Paranoia is a form of insanity characterized by an elaborate system of fixed delusions.
Dementia is characterized by feebleness of mind. It is, in fact, enfeeblement of mind. It is the result of incurable melancholy or mania, and follows diseases like softening of the brain and long indulgence in drink. It may be merely an accompaniment of old age. In dementia there is not only intellectual but mm-al feeble ness. The person is not only silly, weak, child ish, but has no depth of feeling, is indifferett, and cares for nothing. Memory is also impaired. While, however, the things of yesterday are entirely forgotten, the events of early life may throng up and the person live in the past, as it were, calling the persons round him by the names of those he knew in youth, who have been long dead or absent. Demented persons often busy themselves with curiousoccupations. They usually live for many years, and enjoy good health, appetite, and sleep.
Dementia Przecox is a form of mental weak ness occurring in early life— an insanity of adolescence.
Idiocy is a condition of absence of intellect which dates from birth. It is often a conse quence of too close intermarriage, or of drunken ness on the part of the parents. It may be occasioned during infancy by epilepsy, or by injuries to the brain, or by some severe strain or fright.
Idiots have a vacant expression of countenance, small and misshapen head, awkward walk, and are liable to sudden changes of temper and out breaks of spiteful anger. Speech is, as a rule, imperfect, and in one class of idiots is entirely absent. Idiocy is frequently accompanied by dulness of hearing.
Idiots are incurable, but capable of great improvement by careful training.
General Paralysis of the Insane has many symptoms similar to those described under the various other forms of insanity, but has besides, as a special feature, paralysis which slowly extends till it affects all the voluntary muscles. Slowly creeping paralysis may be the first symptom of the disease, paralysis which be gins with loss of muscular power. The patient begins to speak indistinctly; his lips and tongue tremble when he speaks, so that his utterance is tremulous ; his hands tremble when he tries to use them, his legs when he tries to walk, so that he totters and stumbles. It may not be till these symptoms have considerably advanced that signs of insanity appear, signs of mental excitement, of delirium, of delusions, or it may be signs similar to those described under melan cholia. It may be that the disease begins with
melancholy excitement or fits, and that the paralysis does not appear till later. However it be, in the end the person's mind becomes so enfeebled that intelligence and memory have almost disappeared, and he sinks into the con dition of dementia, while the paralysis may be so extreme that he cannot walk, dress or un dress, or feed himself,. without aid, and may even have difficulty in swallowing, has no con trol over his bowels or bladder, and loses power also of feeling.
This disease is practically incurable.
Death usually occurs within three years of the commencement of the disease, death from apoplectic convulsions, or from suffocation from the defect of swallowing allowing food to get into the windpipe, or from exhaustion.
Other forms of insanity exist, such as puer peral insanity, that is, the insanity attending pregnancy, childbirth, and nursing, and insanity attending menstruation, which are described under DISEASE'S OF WOMEN.
The insanity of delirium tremens has already been described (p. 160).
Besides, there is a form of insanity due to self-abuse, accompanied by weak-mindedness, indecision, delusions, and hypochondriasis.
General Treatment of has been remarked that idiocy, dementia, and gen eral paralysis of the insane are practically in curable, so that treatment consists only of care and supervision of the unfortunate sufferers. This implies careful selection of appropriate food, regulation of the bowels, regulation also of hours devoted to sleep, to exercise, so far as the patient can engage in it, to work maybe, or recreation. It has been already said that idiots are capable of great improvement by judicious and constant training. Besides this kind of supervision there is also in such cases a large amount of restraint necessary, moral restraint to control fits of anger, spite, or excess in various other directions, and physical to prevent out bursts of violence that might be dangerous to the patient or others. The best place for such treatment is undoubtedly an asylum. Of course there are many cases of idiots who, if the cir cumstances of the friends permitted it, might be as well treated at home.