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Insane

diseases, mental, patient, functions, treatment, care and institution

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INSANE ASYLUM.—An institution for the care of mentally deranged persons. Such an asylum answers a twofold purpose. I t is intended as a hospital where demented people may receive careful medical treatment with a view to curing them ; or, if this be no longer possible, it serves them as a home in which they may receive all necessary care. Hence, insane asylums are hospitals in the true acceptation of the word, and it is eery much to be regretted that the public still looks upon them as some kind of prison to which a patient is to be transferred only when there is absolutely no other help. This view, which possibly may have been justified in times long past, is not correct at the present day. In keeping with the progress made in the recognition and treatment of mental diseases, the insane asylums of the present day have also acquired an entirely different appearance, in their exterior as well as in their interior.

A large modern institution resembles a group of friendly villas (see Fig. 237), without enclosing walls and latticed windows ; and the interior, with its pictures, mirrors, flowers, etc., differs but little from a cleanly and com fortably appointed private residence (see Fig. 238). Even where the peculiar character of the mental disturbances renders it necessary to take such precautionary measures as the barring of windows and doors, this is so carefully arranged as to be scarcely noticeable. The wards for quiet patients often remain unlocked. Mechanical coercive measures (strait jacket, etc.) have disappeared ; rubber cells do not exist ; and padded cells have become a curiosity. Isolating a patient in a " cell " is avoided as much as possible ; in many places it is altogether forbidden. The former modes of treatment have been displaced by modern and Anyone who for the first time enters the reception-room of an insane asylum will believe himself to be in an ordinary hospital. Patients whose condition will at all permit it are employed in the house or in the yard, in the workrooms or in the garden. Large institutions arc usually connected. with exten sive agricultural establishments. Simple pleasures, such as excursions, theatrical performances, and dances, are also provided for.

The fear that a patient's condition might become aggravated by inter course with other demented persons has been disproved a thousand times by practical experience. The patient is usually sufficiently occupied with

himself, and he does not show great interest in his room-mates. The well regulated life in the institution, the trained nursing, and last, but not least, the removal from the conditions Nvhich caused his affection, act beneficially upon the patient, and are the most important conditions for his recovery.

INSANITY.—it is important in the first place to realise that there is no single disease may be called insanity. The , as such, is more properly a legal and not a medical term. There are a number of diseases which may he grouped under this head, and of late these have been termed the psychoses, or diseases of the mind. Diseases of the mind are not different in any sense from diseases of other organs of the body, the only variation being that the symptoms are different because the functions of the brain substances are not like those of other organs. Thus, irritation in the lung will cause a cough ; while a similar irritation of the brain-substance, which may be occasioned by the same factor (pneumonia-bacteria), may give rise to delirium. It is highly important that the layman should recognise that mind-diseases are precisely like any other kind of diseases, and that a persqn who suffers from an acute attack of mania is not different from one who suffers from an acute pneumonia, and that he should be looked after Nvith as much, if not more, care. Locking him up in a madhouse is inhuman and unnecessary. There is too much superstition still present in the minds of men regarding mental diseases. It would seem that the majority of even intelligent laymen had not progressed beyond the point when people with mental disease were thought to be " possessed of tile devil." Insanities are of various kinds. Just as with other diseases, some cases are very mild, others very severe. The differences in the structures and functions of the various parts of the nervous system will account for the variations. As a rule, all mental disorders run a more protracted course than bodily disorders, because of the finer and more complicated nature of the mind-substances. Briefly expressed, perception, thinking, and acting are the chief mental functions, and in the various forms of insanity the symptoms involve these functions.

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