Of 150 post-mortem examinations in insanity, 106 cases of chronic renal dis ease, or 70.6 per cent., found. Beadles (Jour. Mental Science, Jan., '95).
Of 154 post-mortem cases of insanity, 74 of renal disease, or 4S per cent., found. C. H. Bond (Brit. Med. Jour., Mar. 2, '95).
Of 532 post-mortems in cases of in sanity, 327 cases of chronic renal disease, or 61.466 per cent., found. Bristowe (Brit. Med. Jour., Mar. 2, '95).
In 1700 cases albumin with renal tube casts detected in urine of more than one half of the cases of chronic insanity; 25 per cent. presented clinical evidences suf ficient to enable any competent practi tioner to make a diagnosis of kidney dis ease. In 75 per cent. of 200 cases the kidneys, examined post-mortem, showed pathological changes. Bondurant (Amer. Jour. of Insanity, July, '95).
Exaggerated sexual desire is frequent in mania, and the early stages of general paresis, leading to venereal excesses, but oftener to masturbation. The most shameless acts of exposure and solicita tion are seen in females, although mas turbation is probably more frequent in males. In depressive states, and in the advanced stages of general paresis, sexual desire and power are diminished. Desire sometimes persists when potency is ab sent.
Sexual perversion is a symptom that may accompany any neurosis or psycho sis, and should not be considered as a distinct affection, but as a part of the general symptomatology of insanity. Behr (St. Petersburger med. Woch., Apr. 4, '92).
In acute psychoses menstruation is nearly always arrested. It is said that one of the earliest signs of improvement in acute insanity in women is a return of the menstrual flow.
Conclusions based on a study of the menstrual function in the insane:— I. There is no entirely regular men strual history, if a number of years be taken into account, and that periods falling in from between three and five weeks are to be considered normal.
II. Normal menstruation is an expres sion of the general condition, and its suppression is often only an indication of the needs of the system, and so is a conservative act of nature.
III. In the chronic insane the meno pause makes no radical change in the form of disease.
IV. In acute cases menstruation re turns with regained general health, and is an indication that the system can again sustain the loss of force. It is always to be regretted when there is not, at the same time, increased mental vigor.
V. Tonics and general measures are, as a rule, preferable to direct or local treatment, though sometimes both are valuable.
VI. The underlying conditions which cause irregularities of menstruation are oftener the cause of mental disease than those deviations per se. Bissell (North western Lancet, Apr. 15, '92).
Of 99 cases of chronic insanity, men struation, on the whole, regular; ir regularity occurred in patients generally over 35. Climacteric appeared, on the whole, earlier. Menstruation had influ ence almost certainly in 16 or 18 cases, questionably in 18. Erotism rare. Men strual period seems to exert an actual influence, principally when the pain arising from some genital trouble reacts on the system. Naecke ("Influence of Menstruation on Chronic Psychoses," '95).
The menstrual function in the insane differs in no essential respect from the same process in healthy women, and its influence upon the psychical condition is slight and variable. Nache (Archly f. Psychiatric, Feb. 18, '98).
Among the nervous phenomena of in sanity the most frequent is insomnia. This is sometimes very persistent in mania and general paresis. In the latter and in confusional states it rapidly leads to exhaustion. An occasional symptom of general paresis is a great tendency to sleep.
Headache is a symptom in general paresis, cerebral syphilis, and in melan cholia. In the latter occipital cephal algia is said by some observers to be diag nostic. Headache, more or less intense, also attends most cases of mental dis turbance depending upon gross lesions in the brain.
Convulsions are present in epilepsy, urmmic insanity, general paresis, and syphilitic insanity. The convulsions in general paresis and syphilitic insanity are not typical epileptic seizures, but of the character described as epileptiform. They also occur at times in alcoholic in sanity. The epileptiform attacks of gen eral paresis are usually followed by a comatose or paralytic state lasting several hours or days. In some cases Cheyne Stokes respiration may be present and still the patient recover from the attack_ These apoplectiform seizures also follow true epileptic convulsions at times.
Fixed and irregular pupils or irregu larity in the pupillary reaction is frequent in general paresis.
Tremor is present in alcoholic insanity and in certain forms of mental disturb ance complicating cerebrospinal dis eases. The fibrillary tremor of the tongue and facial muscles in general paresis is diagnostic in many cases.
The tendon - reflexes are affected (usually diminished) in general paresis, alcoholic insanity, and the mental dis turbances of peripheral neuritis. In some forms of melancholia the knee-jerk is increased.
The speech is early affected in general paresis. The scanning speech of the paretic is characteristic. In dementia the speech is often indistinct or slurring. Certain trophic disturbances may also Comparative study of 200 sane and 200 insane men in reference to the develop ment of the mammary gland, in which it is shown that hypertrophy of this organ (gynmcornastia) is from seven to eight times more frequent in the insane. Canger (Revue Inter. de Bibliog., Apr. 25, '93).
be looked upon as physical symptoms of insanity. Thus, the peculiar deformity of the ear termed "othmmatoma," or "the insane ear," is almost limited to insane persons.
In considerable number of insane women asymmetrical conditions of bi laterally-associated muscles observed, especially of the face.
In 411 insane females, excluding gen eral paralytics, inequality of pupils was found in 25 per cent. In 396 chronic cases, except general paralytics, 35 per cent. had inequality of pupils. In 306 recent cases the tongue, when protruded, was deflected from the middle line in 24 per cent. In a number of cases the muscles of expression were more or less paralyzed on one side. J. Turner (Jour. of Mental Sci., Apr., '92).