INSANITY The increase of insanity during late years has directed much attention to preventive measures. Obviously the most important of these should consist in the prevention of the marriage of all individuals possessing a marked family history of any degenerative psychosis, since in a large proportion of cases the malady is hereditary. Marriage need not, how ever, be forbidden when the family history clearly indicates that the insanity of the parent was obviously of the acquired type, though here there is often room for the suspicion of an underlying deep neurotic taint which assisted the onset of mental aberration. The marriage of individuals whose family history on both sides shows a strain of insanity should be regarded as little short of criminal unless the female be beyond the child-bearing period.
In the upbringing of the offspring of parents of neurotic type much may be done by moral and educative treatment, and as stated in the article on Hysteria the children of a mother suffering from the graver degrees of that neurosis should, when possible, be removed from her influence and sent to a boarding-school at a distance. The unstable psychic or neuropathic inherited condition being liable under severe strain to cross the boundary-line between an ordinary neurosis and a confirmed psychosis, every form of severe mental application and all profound emotional strain and sexual excitement should be guarded against as far as possible. The pelt played by syphilis and alcoholism in the production of insanity must always be borne in mind. Though the pernicious habit of self-abuse is often the result of mental deteriora tion, it may certainly become the cause of it in youths with a well-marked neuropathic taint. Therefore in such a close investigation should be pursued regarding the habit, and moral treatment should follow.
The treatment of the different types of insanity—dementia, mania, melancholia, paranoia, idiocy, moral mania, monomania and their varieties—would require for a proper description of the necessary details space very far beyond that at our disposal. Moreover, these details can only be carried out in institutions specially designed for the purpose, and furnished with elaborate machinery for isolating, watching, nursing, dieting, exercising, amusing and instructing the victims of mental dis orders.
Early removal to a suitable institution is of the utmost importance, and as a rule it may be said that in acute cases every day's delay dimin ishes to some extent the chance of permanent restoration. To under
take the care and management of insanity in the patient's home be in the majority of cases a serious mistake and a cruel wrong to the patient, whose chances of recovery would be thereby seriously diminished. Where the patient's ailment is such as does not prevent his travelling and mixing with the public, his early removal from home under the watchful care and close surveillance of a physician during a prolonged tour by rail or sea may be fairly tried with some hope of success before resorting to the restraints of an asylum. Such cases are, however, upon the whole rare where this method of treatment is available or warrant able. Only in a well-equipped asylum can rest, isolation, feeding, moral treatment—psycho-therapeutic or suggestive—be properly carried out, and the objections of the friends of many patients have been met by the introduction of the villa system into most of the modern planned insti tutions.
Feeding is an all-important element in most cases, and often it must be carried out by the nasal tube and siphon. Adam advocates the open air treatment as in the Nordrach system, with very generous feeding. Beyer recommends the use of a bath at 95° F. for hours at a time, the patient spending his day in the bath, where he takes his meals, and is moved from the bath to bed at night. The drug treatment of the various forms of insanity resolves itself into the judicious administration of remedies, with the view to correct the many deviations from the normal physiological state which may exist either as the cause or as the result of the abnormal state of the mind. Thus tonics for loss of appetite, and cod-liver oil, iron, and other restoratives are indicated when emaciation or anemia exists.
Sleep should, speaking generally, be insured. Narcotics should be avoided, except when pure hypnotics fail; the favourite drug is Chloral. fyoseine has given excellent results in several large asylums, and the hypodermic injection of gr. of pure Ilyoscine Hydrobromide generally produces the most desirable calm and sleep. Verona', Sulphonal, Trional, Paraldehyde, Chloralamide, and other hypnotics may be used according to their recognised indications. Opium and its alkaloids are generally objectionable. (See following article.) Bromides are valuable in acute maniacal states, but their administration in all melancholic forms of insanity should be avoided. A favourite hypnotic in many asylums is a mixture of Sodium Bromide and Chloral I Ivdrate.