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upon and arise from syphilitic infection, then it would be more appropriate to arrange it with the toxic insanities.

In the same manner if alcoholic insanity be limited to that one phase of it, which has finally eventuated in a fully developed alcoholic neurosis, and is dependent upon changes in the brain which have become chronic, then it may be arranged as one of the neuropathic insanities. But if it be regarded also as presenting an acute and a subchronic variety, both of which are attended with symptoms and conditions more or less peculiar to them, and are dependent more especially upon the acute and sub-acute effects of alcohol upon the nervous system, then it also would more properly be tabulated with the toxic insanities.

In fact, the arguments for and against almost any combination and groupings of the several genera of insanity may be so numerous that it is quite impossible to arrange any system which will not present objections to some minds; and it is very certain that when so many writers of the highest eminence have failed to agree upon what is the most desirable, the subject is attended with difficulties which are quite insurmountable in the present state of our knowledge. Our conclusion, therefore, is that for the present, and until we discover such means and appliances as shall enable us to determine more fully the nature of the normal physiological activity of that portion of the brain whose function is connected with the thought process, and until we can appreciate more fully and perfectly those pathological changes upon which mental derangement is supposed to depend, all our classifications of insanity must be regarded as merely tentative.

The following arrangement will serve as a basis for these lectures, and I shall refer only to those forms which will probably most frequently come under your observation.

A. SYMPTOMATOLOGICAL.

1. Melancholia.
2. Mania.
3. Primary Delusional Insanity.
4. Folie Circulaire.
5. Dementia.

1.

B. ÆTIOLOGICAL.

Insanity of Puberty.
Epochal. Climacteric Insanity.
(Physiological). Senile Insanity.

( Puerperal Insanity.
Sympathetic Masturbatic Insanity.
(Sexual). Ovarian Insanity.
3.

s Alcoholic Insanity.
Toxic.

Syphilitic Insanity.

2.

INSANIÆ.

4.

Epileptic Insanity.
Neuropathic.

| Hysterical Insanity.

General Paralysis. 5.

Insanity from coarse brain disease. Pathological.

Acute Delirium. (Typhomania). 6.

Phthisical Insanity. Rheumatic In. Other less frequent sanity. genera and species.

Post-febrile Insanity.

LECTURE VI.

MELANCHOLIA.

Two Classes of Mental Disorder— Definition-Ætiology-Heredity-Sex

Climate-Age-Lithæmia – Moral Causes—Mode of Invasion-Symp.
toms, Physical-Diminution of Nerve Energy-Effects upon the Voice
and the Physiognomy-Increase of Action in the Vaso-Motor System-
Loss of Flesh-Cutaneous Surface-Insomnia-Cephalalgia--Symptoms,
Psychical— Morbid Self-consciousness and Introspection-Impressions-
Mental Pain-Lack of Decision-Sphere of Thought Limited-Painful
Sensations— Losses--Fear of Death—Fear of Becoming Insane, etc.—
Periods of Depression which do not Eventuate in Melancholia-Stupor--
May Arise as an Independent Disorder --- Indications of its Approach--
Symptoms--Movements Attended with Discomfort -- Hallucinations--Case
-Refusal of Food— Pupils Insensible to Light---Low Temperature--
Sudden Changes in the Mental State.

The departure of the mind from a normal state of activity is more often than otherwise in one of two directions, viz.: toward a state of debility and diminution of functional activity, or toward a state of increased, though vitiated, function.

These two classes of disorders are embraced under the general terms of melancholia and mania. The first is probably as old as any authentic history of disease itself, and was in familiar use by the earliest teachers. It may be defined as an affection which is attended with depression, a tendency toward introspection, more or less of mental pain, enfeeblement, and partial prostration of the mental and physical faculties, with or without delusions.

Ætiology.-One of the most important factors in the causation of melancholia is heredity. This element exists, according to some authorities, in nearly sixty per cent. of all cases, and may come from either one or both parents or grandparents. It is regarded as more common among females than males; this, however, is not in accordance with my experience. Doubtless the nervous system in females

. is more sensitive, and therefore more susceptible to the effect of moral impressions of all kinds; but, on the other hand, the male, as the bread-winner, or financial agent of the family, is more exposed to the effects of reverses in business and the consequent worry and anxiety than the female, whose sphere of activity is more limited.

Melancholia occurs more frequently, and affects the system with greater intensity, between the ages of thirty and forty, but when inherited more often occurs at the critical periods of life-puberty and the grand climacteric. According to Dagonet, it exists more frequently among the inhabitants of northern climates and of mountainous regions, than among those residing in warmer climates. Disappointments, excessive mental application and strain, reverses in business, masturbation, loss of property, loss of children, anxiety in any and all its forms, and, in fact, any of those experiences and conditions which tend to weaken and especially depress the nervous system, may act as direct causes in the development of the disease. An additional factor in its causation is doubtless a deficiency in the elimination of the products of secondary changes in the elements of the tissues, and a consequent vicious quality of the blood. It may also, to some extent, arise from that systemic condition which has been termed uricæmia, or lithæmia. The products of a deficiency of oxidation act as irritants upon the nervous centres, and

prevent the supervention of that condition of the brain which is necessarily incident to sleep. They may also be an active factor in the causation of mental depression and the emotional disturbances which sometimes occur without melancholia.

Mode of Invasion.—This disorder rarely becomes suddenly developed. There usually exists a considerable period of incubation, during which changes of mental condition may occur, such as vague apprehension, unusual irritableness, or alternate states of depression and hopefulness. The length of time during which the latter state continues tends to become shorter; the person loses interest in his usual work, and, finally, abandons it altogether; remains at home, is silent and unhappy, and cannot be induced to seek for amusement or change, nor to engage in much active exercise of mind or body. The sphere of normal mental activity becomes transferred from the external or objective world, where its enjoyment has more largely existed, to a subjective one; and here it tends constantly toward a more and more limited field, and in proportion as this occurs the intensity of mental pain is increased.

The period during which these prodromatous conditions exist may vary very considerably. It usually extends over several months, and may extend over years. The individual is generally at first fully aware of the changed state of his feelings, but shrinks from making it known to others. He is able to follow his usual occupations; his mind is clear in reference to his relation to duties, but, especially when alone, is filled with painful emotions. When reminded that he becomes unduly absorbed in his own reflections and is unmindful of his relations to others, he may make an effort to resume his former habits of thought and action, but this is successfully done only for a longer or

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