity are due to developmental changes in the brain, but the general similarity in character of the symptoms coincident with the period of puberty or of the menopause justifies the assumption of such changes, even in the absence of di rect demonstration.
Investigations carried on at St. Peter's State Hospital, Minnesota, show that menstrual disorder and pelvic disease, while quite common among insane women, in the majority of cases bear no apparent relation to the insanity; nor is the intensity of the mental disturbance in proportion to the gravity of the phys ical disease. Operative interference is called for in the treatment of pelvic dis ease among the insane for the same reasons that would determine the neces sity for such treatment among the sane. H. A. Tomlinson and M. E. Bassett (Jour. Amer. Med. Assoc., Sept. 30, '99).
Pregnancy may, under certain circum stances, be one of the etiological factors of insanity. Its etiological importance, however, is not proved by either statis tics or clinical observation. It is not, therefore, permissible to terminate preg nancy on account of a psychosis, unless there are special indications for such in tervention. W. Hirsch (Med. Record, Jan. 6, 1900).
Pelvic disorder is often associated with mental disease, and may be a fac tor in its causation, but it is seldom, if ever, the sole cause of insanity. No characteristic psychosis is associated with pelvic disease in women. No rela tion is to be found between the in tensity of the mental disturbance and the severity and extent of the pelvic dis ease. J. C. Doolittle (Va. Med. Semi monthly, July 12, 1901).
Symptoms.—The symptoms of in sanity may be divided into physical and psychical or mental. The former are referable to the circulatory, digestive, secretory, genitourinary, and nervous systems. The general nutrition of the body is frequently defective. Chapin states that "90 per cent. of the admis sions to the hospitals present the condi tion and appearance of some form of bodily ill-health." The source of mental diseases is not only in the brain itself, but in all the organs. For this reason no pathological
changes are found in the brain in many mental diseases, and when, with time, they do appear, they are consecutive, but not primly. In examining and diag nosing the psychical condition of a man, one must closely and minutely examine the whole organism, and not omit any change in any organ, though seemingly insignificant, since experience teaches that very serious changes in the func tion of the brain arise from insignificant changes either in the nerves or in other organs. Ladislas Kohlberger (Przeglad Lekarski, Nos. 25 and 26, '93).
Report on examinations of the urine of 200 insane cases. The average quan tity passed in twenty-four hours was 112• cubic centimetres in male, and 1020 in female. The average specific gravity was 1.019. The reaction was invariably acid. The amount of total solids was under the normal. The urea was decreased. Phosphates were decreased in nearly all the excited cases, and increased in the depressed patients. Oxalates were in excess in 6 of the depressed patients. The chlorides were found increased in 3 epileptics immediately following the seizures and in 1 general paralytic following a convulsive attack. Excess of uric acid was frequently observed in dementia, and several times in gen eral paralysis. Excessive orates were usually associated with dyspepsia. Pep tone was found present in 2 of 12 cases of general paralysis. Albumin was found 4 times in the 200 cases. There was frequently reduction of copper in the presence of uric acid. Glucose was pres ent 6 times. Two of these cases were general paralytics. E. G. Klein (Phila. Med. Jour., from N. Y. Med. Jour., Mar. 18, '99).
Anemia is extremely frequent, espe cially in states of depression and mental confusion. In the large majority of cases of acute insanity careful inquiry will de velop the fact that preceding the attack there was progressive loss of weight.
Depression of the circulation, weak ened heart-action, and an apparent lack of vascular tonus are frequent. They are most notable in melancholia, general paresis, and consecutive dementia. Vas omotor spasm is often present in par anoia, combined with oppression of breathing, and a sense of great anxiety.